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

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This training will cover

• Overview of Pre-natal CAWEM Expansion Program

• “CAWEM Plus” benefit package

• Eligibility

• CM system coding & notices

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Program extends pre-natal benefits to CAWEM women

in 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.

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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

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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

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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

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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

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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.

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CWX coding for 06/10/11 DUE date

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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.

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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

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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)

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Example of CWM coding after the baby is born

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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CM notices

• CM 2D Pre-Natal Approval Notice– Automatically sent when adding new CAWEM Plus client

• CM 01G CWX Benefits End – Advance Notice– Automatically 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 is not notified timely of pregnancy ending and there are other children in the household receiving MAA/MAF

• CM 85B County 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

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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

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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

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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

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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