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

Pre-Natal CAWEM Expansion (CWX) Now in 7 Counties. This training will cover. Overview of Pre-natal CAWEM Expansion Program “CAWEM Plus” benefit package Eligibility CM system coding & notices . Program extends pre-natal benefits to CAWEM women in Lane County.

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

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

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

  3. Program extends pre-natal benefits to CAWEM womenin 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. 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. 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. 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. 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. 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. CWX coding for 06/10/11 DUE date

  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. CWX eligibility process, continued • A CM system notice is sent in the 8th 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. 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. Example of CWM coding after the baby is born

  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. 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. 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. 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. Example of CWX automatic close notice • Angela is a pregnant CAWEM OPP client; the baby is due June 23, 2011. DUE is 06/11 • June 23 is past the 15th 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. 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. 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 15th of the month, the CWX need/resource code will need to be manually changed to the next month

  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. 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. 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. What happens when the client’s pregnancy ends before their DUE date month? • The worker ends the client’s CWX benefits for the 1st 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. 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. CM notices • CM 2DPre-Natal Approval Notice • Automatically sent when adding new CAWEM Plus client • CM 01GCWX Benefits End – Advance Notice • Automatically sent the month before the DUE need/resource end date (8th month of pregnancy) • CM 84BCounty 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 85BCounty 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. 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. 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. 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. Questions? SSP-Policy, Medical e-mail address Joyce Clarkson 503-945-6106 Michelle Mack 503-947-5129 Carol Berg 503-945-6072 Vonda Daniels 503-945-6088 Jewel Kallstrom 503-947-2316 Audray D. Hunter 503-947-5519

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