Attachment 3 (10/14/2010) MEDICARE SAVINGS PROGRAM APPLICATION FROM SOCIAL SECURITY APPLICATION PROCESSING IN KAECSES
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1 Attachment 3 (10/14/2010) MEDICARE SAVINGS PROGRAM APPLICATION FROM SOCIAL SECURITY APPLICATION PROCESSING IN KAECSES (1) Applicants not known or with an inactive medical program in KAECSES CLIR (Client Inquiry/Registration Menu) Completion of this screen is mandatory. Register an MS program type (with a QO or LO subtype). The receipt date is the application date. The SSA application date is the proration date. Both spouses shall be registered the applicant shall be the case head. An automatic TPQY request is sent upon registration. ADDR (Address) Completion of this screen is mandatory. Enter the address and telephone number reported on the application. INDA (Interview Data) Completion of this screen is optional. The interview will default to E for exempt. SEPA (Setup Participation) Completion of this screen is mandatory. The applicant shall be coded IN. The spouse shall be coded either IN (Medicare beneficiary) or DI (not a Medicare beneficiary). MEIN (Medicare Information) Completion of this screen is mandatory. The Medicare information should auto populate this screen from the EATSS system upon registration (this is a multiple day process). MERE (Medical Resources) Completion of this screen is mandatory. The medical subtype is either AD (Disabled) or OA (Aged). Enter an N in the Insurance Code field. SSDO (SSN/Date of Birth/Sex) Completion of this screen is mandatory. Enter the SSN, date of birth and sex for the applicant and spouse from the information reported on the application. If the applicant is deceased, enter the date of death from the application. ETRC (Ethnicity/Residency/Citizenship/Identity) Completion of this screen is mandatory. For an applicant or spouse previously unknown to KAECSES, enter Race as O, Ethnicity as N, Language Spoken as UN, Language Written as UN, Other Media as N, Citizenship as US and Identity as Y. 1
2 MAST (Marital Status) Completion of this screen is optional. The screen shall be completed at review. SPRD (Specified Relative/Deprivation/Child Support) Skip this screen entirely inapplicable. CHSE (Child Support Enforcement Referral) Skip this screen entirely inapplicable. LIRE (Liquid Resources) Completion of this screen is optional. These resources shall be VEHI (Vehicles) Completion of this screen is optional. These resources shall be verified and entered at review. OTAP (Other Assets/Property) Completion of this screen is optional. These resources shall be MSRD (MS Resource Determination) Completion of this screen is mandatory. UNIN (Unearned Income) Completion of this screen is mandatory if unearned income is reported. Enter the income reported on the application. The SSA income for each spouse must be verified and entered separately. All other unearned income shall be entered by the applicant. PICK (Pickle) Completion of this screen is mandatory. If QMB eligible, a QO code shall be entered in the SMI field for the first 4 months of the year (if necessary). If LMB eligible, an LO code shall be entered in the SMI field. If Expanded LMB eligible, an LL code shall be entered in the SMI field. After the PICK screen has been updated, the MSID and SPEN (with PEN entered) screens must be processed to authorize eligibility. EAIN (Earned Income) Completion of this screen is mandatory if earned income is reported. The yearly amount reported on the application must be manually annualized by dividing by 12. Enter the monthly income for each spouse. SEEI (Self Employment/Intermittent Income) - Completion of this screen is mandatory if self employment income is reported. The yearly amount reported on the application must be annualized by dividing by 12. Enter the monthly amount for each spouse. EXNS (Expense/Need Standard) Skip this screen entirely inapplicable. 2
3 MSID (MS Income Determination) Completion of this screen is mandatory. SPEN (Spenddown) Completion of this screen is mandatory. Enter PEN to authorize and set a 12 month review period. MEEX (Medical Expenses) Skip this screen entirely inapplicable. LOTC (Long Term Care) Skip this screen entirely inapplicable. MSED (MS Eligibility Determination) Skip this screen entirely inapplicable for an approval. NORE (Notice Request) Completion of this screen is mandatory. Based on the applicable program approved, one of the following approval notices shall be sent N160 (QMB Approval MIPPA), N161 (LMB Approval MIPPA) or N162 (Expanded LMB Approval MIPPA). (2) Applicants with an active program (other than medical) in KAECSES CLIM (Client Inquiry) Completion of this screen is mandatory. Inquire on the applicant to find the active program case number. APMA (Application Maintenance) Completion of this screen is mandatory. Register an MS program type (with a QO or LO subtype). The receipt date is the application date. The SSA application date is the proration date. Both spouses shall be registered the applicant shall be the case head. Send a new TPQY request for the applicant and spouse if a current TPQY does not exist in EATSS. ADDR (Address) Completion of this screen is optional. Assume the current address and telephone number listed on the ADDR screen is correct, even if different from the address and/or telephone number reported on the application. INDA (Interview Data) Completion of this screen is optional. The interview will default to E for exempt. SEPA (Setup Participation) Completion of this screen is mandatory. The applicant shall be coded IN. The spouse shall be coded either IN (Medicare beneficiary) or DI (not a Medicare beneficiary). 3
4 MEIN (Medicare Information) Completion of this screen is mandatory. The Medicare information should auto populate this screen from the EATSS system upon registration (if there is a current TPQY) or with a new TPQY request (this is a multiple day process). MERE (Medical Resources) Completion of this screen is mandatory. The medical subtype is either AD (Disabled) or OA (Aged). Enter an N in the Insurance Code field. SSDO (SSN/Date of Birth/Sex) Completion of this screen is mandatory. Enter the SSN, date of birth and sex for the applicant and spouse from the information reported on the application. If the applicant is deceased, enter the date of death from the application. ETRC (Ethnicity/Residency/Citizenship/Identity) Completion of this screen is mandatory. For a spouse previously unknown to KAECSES, enter Race as O, Ethnicity as N, Language Spoken as UN, Language Written as UN, Other Media as N, Citizenship as US and Identity as Y. MAST (Marital Status) Completion of this screen is optional. The screen shall be completed at review. SPRD (Specified Relative/Deprivation/Child Support) Skip this screen entirely inapplicable. CHSE (Child Support Enforcement Referral) Skip this screen entirely inapplicable. LIRE (Liquid Resources) Completion of this screen is optional. These resources shall be VEHI (Vehicles) Completion of this screen is optional. These resources shall be verified and entered at review. OTAP (Other Assets/Property) Completion of this screen is optional. These resources shall be MSRD (MS Resource Determination) Completion of this screen is mandatory. UNIN (Unearned Income) Completion of this screen is mandatory if unearned income is reported. Enter the income reported on the application. The SSA income for each spouse must be verified and entered separately. All other unearned income shall be entered by 4
5 the applicant. PICK (Pickle) Completion of this screen is mandatory. If QMB eligible, a QO code shall be entered in the SMI field for the first 4 months of the year (if necessary). If LMB eligible, an LO code shall be entered in the SMI field. If Expanded LMB eligible, an LL code shall be entered in the SMI field. After the PICK screen has been updated, the MSID and SPEN (with PEN entered) screens must be processed to authorize eligibility. EAIN (Earned Income) Completion of this screen is mandatory if earned income is reported. The yearly amount reported on the application must be manually annualized by dividing by 12. Enter the monthly income for each spouse. SEEI (Self Employment/Intermittent Income) - Completion of this screen is mandatory if self employment income is reported. The yearly amount reported on the application must be annualized by dividing by 12. Enter the monthly amount for each spouse. EXNS (Expense/Need Standard) Skip this screen entirely inapplicable. MSID (MS Income Determination) Completion of this screen is mandatory. SPEN (Spenddown) Completion of this screen is mandatory. Enter PEN to authorize and set a 12 month review period. The review period may be set to match the review of the other open program. MEEX (Medical Expenses) Skip this screen entirely inapplicable. LOTC (Long Term Care) Skip this screen entirely inapplicable. MSED (MS Eligibility Determination) Skip this screen entirely inapplicable for an approval. NORE (Notice Request) Completion of this screen is mandatory. Based on the applicable program approved, one of the following approval notices shall be sent N160 (QMB Approval MIPPA), N161 (LMB Approval MIPPA) or N162 (Expanded LMB Approval MIPPA). (3) Applicants with an active medical program in KAECSES KAECSES processing of MSP applications with an open medical program shall be handled on a case by case basis. Please refer to the MIPPA MSP Application Processing Memo (Policy No: ) for guidance. 5
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