Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth Eligibility Operations Memo 11-08 November 15, 2011 TO: MassHealth Eligibility Operations Staff FROM: Amy Andrade, Director, Member and Provider Services RE: Revisions to the Medical Benefit Request, the Senior Medical Benefit Request, Other Forms, and the Virtual Gateway Introduction MassHealth has revised the Medical Benefit Request (MBR), the Senior Medical Benefit Request (SMBR), and other related forms to clarify policy and capture applicant information to appropriately determine eligibility for individuals who are visitors to Massachusetts. In addition, there are changes to clarify current policy and to the format of the forms. As a result, MA21, the Virtual Gateway (VG) Common Application, and MassHealth notices have been revised. These changes are effective October 1, 2011. This memo explains the changes to the forms and VG, why the changes were made, the revisions to the MA21 screens and notices, and the responsibilities of MassHealth staff. Changes to the MBR, SMBR, and VG The MBR, SMBR, and VG were changed as follows. Revisions common to the MBR and SMBR * Visitor (VIS) section: This section was removed and replaced with a new section addressing residency. * Residency (MAR) section: A new section was added to determine whether individuals who are applying for benefits are residents of Massachusetts and if they intend to remain in the state. * Health Insurance You Have Now and Subsidized Health Insurance You May Be Eligible For sections: All references to the Fishing Partnership Health Plan (FPHP) were removed. o In Part A – Health Insurance You Have Now (HIN): The FPHP was removed as an insurance-type option. o In Part B – Subsidized Insurance You May Be Eligible For (SIA): The question about income from the commercial fishing industry was removed. (continued on next page) Eligibility Operations Memo 11-08 November 15, 2011 Page 2 Changes to the MBR, SMBR, and the VG (cont.) *Signature page: Language was added to ensure that the individuals signing the application are aware that the signature certifies the correctness of not only the application and the supplements submitted in conjunction with the application, but also the correctness of any other documents and forms that are submitted or required by MassHealth. Revisions unique to the MBR * Instructions – first page: There are minor formatting changes and grammatical corrections. * Instructions – second page: A reference to the FPHP was removed. * American Indian/Native American section: The section was relocated and both the statement and the question were updated. * Supplement B: Absent Parent Questions and Assignment of Rights: The language in the third line of instructions at the top of the first page was updated to include specific instructions to sign Part E (signature section). In addition, the language in Part E was revised. Revisions unique to the SMBR * Instructions – second page: The mailing addresses have been changed to advise applicants where to submit an application. The addresses are based on the type of benefits requested. o Applications for benefits for those living in the community (including those applying for waiver benefits, such as Frail Elder, Kaleigh Mulligan, and PACE) should be mailed to the Central Processing Unit (CPU) in Charlestown. o Applications for long-term-care services in long-term-care facilities should be mailed to the MassHealth Enrollment Center (MEC) that is closest to where the facility is located. * American Indian/Alaska Native section: This section was added to the application. Virtual Gateway Revisions The Virtual Gateway has been updated to include all of the changes and additions for the MBR and the SMBR (with the exception of mailing addresses for individuals who need long-term-care services in a long- term-care facility). MA21 has been updated to import the information to the appropriate events. (continued on next page) Eligibility Operations Memo 11-08 November 15, 2011 Page 3 Related Forms Absent-Parent Questions and Assignment of Rights (AP-1) This stand-alone form has been updated with the same changes as the Supplement B: Absent-Parent Questions and Assignment of Rights in the MBR. Long-Term-Care Supplement (LTC-SUPP) This stand-alone form has been updated to include the mailing addresses that mimic the mailing addresses located on the instruction pages of the SMBR. Eligibility Representative Designation Form (ERD) * What an eligibility representative does section: The reference to the Uncompensated Care Pool (former name of the Health Safety Net) was removed. * Where to send the form section: This section has been updated to include the various mailing addresses. MassHealth Buy-In application and instructions (MHBI-1 and MHBI-2) This application has been updated to include a different mailing address (CPU in Charlestown). Annual Review Forms (ERVs and MERs) The eligibility review forms are being revised to add the absent parent changes (ERVs) and the updated signature page information (ERVs and MERs). Changes about American Indians and Alaska Natives American Indians and Alaska Natives who are eligible for or who have ever received an item or service furnished by the Indian Health Service, an Indian tribe, a tribal organization, or an urban Indian organization, or from a non-Indian health-care provider through a referral from an Indian health-care provider are exempt from paying copayments and premiums as MassHealth members. This update eliminates the portion of the question that asked only for those American Indians and Alaska Natives under age 19. The policy now applies to all American Indians and Alaska Natives regardless of age. Residency Information The resident question asks individuals if they are residents of Massachusetts and if they intend to remain in the state. It will be used to identify those individuals who may be eligible for benefits and those who do not meet the criteria. (continued on next page) Eligibility Operations Memo 11-08 November 15, 2011 Page 4 Residency Information (cont.) This information has been identified as critical data and is required before an application can be entered into MA21. This question will not be on review forms as it is intended to identify applicants who are not Massachusetts residents on the initial request for benefits. Virtual Gateway and Importing to MA21 The Virtual Gateway (VG) has been enhanced to require answers for the residency question and remove the visitor and Fishing Partnership Health Plan questions. The import of a VG MBR/SMBR into MA21 will continue as usual. All new questions will be imported to the appropriate MA21 event, including the new MAR event. All new e-MBRs and e-SMBRs will continue to be imported. All e-MBRs and e-SMBRs submitted for existing individuals on MA21 will continue to be manually imported. Since the VG required responses to applicable questions, the missing critical data (MCD) issue for the residency question is not applicable. CPU and MEC Processing Before entering a new MBR or SMBR into MA21, workers should review the application for completeness. Residency section If the residency question is not answered for each applicant, workers must treat the applications as having MCD and follow current procedures for obtaining the required data. Processing outdated MBRs or SMBRs Since applicants may submit an outdated MBR or SMBR with the visitor questions, please follow the procedures presented in training to ensure the visitor information is converted to the residency requirement properly. (continued on next page) Eligibility Operations Memo 11-08 November 15, 2011 Page 5 MA21 Notices The MA21 paragraph language has been updated. * Proof of residency: If there is any question of residency, such as conflicting or contradictory information about the applicant’s place of residence, MassHealth may ask the applicant to provide proof of residency. A residency paragraph will be included in the verification request notice if residency has not been marked “verified” on MA21. The applicant will have 60 days (if under age 65) or 30 days (if aged 65 or older) to submit the documentation. The request will identify the types of documents that can be submitted to prove Massachusetts residency. The acceptable documentation includes the following. * For adults o lease or mortgage statement; o city or town real-estate tax bill; o rent receipt; o current utility bill; o statement from a shelter; or o notarized affidavit supporting residency * For children o school records; o nursery-school or day-care records; or o notarized affidavit supporting residency * Missing critical data: The MCD notice has been updated to include a statement advising applicants that the residency information was not provided. Suspected Fraud According to policy, residency is self-declared unless there is conflicting or contradictory information about the applicant’s declared place of residence. If, for any reason, there is a suspicion that the applicant is providing fraudulent information, process the application and then follow procedures for reporting the information to the MassHealth Operations Integrity Unit. Outdated Forms MassHealth will continue to accept the previous version until supplies are exhausted. Workers should follow the procedures presented during training for processing information from outdated applications. (continued on next page) Eligibility Operations Memo 11-0 November 15, 2011 Page 6 Form Location The revised forms, except the ERVs and MERs, can be found on the Applications and Member Forms page on the MassHealth Web site at www.mass.gov/masshealth. Questions If you have any questions about this memo, please have your MEC designee contact the Policy Hotline.