Ex Parte Determinations and other Processes. After 7-1-11 for Childless Adult Members Who Are No Longer Eligible as Childless Adults and for Children Aging Out of 1931, SOBRA Child, YATI and KidsCare • On June 28, 2011, and every month thereafter, any Childless Adult who is age 65 and older, or who is under age 65 and has Medicare, who is eligible as a Childless Adult for the following month will be transferred to the SSI MAO program and will be redetermined under that category. These members will be identified in our PMMIS system and their eligibility key codes will be changed from Childless Adult to SSI MAO-Aged or SSI MAO-Disabled. We have an automated process from PMMIS to post this change back into DES’ AZTECS system and AHCCCS’ ACE system to close the Childless Adult case. There will be no break in coverage for these members. If they lose coverage for Childless Adults for any other eligibility reason, i.e., excess income, loss of residency, etc, they will not be moved to SSI MAO. AHCCCS and DES may become aware of these other reasons for losing eligibility for the Childless Adults program through a variety of means, such as, redetermination, self reporting (all Medicaid members are required to report changes in their circumstances), or PARIS updates (which is a data system that allows state Medicaid agencies across the country to share data regarding state residency and other issues). AHCCCS will look for individuals who are age 65 and older, and for individuals under age 65 with Medicare every month subsequent to June 28, 2011. This process will ensure that individuals turning 65 or individuals under age 65 receiving Medicare are moved to SSI MAO. The same process described for June 28, 2011 will be followed each month. By transferring these individuals prior to our month end processing, we will get them into the correct capitation rate category prior to paying monthly capitation to our contractors for the following month. These individuals will be scheduled for a redetermination based on their next redetermination due date for AHCCCS Care. AHCCCS makes a file available monthly to all of its contracted health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through Interactive Voice Response (a phone bank) and through batch processing. Batch processing allows the registered provider to access information on multiple members at one time. Batch processing will be updated effective October 1, 2011. Members age 65 and older or under age 65 with Medicare, who are moved to SSI MAO and subsequently determined to be ineligible under the requirements for that program, will be returned to the Childless Adult program without a break in coverage. • On June 28, 2011, and every month thereafter, any Seriously Mentally Ill (SMI) adult, who is eligible under the Childless Adult program for the following month will be moved into the SSI MAO program and will be redetermined under that category. If they lose coverage for Childless Adults for any other eligibility reason, e.g., excess income, loss of residency, etc, they will not be moved to SSI MAO. AHCCCS and DES may become aware of these other reasons for losing eligibility (e.g., excess income, loss of residency) for the Childless Adults program through a variety of means, such as, redetermination, self reporting (all Medicaid members are required to report changes in their circumstances), or PARIS updates. SMI members are identified by the Arizona Department of Health Services (ADHS) through their Regional Behavioral Health Authorities (RBHAs) and their behavioral health provider network. This information is posted in the AHCCCS PMMIS system. AHCCCS will look for individuals who are SMI every month subsequent to June 28, 2011. This process will ensure that individuals diagnosed as SMI are moved to SSI MAO. The same process described for June 28, 2011 will be followed each month. By transferring these individuals prior to our month end processing, we will get them into the correct capitation rate category prior to paying monthly capitation to our contractors for the following month. These individuals will be scheduled for a redetermination based on their next redetermination due date for AHCCCS Care. AHCCCS will share a listing of transferred SMI members who are due for renewal within 60 days with each Regional Behavioral Health Authority (RHBA) on a monthly basis. The RBHAs work with their providers; application assistor staff use Health-e-Arizona to complete the renewal application, including submission of any necessary documentation. Application assistors are individuals employed by a Health-e- Arizona facility who are trained in using the Health-e-Arizona product and helping individuals complete the application process. Using Health-e-Arizona will allow the RBHA providers to track and follow up with the renewal process, and ensure members have support in completing the process. In addition, AHCCCS has reached agreement with the Disability Determination Service Administration (DDSA) to significantly streamline the process of collecting and submitting documentation for the disability determination, if one is required. Typically, the disability determination through DDSA requires a lot of documentation. AHCCCS is working with DDSA to allow RHBA providers to submit data that is essential to the disability determination directly to DDSA. This way, DDSA can coordinate with providers to obtain the required documentation rather than rely solely on the individual. AHCCCS makes a file available monthly to all of its contracted health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. SMI members who are moved to SSI MAO and subsequently determined to be ineligible under the requirements for that program will be returned to the Childless Adult program without a break in coverage. • Effective June 28, 2011, and every month thereafter, Childless Adults who have a diagnosis of HIV/AIDs and/or take antiretrovirals, and lose coverage under the Childless Adults program, because they did not comply with the redetermination process, will be moved into the SSI MAO program and will be redetermined under the rules of that category. If the adult with HIV/AIDS does not meet the requirements for SSI MAO, that individual’s eligibility ends. Adults with HIV/AIDS, who are moved to SSI MAO, because they did not comply with the Childless Adult redetermination process, will not have a break in coverage when they are transferred from the Childless Adults program to SSI MAO. Adults with HIV/AIDS, who are moved to SSI MAO, will be scheduled for a redetermination as soon as possible, since they lost AHCCCS Care for failure to comply with the redetermination process. If the adult with HIV/AIDS loses coverage for Childless Adults for any other eligibility reason, i.e., excess income or loss of residency, they will not be moved to SSI MAO. AHCCCS will identify these individuals based on the diagnosis code of 042 and/or antiretrovirals for which there are encounters and claims in the PMMIS system. AHCCCS will look for these individuals every month before our month end processing, starting June 28, 2011. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. • Other Childless Adults who lose coverage because they did not comply with the redetermination process, will be advised by the eligibility agency using Notice #7 that they are no longer eligible for AHCCCS Care, that they can file an appeal if they believe their eligibility was discontinued in error and that they can apply for Medicaid, if they believe they are aged, blind, disabled, pregnant, or the parent of a deprived child. They will receive a final notification from AHCCCS using Notice #6 that their eligibility is ending and advising them to complete their renewal prior to the effective date of their discontinuance. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. • Children who are aging out of the 1931, SOBRA Child, YATI and KidsCare programs, and meet the qualifications for Childless Adults, can continue to be determined eligible for Childless Adults after the enrollment freeze is in effect. Children who have a redetermination due the month they are aging out of the 1931, SOBRA Child, YATI and KidsCare programs must comply with the redetermination process. If they do not comply with the redetermination, and as a result, lose coverage, and then reapply after the effective date of the discontinuance of their coverage, they cannot be determined eligible for Childless Adults. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. DES and AHCCCS staff will automatically determine eligibility for children aging out of the 1931, SOBRA Child, YATI and KidsCare programs, who do not have a redetermination due. If DES and AHCCCS staff are unable to complete the eligibility determination for the child before the child ages out, the child will be transferred to Childless Adults and will remain eligible for Childless Adults if they meet all other eligibility criteria. The child’s redetermination date will remain the same as it was under his or her previous eligibility category. • Households are advised that they can submit a paper application or can use the Health-e-Arizona on line application at xxx.xxxxxxxxxxxxxx.xxx. • All households that have not submitted a renewal application by the second week of the renewal month receive an automated reminder call, if they have a phone number.
Appears in 4 contracts
Samples: Special Terms and Conditions, Special Terms and Conditions, Special Terms and Conditions
Ex Parte Determinations and other Processes. After 7-1-11 for Childless Adult Members Who Are No Longer Eligible as Childless Adults and for Children Aging Out of 1931, SOBRA Child, YATI and KidsCare • On June 28, 2011, and every month thereafter, any Childless Adult who is age 65 and older, or who is under age 65 and has Medicare, who is eligible as a Childless Adult for the following month will be transferred to the SSI MAO program and will be redetermined under that category. These members will be identified in our PMMIS system and their eligibility key codes will be changed from Childless Adult to SSI MAO-Aged or SSI MAO-Disabled. We have an automated process from PMMIS to post this change back into DES’ AZTECS system and AHCCCS’ ACE system to close the Childless Adult case. There will be no break in coverage for these members. If they lose coverage for Childless Adults for any other eligibility reason, i.e., excess income, loss of residency, etc, they will not be moved to SSI MAO. AHCCCS and DES may become aware of these other reasons for losing eligibility for the Childless Adults program through a variety of means, such as, redetermination, self reporting (all Medicaid members are required to report changes in their circumstances), or PARIS updates (which is a data system that allows state Medicaid agencies across the country to share data regarding state residency and other issues). AHCCCS will look for individuals who are age 65 and older, and for individuals under age 65 with Medicare every month subsequent to June 28, 2011. This process will ensure that individuals turning 65 or individuals under age 65 receiving Medicare are moved to SSI MAO. The same process described for June 28, 2011 will be followed each month. By transferring these individuals prior to our month end processing, we will get them into the correct capitation rate category prior to paying monthly capitation to our contractors for the following month. These individuals will be scheduled for a redetermination based on their next redetermination due date for AHCCCS Care. AHCCCS makes a file available monthly to all of its contracted health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through Interactive Voice Response (a phone bank) and through batch processing. Batch processing allows the registered provider to access information on multiple members at one time. Batch processing will be updated effective October 1, 2011. Members age 65 and older or under age 65 with Medicare, who are moved to SSI MAO and subsequently determined to be ineligible under the requirements for that program, will be returned to the Childless Adult program without a break in coverage. • On June 28, 2011, and every month thereafter, any Seriously Mentally Ill (SMI) adult, who is eligible under the Childless Adult program for the following month will be moved into the SSI MAO program and will be redetermined under that category. If they lose coverage for Childless Adults for any other eligibility reason, e.g., excess income, loss of residency, etc, they will not be moved to SSI MAO. AHCCCS and DES may become aware of these other reasons for losing eligibility (e.g., excess income, loss of residency) for the Childless Adults program through a variety of means, such as, redetermination, self reporting (all Medicaid members are required to report changes in their circumstances), or PARIS updates. SMI members are identified by the Arizona Department of Health Services (ADHS) through their Regional Behavioral Health Authorities (RBHAs) and their behavioral health provider network. This information is posted in the AHCCCS PMMIS system. AHCCCS will look for individuals who are SMI every month subsequent to June 28, 2011. This process will ensure that individuals diagnosed as SMI are moved to SSI MAO. The same process described for June 28, 2011 will be followed each month. By transferring these individuals prior to our month end processing, we will get them into the correct capitation rate category prior to paying monthly capitation to our contractors for the following month. These individuals will be scheduled for a redetermination based on their next redetermination due date for AHCCCS Care. AHCCCS will share a listing of transferred SMI members who are due for renewal within 60 days with each Regional Behavioral Health Authority (RHBA) on a monthly basis. The RBHAs work with their providers; application assistor staff use Health-e-Arizona to complete the renewal application, including submission of any necessary documentation. Application assistors are individuals employed by a Health-e- Arizona facility who are trained in using the Health-e-Arizona product and helping individuals complete the application process. Using Health-e-Arizona will allow the RBHA providers to track and follow up with the renewal process, and ensure members have support in completing the process. In addition, AHCCCS has reached agreement with the Disability Determination Service Administration (DDSA) to significantly streamline the process of collecting and submitting documentation for the disability determination, if one is required. Typically, the disability determination through DDSA requires a lot of documentation. AHCCCS is working with DDSA to allow RHBA providers to submit data that is essential to the disability determination directly to DDSA. This way, DDSA can coordinate with providers to obtain the required documentation rather than rely solely on the individual. AHCCCS makes a file available monthly to all of its contracted health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. SMI members who are moved to SSI MAO and subsequently determined to be ineligible under the requirements for that program will be returned to the Childless Adult program without a break in coverage. • Effective June 28, 2011, and every month thereafter, Childless Adults who have a diagnosis of HIV/AIDs and/or take antiretrovirals, and lose coverage under the Childless Adults program, because they did not comply with the redetermination process, will be moved into the SSI MAO program and will be redetermined under the rules of that category. If the adult with HIV/AIDS does not meet the requirements for SSI MAO, that individual’s eligibility ends. Adults with HIV/AIDS, who are moved to SSI MAO, because they did not comply with the Childless Adult redetermination process, will not have a break in coverage when they are transferred from the Childless Adults program to SSI MAO. Adults with HIV/AIDS, who are moved to SSI MAO, will be scheduled for a redetermination as soon as possible, since they lost AHCCCS Care for failure to comply with the redetermination process. If the adult with HIV/AIDS loses coverage for Childless Adults for any other eligibility reason, i.e., excess income or loss of residency, they will not be moved to SSI MAO. AHCCCS will identify these individuals based on the diagnosis code of 042 and/or antiretrovirals for which there are encounters and claims in the PMMIS system. AHCCCS will look for these individuals every month before our month end processing, starting June 28, 2011. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. • Other Childless Adults who lose coverage because they did not comply with the redetermination process, will be advised by the eligibility agency using Notice #7 that they are no longer eligible for AHCCCS Care, that they can file an appeal if they believe their eligibility was discontinued in error and that they can apply for Medicaid, if they believe they are aged, blind, disabled, pregnant, or the parent of a deprived child. They will receive a final notification from AHCCCS using Notice #6 that their eligibility is ending and advising them to complete their renewal prior to the effective date of their discontinuance. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. • Children who are aging out of the 1931, SOBRA Child, YATI and KidsCare programs, and meet the qualifications for Childless Adults, can continue to be determined eligible for Childless Adults after the enrollment freeze is in effect. Children who have a redetermination due the month they are aging out of the 1931, SOBRA Child, YATI and KidsCare programs must comply with the redetermination process. If they do not comply with the redetermination, and as a result, lose coverage, and then reapply after the effective date of the discontinuance of their coverage, they cannot be determined eligible for Childless Adults. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. DES and AHCCCS staff will automatically determine eligibility for children aging out of the 1931, SOBRA Child, YATI and KidsCare programs, who do not have a redetermination due. If DES and AHCCCS staff are unable to complete the eligibility determination for the child before the child ages out, the child will be transferred to Childless Adults and will remain eligible for Childless Adults if they meet all other eligibility criteria. The child’s redetermination date will remain the same as it was under his or her previous eligibility category. • Households are advised that they can submit a paper application or can use the Health-e-Arizona on line application at xxx.xxxxxxxxxxxxxx.xxx. • All households that have not submitted a renewal application by the second week of the renewal month receive an automated reminder call, if they have a phone number.
Appears in 2 contracts
Samples: Special Terms and Conditions, Special Terms and Conditions
Ex Parte Determinations and other Processes. After 7-1-11 for Childless Adult Members Who Are No Longer Eligible as Childless Adults and for Children Aging Out of 1931, SOBRA Child, YATI and KidsCare • On June 28, 2011, and every month thereafter, any Childless Adult who is age 65 and older, or who is under age 65 and has Medicare, who is eligible as a Childless Adult for the following month will be transferred to the SSI MAO program and will be redetermined under that category. These members will be identified in our PMMIS system and their eligibility key codes will be changed from Childless Adult to SSI MAO-Aged or SSI MAO-Disabled. We have an automated process from PMMIS to post this change back into DES’ AZTECS system and AHCCCS’ ACE system to close the Childless Adult case. There will be no break in coverage for these members. If they lose coverage for Childless Adults for any other eligibility reason, i.e., excess income, loss of residency, etc, they will not be moved to SSI MAO. AHCCCS and DES may become aware of these other reasons for losing eligibility for the Childless Adults program through a variety of means, such as, redetermination, self reporting (all Medicaid members are required to report changes in their circumstances), or PARIS updates (which is a data system that allows state Medicaid agencies across the country to share data regarding state residency and other issues). AHCCCS will look for individuals who are age 65 and older, and for individuals under age 65 with Medicare every month subsequent to June 28, 2011. This process will ensure that individuals turning 65 or individuals under age 65 receiving Medicare are moved to SSI MAO. The same process described for June 28, 2011 will be followed each month. By transferring these individuals prior to our month end processing, we will get them into the correct capitation rate category prior to paying monthly capitation to our contractors for the following month. These individuals will be scheduled for a redetermination based on their next redetermination due date for AHCCCS Care. AHCCCS makes a file available monthly to all of its contracted health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through Interactive Voice Response (a phone bank) and through batch processing. Batch processing allows the registered provider to access information on multiple members at one time. Batch processing will be updated effective October 1, 2011. Members age 65 and older or under age 65 with Medicare, who are moved to SSI MAO and subsequently determined to be ineligible under the requirements for that program, will be returned to the Childless Adult program without a break in coverage. • On June 28, 2011, and every month thereafter, any Seriously Mentally Ill (SMI) adult, who is eligible under the Childless Adult program for the following month will be moved into the SSI MAO program and will be redetermined under that category. If they lose coverage for Childless Adults for any other eligibility reason, e.g., excess income, loss of residency, etc, they will not be moved to SSI MAO. AHCCCS and DES may become aware of these other reasons for losing eligibility (e.g., excess income, loss of residency) for the Childless Adults program through a variety of means, such as, redetermination, self reporting (all Medicaid members are required to report changes in their circumstances), or PARIS updates. SMI members are identified by the Arizona Department of Health Services (ADHS) through their Regional Behavioral Health Authorities (RBHAs) and their behavioral health provider network. This information is posted in the AHCCCS PMMIS system. AHCCCS will look for individuals who are SMI every month subsequent to June 28, 2011. This process will ensure that individuals diagnosed as SMI are moved to SSI MAO. The same process described for June 28, 2011 will be followed each month. By transferring these individuals prior to our month end processing, we will get them into the correct capitation rate category prior to paying monthly capitation to our contractors for the following month. These individuals will be scheduled for a redetermination based on their next redetermination due date for AHCCCS Care. AHCCCS will share a listing of transferred SMI members who are due for renewal within 60 days with each Regional Behavioral Health Authority (RHBA) on a monthly basis. The RBHAs work with their providers; application assistor staff use Health-e-Arizona to complete the renewal application, including submission of any necessary documentation. Application assistors are individuals employed by a Health-e- Arizona facility who are trained in using the Health-e-Arizona product and helping individuals complete the application process. Using Health-e-Arizona will allow the RBHA providers to track and follow up with the renewal process, and ensure members have support in completing the process. In addition, AHCCCS has reached agreement with the Disability Determination Service Administration (DDSA) to significantly streamline the process of collecting and submitting documentation for the disability determination, if one is required. Typically, the disability determination through DDSA requires a lot of documentation. AHCCCS is working with DDSA to allow RHBA providers to submit data that is essential to the disability determination directly to DDSA. This way, DDSA can coordinate with providers to obtain the required documentation rather than rely solely on the individual. AHCCCS makes a file available monthly to all of its contracted health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. SMI members who are moved to SSI MAO and subsequently determined to be ineligible under the requirements for that program will be returned to the Childless Adult program without a break in coverage. • Effective June 28, 2011, and every month thereafter, Childless Adults who have a diagnosis of HIV/AIDs and/or take antiretrovirals, and lose coverage under the Childless Adults program, because they did not comply with the redetermination process, will be moved into the SSI MAO program and will be redetermined under the rules of that category. If the adult with HIV/AIDS does not meet the requirements for SSI MAO, that individual’s eligibility ends. Adults with HIV/AIDS, who are moved to SSI MAO, because they did not comply with the Childless Adult redetermination process, will not have a break in coverage when they are transferred from the Childless Adults program to SSI MAO. Adults with HIV/AIDS, who are moved to SSI MAO, will be scheduled for a redetermination as soon as possible, since they lost AHCCCS Care for failure to comply with the redetermination process. If the adult with HIV/AIDS loses coverage for Childless Adults for any other eligibility reason, i.e., excess income or loss of residency, they will not be moved to SSI MAO. AHCCCS will identify these individuals based on the diagnosis code of 042 and/or antiretrovirals for which there are encounters and claims in the PMMIS system. AHCCCS will look for these individuals every month before our month end processing, starting June 28, 2011. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. • Other Childless Adults who lose coverage because they did not comply with the redetermination process, will be advised by the eligibility agency using Notice #7 that they are no longer eligible for AHCCCS Care, that they can file an appeal if they believe their eligibility was discontinued in error and that they can apply for Medicaid, if they believe they are aged, blind, disabled, pregnant, or the parent of a deprived child. They will receive a final notification from AHCCCS using Notice #6 that their eligibility is ending and advising them to complete their renewal prior to the effective date of their discontinuance. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. • Children who are aging out of the 1931, SOBRA Child, YATI and KidsCare programs, and meet the qualifications for Childless Adults, can continue to be determined eligible for Childless Adults after the enrollment freeze is in effect. Children who have a redetermination due the month they are aging out of the 1931, SOBRA Child, YATI and KidsCare programs must comply with the redetermination process. If they do not comply with the redetermination, and as a result, lose coverage, and then reapply after the effective date of the discontinuance of their coverage, they cannot be determined eligible for Childless Adults. AHCCCS makes a file available monthly to health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), through IVR and through batch processing. Batch processing will be updated effective October 1, 2011. DES and AHCCCS staff will automatically determine eligibility for children aging out of the 1931, SOBRA Child, YATI and KidsCare programs, who do not have a redetermination due. If DES and AHCCCS staff are unable to complete the eligibility determination for the child before the child ages out, the child will be transferred to Childless Adults and will remain eligible for Childless Adults if they meet all other eligibility criteria. The child’s redetermination date will remain the same as it was under his or her previous eligibility category. • Households are advised that they can submit a paper application or can use the Health-e-Arizona on line application at xxx.xxxxxxxxxxxxxx.xxx. • All households that have not submitted a renewal application by the second week of the renewal month receive an automated reminder call, if they have a phone number.
Appears in 2 contracts
Samples: Special Terms and Conditions, Special Terms and Conditions
