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1 Pre-Natal CAWEM Expansion (CWX) Now in 7 Counties.

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Presentation on theme: "1 Pre-Natal CAWEM Expansion (CWX) Now in 7 Counties."— Presentation transcript:

1 1 Pre-Natal CAWEM Expansion (CWX) Now in 7 Counties

2 2 This training will cover Overview of Pre-natal CAWEM Expansion Program “CAWEM Plus” benefit package Eligibility CM system coding & notices

3 3 Program extends pre-natal benefits to CAWEM women in Lane County Began in 04/01/2008 in Multnomah and Deschutes counties Five additional counties were added 10/01/09. These counties were: Benton, Clackamas, Hood River, Jackson, Lincoln* Lane County is being added to the program effective January 1, 2011 * Due to budget constraints, the program was ended in Lincoln County in December 2009.

4 4 Pre-Natal CAWEM Expansion Program overview Combines federal (CHIP) monies with county & state funding CAWEM Plus benefit package for pregnant CAWEM women CAWEM Plus is primarily to provide pre- natal benefits CAWEM Plus benefits end the day after the baby is born

5 5 Pre-Natal CAWEM Expansion Program Covers almost all OHP Plus medical services during pregnancy Services that are not covered: –Death with dignity –Sterilization –Therapeutic abortion –Hospice

6 6 Clients not in managed care CAWEM Plus clients cannot be enrolled in managed care CAWEM Plus clients will be placed on an open card CAWEM Plus clients can still see their regular doctor if the doctor accepts the open card

7 7 CWX coding When approved, use both CWM and CWX case descriptor and CWX need/resource code with end date CWX coding tells MMIS to provide CAWEM Plus CWX N/R date is based on due date. If we’re not notified timely that the pregnancy has ended, the CWX N/R date triggers CM close (85B) or reduction (86B) notice

8 8 CWX coding example Morena is pregnant and due 06/10/11.The DUE date is entered as DUE 06/11. Since 06/10/11 is before 06/15/11, the CWX end date is 06/11. If Morena were due 06/20/11, the DUE date would be 06/11, but the CWX date would be 07/11 to provide time for a 10- day notice.

9 9 CWX coding for 06/10/11 DUE date

10 10 CWX eligibility process Once the CWX coding is added, the CM system automatically sends a 2D CWX approval notice The approval notice is also a reduction notice No additional notice is required if DHS is notified timely.

11 11 CWX eligibility process, continued A CM system notice is sent in the 8 th month of pregnancy reminding mother her benefits will be reduced to CAWEM the day after her baby is born The day after the baby is born, the mother’s benefits are reduced to CAWEM (see next slide for specific coding information) Baby is AEN 5503 will add the AEN if they are notified of the birth instead of the branch

12 12 Coding changes when baby is born Use a “medi” action on the UCMS screen to add the newborn and reduce the mother to CAWEM. The UCMS effective date is the newborn’s date of birth Add newborn with a start date of DOB and AEN for one year Change mom’s start date to match the newborn’s DOB. The CM system will reduce her benefits to CAWEM effective the next day Remove the CWX case descriptor and need/resource code from mom (leave the DUE date)

13 13 Example of CWM coding after the baby is born

14 14 What happens if DHS is not notified of birth? CWX need/resource end date will trigger CM close (85B) or reduction notice (84B) –Won’t happen often Except for some MAA/MAF CWX clients, the mother’s medical will be reduced to CAWEM the first of the next month after the CWX end date

15 15 MAA/MAF CWX clients If mom is MAA/MAF and there are other children in the household, benefits are reduced to CAWEM effective the first of next month If mom is MAA/MAF and there are no other children in the household or mom is OPP, benefits are closed effective the end of the month

16 16 Example of CWX automatic reduction notice Maria is a pregnant CAWEM MAA client with other MAA children; the new baby is due July 10, 2011 DUE and CWX N/R date is 07/11 If DHS is not notified of birth, 10-day reduction notice is automatically sent reducing Maria’s medical to CAWEM effective August 1, 2011

17 17 Example, continued Client still has 60 days protected CAWEM eligibility based on the DUE need/resource date No “due process” for other benefits because it’s already after when we should have been notified of birth Restore benefits to CWX if she contacts branch and she’s still pregnant

18 18 Example of CWX automatic close notice Angela is a pregnant CAWEM OPP client; the baby is due June 23, DUE is 06/11 June 23 is past the 15 th of the month, so the CWX need/resource end date is 07/11 If DHS is not notified of birth, 10-day close notice (85B) will automatically be sent to end Angela’s medical effective July 31 If Angela contacts the branch and she is still pregnant, restore her benefits to CWX and add the DUE need/resource back onto her CM case

19 19 CM system conversion for Lane County implementation Pregnant CAWEM with DUE 01/11 or later will be automatically converted to CAWEM Plus benefits during December EOM processing CWX case descriptor and need/resource codes will be added automatically CWX need/resource date will be added to match DUE need/resource date Only for FIPS codes of 039

20 20 Conversion issue – CWX end date Report will be available on View Direct around January 1 showing all cases that were converted to CAWEM Plus 5503 will work report to ensure correct CWX date is coded If due date is after the 15 th of the month, the CWX need/resource code will need to be manually changed to the next month

21 21 What happens if pregnant CAWEM client moves into area? Report of new eligibles is generated daily listing every CWM pregnant client who has moved into one of the 7 CWX counties 5503 will work report and add coding to issue CAWEM Plus benefits –5503 will use MEDI action to add CWX coding effective date of transfer action

22 22 What happens if the CAWEM Plus client moves out of area? CAWEM Plus is only for residents in one of the 7 counties No longer in Pre-natal CAWEM Expansion Program if they move out of county area, even if they are still pregnant when they move Even though CWX has to end, they will continue to have protected CWM eligibility 2 day process to transfer case

23 23 CM actions to transfer out, Day 1 Send the 10-day CMRCWXR or SPRCWXR notice of reduction (from CAWEM Plus to CAWEM) On the CM system: –First day,enter a Compute action on the UCMS screen effective the first of the next month –Second day, enter the change in address and remove the CWX coding

24 24 What happens when the client’s pregnancy ends before their DUE date month? The worker ends the client’s CWX benefits for the 1 st of the month after the 10-day notice period and sends the CMRCWXR or SPRCWXR notice of reduction The client remains on CWM through their protected 60-day post partum eligibility period

25 25 CM actions when pregnancy ends early Send the CMRCWXR or SPRCWXR notice of reduction Enter a Compute action for the first of the month following 10-day notice period Remove the CWX case descriptor and need/resource Update medical start date to the first of the next month Update DUE need/resource to match the month/year the pregnancy ended

26 26 CM notices CM 2D Pre-Natal Approval Notice –Automatically sent when adding new CAWEM Plus client CM 01G CWX Benefits End – Advance Notice –Automatically sent the month before the DUE need/resource end date (8 th month of pregnancy) CM 84B County Pre-Natal Reduction –Automatically sent based on CWX need/resource end date when DHS is not notified timely of pregnancy ending and there are other children in the household receiving MAA/MAF CM 85B County Pre-Natal Close –Automatically sent based on CWX need/resource end date when DHS is not notified timely of pregnancy ending and mom is receiving OPP

27 27 CM notices, continued CMRCWXR or SPRCWXR – CWX Reduce – Pregnancy ends or moved out of county –Available on notice writer and sent by the worker when a CWX client moves out of the county or the pregnancy ends prior to the month indicated by the DUE need/resource end date

28 28 NoticeWriter notices, part 1 Example: Maria is due September 15, however, we’re notified in July that she lost the baby. Send the 10-day CMRCWXR reduction notice and compute to remove CWX coding the first of the month after the 10-day notice period. Update the DUE need/resource end date to 07/XX - Maria will continue to receive CAWEM through her 60-day protected eligibility period

29 29 NoticeWriter notices, part 2 Example: Petra notifies us she’s moving to Roseburg to be with her mother. Send 10- day CMRCWXR reduction notice. Compute to remove CWX coding the first of the month after the 10-day notice period and to change the address and branch - Petra will continue to receive CAWEM through her 60-day protected eligibility period

30 30 Questions? SSP-Policy, Medical address Joyce Clarkson Michelle Mack Carol Berg Vonda Daniels Jewel Kallstrom Audray D. Hunter


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