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 Pre-Natal CAWEM Expansion (CWX).   Overview of Pre-natal CAWEM Expansion Program  “CAWEM Plus” benefit package  Eligibility  CM system coding &

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Presentation on theme: " Pre-Natal CAWEM Expansion (CWX).   Overview of Pre-natal CAWEM Expansion Program  “CAWEM Plus” benefit package  Eligibility  CM system coding &"— Presentation transcript:

1  Pre-Natal CAWEM Expansion (CWX)

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

3   Began 04/01/2008 in Multnomah and Deschutes counties  Five additional counties added 10/01/09: Benton, Clackamas, Hood River, Jackson, Lincoln*  Lane County added 01/01/11 *Due to budget constraints, the program was ended in Lincoln County in December CWX History

4   Columbia, Crook, Douglas, Jefferson, Morrow, Union and Wasco counties were added to the program July 1, 2011  Umatilla County added to the program April 1, 2012 CWX History

5   10/01/2013: CWX Expanded to every County in Oregon CWX History

6   Combines federal (CHIP) monies with county & state funding  CAWEM Plus benefit package for pregnant CAWEM women  CAWEM Plus is primarily to benefit the unborn child  CAWEM Plus benefits end the day after the baby is born Note: Consumer still has 60 days protected CAWEM eligibility based on the DUE N/R date Pre-Natal CAWEM Expansion Program (CWX)

7   Covers almost all OHP Plus medical services during pregnancy  Services not covered:  Death with dignity  Sterilization  Therapeutic abortion  Hospice Pre-natal CAWEM Expansion Program

8   CAWEM Plus consumers are not enrolled in a CCO  CAWEM Plus consumers will remain on an open card  CAWEM Plus consumers can still see their regular doctor if they accept an open card CWX Consumers not Enrolled

9   C/D of both CWM and CWX  CWX coding tells MMIS to provide CAWEM Plus  CM automatically sends an approval notice when CWX added (2D)  N/R of both CWX and DUE  the CWX date is the month in which 10-day notice period lands  the DUE date is the month that the consumer is due to deliver CWX coding

10   If the Consumer’s expected due date is on or before the 15 th :  Code a CWX of that month  If the Consumer’s expected due date is after the 15 th :  Code a CWX of the following month CWX N/R Coding

11  Henriquetta is due to deliver her baby on 10/09/13. She is eligible for OSIPM CWM. What coding will you have on the case and what dates will you use? Coding Example

12  CWX coding for 10/09/2013 DUE date

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14   Maritza is expected to deliver her child on 10/16/13. She is eligible for OSIPM CWM. What coding will you have on the case and what dates will you use Coding Example

15  CWX coding for 10/16/13 DUE date

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17   CM approval notice is also a reduction notice  Mother’s benefits reduced to CAWEM the day after the pregnancy ends  Baby is an AEN  5503 will add the AEN when they are notified of the birth  If the agency is not notified timely that the pregnancy has ended, the CWX N/R date triggers a reduction notice (86B) When notified timely that pregnancy ended, CAWEM Plus reduced to CAWEM

18   Use a “MEDI” action on the CM case and reduce the mother to CAWEM. The effective date will be the newborn’s DOB  Change mom’s start date to match the newborn’s DOB. Her benefits will reduce to CAWEM the next day  Remove CWX C/D and N/R coding  Send a MEDC form to 5503 to notify them of the birth of the baby Coding changes when baby is born

19   CWX N/R end date will trigger CM reduction notice (84B)  Benefits are reduced to CAWEM on the first of next month What if the agency is not notified of the birth?

20   Maria is a pregnant CWX consumer; the new baby is due May 13, 2013  DUE and CWX N/R date is 05/13  If the agency is not notified of birth:  10-day reduction notice will automatically be sent to reduce Maria’s medical to CAWEM for June 1 Example of CWX automatic reduction notice

21   Consumers still have 60 days protected CAWEM eligibility based on the DUE N/R date  Restore benefits to CWX and update coding if she contacts the branch and is still pregnant Example, cont.

22   The worker ends the consumer’s CWX benefits for the 1st of the month after the 10- day notice period and sends the CMRCWXR or SPRCWXR notice of reduction through NOTM  The consumer remains on CWM through their protected 60-day post partum eligibility period What if the consumer’s pregnancy ends before their DUE month?

23   Enter a “COMPUTE” action for the first of the month following 10-day notice period  Remove the CWX C/D and N/R codes  Update the DUE N/R to match the month/year the pregnancy ended  Update the medical start date to the first of the next month  Send the CMRCWXR or SPRCWXR notice of reduction System actions when pregnancy ends early

24   CMR2CWM and SPR2CWM : Reduce to CAWEM; not in pilot Example: Margaret is due December 15. However, we’re notified in November that she lost the baby. Send the 10-day CMR2CWM reduction notice and compute to remove CWX coding the first of the month after the 10-day notice period. NOTM notices

25   CM 2D Pre-natal Approval Notice - Automatically sent when adding new CAWEM Plus consumer  CM 01G CWX Benefits End – Advance Notice - A utomatically sent the month before the DUE need/resource end date (8th month of pregnancy)  CM 84B County Pre-natal Reduction - Automatically sent based on CWX need/resource end date when DHS/OHA is not notified timely of pregnancy ending CM notices


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