Overview of Pre-natal CAWEM Expansion Program “CAWEM Plus” benefit package Eligibility CM system coding & notices This training will cover
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 2009. CWX History
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
10/01/2013: CWX Expanded to every County in Oregon CWX History
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)
Covers almost all OHP Plus medical services during pregnancy Services not covered: Death with dignity Sterilization Therapeutic abortion Hospice Pre-natal CAWEM Expansion Program
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
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
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
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
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
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
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?
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
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.
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?
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
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
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