Low Income Subsidy (LIS)

Created on: 
Nov 22 2016

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is the Low Income Subsidy (LIS) interface?

This interface was developed to comply with Public Law 110-275 section 113 Eliminating Barriers to Enrollment under the Medicare Improvements Patients and Providers Act (MIPPA). The LIS program is federally funded assistance for the Medicare Part D program.

The LIS interface provides information from the Social Security Administration (SSA) regarding clients who have applied for LIS.

How often is the Low Income Subsidy (LIS) file received?

The Social Security Administration (SSA) sends the LIS file on a daily basis.

What information is received from the Social Security Administration (SSA) on the Low Income Subsidy (LIS) file?

The LIS interface file contains the demographics, income and partial resource information pertaining to clients who are just becoming eligible for Medicare. It also provides information for:

  • Clients who are reaching their 24th month of disability, and
  • Medicare Savings Program (MSP) clients moving into the State and who have completed an LIS application.

When is a client considered matched between ACES and the Low Income Subsidy (LIS) file?

A client is considered a match when all of the following information is identical between the client’s ACES case and the LIS file:

  • Social Security Number,
  • Date of Birth, and
  • Name.

How am I notified when there is a discrepancy between the information in ACES versus what is sent on the Low Income Subsidy (LIS) file?

Alerts are generated to the worker of record unless the client's has an out of state zip code or doesn't match the zip code in ACES. These Assistance Units (AUs) are assigned to CSC 128 -District 2 Customer Service Center and the default user.

When there is a discrepancy in the Social Security Number, name or date of birth between the LIS Application file and ACES, a two-tier discrepancy Alert 430 - LIS MATCH DISCREPANCY - REVIEW FOR MSP PROGRAM is generated.

When ACES receives a record with a date of death for a spouse, a two-tier discrepancy Alert 431 - SPOUSE IN THE LIS FILE DECEASED PER ACES generates and spouse isn't added to the pending Qualified Medicare Beneficiary (S03) AU.

What happens when ACES does not auto-screen a Qualified Medicare Beneficiary (S03) Assistance Unit (AU)?

An S03 AU is not auto-screened under the following conditions:

  • If there is a discrepancy in the client’s name, date of birth or Social Security Number between ACES and the Low Income Subsidy (LIS) file.
  • If the client is deceased per ACES coding.
  • If the client is active or pending on a S03 AU.
  • If the LIS file contains a spouse or other household members that aren't already known to ACES, Alert 247 - SDX SHOWS CLIENT  MARRIED, ACES DOES NOT is generated to the user of record to review household composition.

When auto-screen is not possible, an S03 AU should be manually screened if appropriate.

What if the client’s name, date of birth and gender matches ACES, but the Social Security Number (SSN) doesn't match?

The system compares the SSN number-by-number and if seven of nine numbers match and it isn't federally verified, the client’s SSN is updated in ACES and the client is considered known. If seven of the nine numbers don't match, the appropriate alert is auto generated to the worker of record.

Online Processing

How do I access the Low Income Subsidy (LIS) application information in aces.online?

To access the LIS application information in aces.online, take the following steps:

  1. From the Welcome Back page, enter the following information in the Quick Navigation section:
  • Select a Type of ID field - Select Client from the drop down menu.
  • Enter an ID field - Enter the [Client ID].
  • Select a Page field - Select LIS Application from the drop down menu.
  • Click Go and the LIS Application page displays.

What happens when there is an exact match between ACES client data and the Low Income Subsidy (LIS) file?

When there is an exact match between ACES and the LIS file, the following happens:

  • The system screens or adds in a pending Qualified Medicare Beneficiary (S03) Assistance Unit (AU) with the application date set to the date the client applied for LIS through the Social Security Administration (SSA).
  • The Standard of Promptness (SOP) count begins from the date ACES processes the LIS file.
    • This is the only program where the SOP count begins from the date we receive the LIS input file from SSA.
  • The LIS Application page in aces.online is populated with the information received in the LIS interface file.
  • The following are populated in ACES 3G with the information received in the LIS interface file:
    • On the Contact Information page, ACES complete the following fields:
      • Primary Language field - Set to English (EN).
      • Address Line 1 field - The information from the LIS address lines are used to populate the address lines in ACES, unless the client is the head of household on an active or pending AU.
      • City/State/Zip fields - The information from the LIS interface is used to populate the city, state, and zip.
    • On the Authorized Representatives/Payees page, if appropriate ACES updates the Authorized Representative data on any active or pending medical AUs copied over to the auto-screened S03 AU.
    • On the Client Details page, ACES completes the following fields:
      • Name
      • SSN
      • Birth Date
      • Sex
      • Race field - Set to Unreported (999).
      • Extra Help Needed field - Set to Not Present (P).
  • Letter 023-02 (General Request for Information or Action) is generated with the appropriate conditional text block.

What happens if the Low Income Subsidy (LIS) beneficiary is not known to ACES?

When the client is not known to ACES, the system takes the same steps as in What happens when there is an exact match between ACES client data and the Low Income Subsidy (LIS) file? 

When does the system auto-deny a Qualified Medicare Beneficiary (S03) Assistance Unit (AU) that was auto-screened?

The pending S03 AU auto-denies after 30 days if an interview hasn't been initiated on the Pending Applications page with Reason Code 230 - Verification and Letter 004-05 (General Denial - No Information) is generated.

Mainframe Processing

How do I access the Low Income Subsidy (LIS) screens?

To access the LIS application file take the following steps:

  1. From the WMEN screen, select Option [L] - File Inquiry.
  2. On the LMEN screen, complete the following fields:
  • Selection field - Enter [J] - LIS Application.
  • Client SSN field - Enter the [client's Social Security Number], or
  • Client ID field - Enter the [Client ID number].
  1. <TRANSMIT> and the LIS1 screen displays the client’s demographics data and the LIS approval details.
  2. To access the LIS2 screen by pressing <F14>. The LIS2 screen displays the earned income, unearned income and resources of the client and the spouse as reported to the Social Security Administration (SSA).

The LIS data can also be accessed from the UNER and the EARN screens.

What happens when there is an exact match between ACES client data and the Low Income Subsidy (LIS) file?

When there is an exact match between ACES and the LIS file, the following happens:

  • The system screens or adds in a pending Qualified Medicare Beneficiary (S03) Assistance Unit (AU) with the application date set to the date the client applied for LIS through the Social Security Administration (SSA).
  • The Standard of Promptness (SOP) count begins from the date ACES processes the LIS file.
    • This is the only program where the SOP count begins from the date we receive the LIS input file from SSA.
  • The following are populated with the information received in the LIS interface file:
    • LIS1 and LIS2 screens.
    • On the ADDR screen, ACES complete the following fields:
      • Prim Lang field - Set to [EN] - English.
      • Address Line 1 field - The information from the LIS address lines are used to populate the address lines in ACES, unless the client is the head of household on an active or pending AU.
      • City, State and Zip fields - The information from the LIS interface is used to populate the city, state, and zip.
    • On the AREP screen, if appropriate ACES updates the Authorized Representative data on any active or pending medical AUs copied over to the auto-screened S03 AU.
    • On the DEM1 screen, ACES completes the following fields:
      • Client Name
      • SSN1
      • DOB (MM DD YYYY)
      • Sex
      • Race Cd field - Set to [999 - Not Spanish/Hispanic].
    • On the DEM2 screen, the Response to EA Question field is set to [P] - Not Present.
  • Letter 023-02 (General Request for Information or Action) is generated with the appropriate conditional text block.

What happens if the Low Income Subsidy (LIS) beneficiary is not known to ACES?

When the client is not known to ACES, the system takes the same steps as in What happens when there is an exact match between ACES client data and the Low Income Subsidy (LIS) file? 

When does the system auto-deny a Qualified Medicare Beneficiary (S03) Assistance Unit (AU) that was auto-screened?

The pending S03 AU auto-denies after 30 days if an interview hasn't been initiated on the PEND screen with Reason Code 230 - Verification and Letter 004-05 (General Denial - No Information) is generated.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.