ADATSA MEDICAL
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ADATSA MEDICAL


Revised January 10, 2014



NOTE:

As a result of implementation of the Affordable Care Act (ACA), effective with applications received on or after 01/01/2014, this medical program is no longer valid. Clients would need to apply for medical through the healthplanfinder. See EAZ Manual – Medical Assistance Programs – ACA.


Alcohol and Drug Addiction Treatment Support Act - (ADATSA)(GW/W01) (Invalid 01/01/14)

Alcohol and Drug Addiction Treatment Support Act - (ADATSA)(W02) (Invalid 01/01/14)

Alcoholism and Drug Detoxification Program - (W03) (Invalid 01/01/14)

 


ALCOHOL AND DRUG ADDICTION TREATMENT SUPPORT ACT (ADATSA) (GW/W01) (Invalid 01/01/14)

Who is eligible to receive W01 medical?

 


Who is eligible to receive W01 medical?

 

·         Clients active on ADATSA GW/W01with a financial responsibility code of RE – Recipient.   For more information, see Alcohol and Drug Addiction Treatment Support Act (ADATSA) (GW/W01).


ALCOHOL AND DRUG ADDICTION TREATMENT SUPPORT ACT (ADATSA) (W02) (Invalid 01/01/14)

Who is eligible to receive W02 medical?

 

How long is the W02 certification period?

 

How do I screen W02 medical?

 

How do I process a pending W02 AU?

 

How do I process W02 for a client who is determined not financially eligible?

 

How do I process an application for a client in Methadone Maintenance?

 

How do I process a W02 application for a client not eligible for ADATSA Treatment services when determined by Social Services?

 

Will ACES close a W02 when the End Date has been reached?

 

What is the coding for various treatment situations?

 


 

Processing Alternative

Medical

PR 275860

CQ 3230

 

Who is eligible to receive W02 medical?

 

·         Individuals who meet the requirements in EAZ Manual – WAC 182-508-0320 ADATSA -Eligible individuals and

 

o    are waiting for treatment placement or

o    are receiving methadone maintenance services or

o    have declined shelter services

 

How long is the W02 certification period?

 

·         W02 is certified for up to six months.

 

How do I screen W02 medical?

 

·         To screen a W02 AU, take the following steps:

 

1.    From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

 


NOTE:

If there is a pending GW/W W01 AU and the client is waiting admittance to a treatment program,  enter the Medical Only – Waiting List for Bed coding (see coding chart) and the GW/W01 will sprout a GW/W02 AU.

For clients entering inpatient treatment, rescreen the original W01 and update the living arrangement, treatment and institution coding (see chart). Close the existing GW/W02

See Alcohol and Drug Addiction Treatment Support Act (ADATSA) (W02).


2.    On the Applicant page, enter the applicant’s (head of household) Name, Residential and Mailing Addresses.  Continue with the screening process until you reach the Programs page.

 

3.    On the Programs page:

 

o     Click the checkbox next to Medical.

 

o     Click the Next button.

 

4.    On the Finalize page, click the Specify program box.

 

5.    On the Specify Program page:

 

o    Select Medical (MA) from the drop down menu.

 

o    Select ADATSA Medical Only (W02) from the Medical Coverage Group drop down menu.

 

o    Click NEXT. 

 

6.    On the Finalize page:

 

o    Click the box next to Medical Assistance (MA), Coverage Group ADATSA Medical Only (W02).

 

o    Enter the application date.

 

o    Click Commit.

 

How do I process a pending W02 AU?

 

·         To process a W02 AU, take the following steps:

 

1.    From AMEN, select Option O – Interview.

 

2.    On the STAT screen, enter [PN] - Applicant in the Finl Resp field for the applicant. 

 

3.    On the DEM1 screen and  DEM2 screens, use the chart below to determine coding:

 

Shelter Only – Declined Treatment

AH

4, 5, 6

AP

LN/LO

A

Program=GW

Type = Z

Medical Only – Declined shelter services

AH

W

AD

N/A

MA

Program=MA

Type = Z

Medical Only – Waiting list for bed

AH

W

AW

N/A

MA

Program=MA

Type = W

Medical Only – Methadone Maintenance

AH

W

AM

N/A

MA

Program=MA

Type = W

 

On the DEM2 screen:

 

o    Enter the appropriate Approv Date, Estab Date and End Date fields from the ADATSA assessment provided by Social Services.

 

5.    Complete the interview following the steps in the Interview chapter.

 

6.    After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.

 

7.    After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the W02 eligibility determination.

 

How do I deny W02 for a client who is determined not financially eligible?

 

·         If the client is not financially eligible, deny the AU using a 500 level Reason Code.  For more information see How do I manually deny an AU or client for all months? 


NOTE:

No letter is generated for a 500 reason code.  The system will not allow an entry in the Letter Override field.  Create a denial letter in aces.online, citing the reason for the denial and the appropriate WAC reference in the free form text box.


How do I deny W02 when Social Services determines a client isn’t eligible for ADATSA Treatment services?

 

If a client is determined by social services to not be eligible for ADATSA treatment, take the following steps:

 

1.    From AMEN, select Option O – Interview.

 

2.    On the DEM1 screen, enter [the appropriate code] in the Liv Arngmt field. See <F1> Help.

 

3.    On the DEM2 screen, leave the following fields blank:

 

o    Dis/Incp/ESRD

o    Approv Source

o    Approv Date

o    Estab and  End Date

 

4.    Call DONE and <Transmit>.

 

5.  Follow the steps in the Process Application Month and  Finalize Chapters.

 

Will W02 auto-close when the Incapacity End date on DEM2 screen has been reached?

 

·         ACES doesn’t AUTO-close a W02 AU based on the End Date field on the DEM2 screen.  To close a W02 AU, follow the steps in How do I manually close an AU or client?

 


ALCOHOLISM AND DRUG DETOXIFICATION PROGRAM (W03) (Invalid 01/01/14)

Who is eligible to receive W03 medical?

 

How long is the W03 certification period?

 

How do I screen W03 medical?

 

How do I process a pending W03 AU?

 


 

Who is eligible to receive W03 medical?

 

·         Individuals who meet the following conditions may be eligible for W03 (DETOX):

 

o    Applicants who are not eligible for CN or MN medical in other DSHS programs

 

o    Applicants who have income and resources at or below the TANF standards

 

o    Applicants in counties that do not have direct DETOX contracts with the Division of Alcohol and Substance Abuse (DASA).

 

·         See EAZ Manual – WAC 182-508-0305 Detoxification - Covered services.

 

How long is the W03 certification period?

 

·         W03 is certified through the end of the month in which 3 to 5 days of covered treatment ends.

 

How do I screen W03 medical?


NOTE:

The user must determine eligibility for DETOX before the case is entered into ACES. ACES issues benefits for DETOX after the user has determined program eligibility.


·         To screen a W03 AU, complete the following steps:

 

1.    From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

 

2.    On the Applicant page, enter the applicant’s (head of household) Name, Residential and Mailing Addresses.  Continue with the screening process until you reach the Programs page.

 

3.    On the Programs page:

 

o     Click the checkbox next to Medical.

 

o     Click the Next button.

 

4.    On the Finalize page, click the Specify Program box.

 

5.    On the Specify Program page:

 

o    Go to Select Program.

 

o    Click on DETOX Medical Care Services W03 from list of Medical Coverage Groups.

 

6.    On the Finalize page:

 

o    Enter application date

 

o    Click Commit.

 

How do I process a pending W03 AU?

 

·         To process a pending W03 AU after manually determining eligibility, take the following steps:

 

1.    From AMEN , select Option O – Interview.

 

2.    Complete the interview following the instructions in the Interview chapter. 

 

3.    After the interview data has been committed, access the AU from the AMEN Option P – Process Application Months and follow the steps in Process Application Months.

 

4.    After all pending months have been processed, select Option Q – Finalize. Follow the instructions in the Finalize Application chapter to complete the W03 processing and to finalize the application.

 

o    The SPEC screen will automatically appear during the finalize process.  On the SPEC screen, enter [Y] in the confirm field.

 

o    ACES will auto deny the ongoing month with Reason Code 243 – Detox Auto Denial – For Administrative Use Only.  User must determine eligibility in any other pending months.


EXAMPLE

Client enters DETOX on 10/24/07 (application date).  User is processing the application on 11/16/07.  12/07 is the ongoing month.  ACES will AUTO deny 12/07 with Reason Code 243 – Detox Auto Denial - For Administrative Use Only.  DETOX is only approved for 3 to 5 days.  The fifth day is 10/29/07.  User must deny DETOX for 11/07 by entering denial Reason Code 543 – Detox FW Closure - For Administrative Use Only on the SPEC screen for 11/07.

Modification Date: January 10, 2014