FAQ - Title V MCH 08

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Clinical/Services

Billing/Eligibility

Administrative

 

Clinincal/Services

 

 

Billing/Eligibility

Q. If a child is enrolled in Eligible for CHIP but the parents state that they cannot afford the CHIP premium, can they still be enrolled in Title V CH and Dental and PCH?

A. If a client is eligible and enrolled in CHIP, they are classisfied as CHIP eligible.  This means that they are not Title V eligible.  At this time Title V does not have a mechanism in place to assist with premiums.  It is not allowable to be Title V eligible if they cannot afford the premiums. (Section II, chapter 1, page II-11)

Check with the regional case manager as to whether there is any assistance for CHIP premiums.

Q. Is the income of a non-legal gardian, blood related and not blood related, considered in the family composition for a childs eligibility to receive Title V Child Health services.  For example:  A child living with an uncle, but not the legal gardian.  A child living with a non blood relative and not a legal gaurdian. (6/2008)

A. If a client is eligible and enrolled in CHIP, they are classisfied as CHIP eligible.  This means that they are not Title V eligible.  At this time Title V does not have a mechanism in place to assist with premiums.  It is not allowable to be Title V eligible if they cannot afford the premiums. (Section II, chapter 1, page II-11)

Check with the regional case manager as to whether there is any assistance for CHIP premiums.

Q. This question pertains to the eligibility determination and billing components of the 08 manual. Section 11, page 11 presumptive eligibility and section III page 4 non-reimbursement expenditures seems to conflict.. As per section II, visits for a client who is potentially eligibile for Medicaid can be billed to Title V for a 90 day period. As per section III, a visit of a client that does not complete the application process cannot be billed. (10/2007)

Scenerio: A client who vsits in January and is presumptive eligible for Medicaid, visits again in March, and at a May visit the Medicaid application process has not benn completed. Do those visits in January and March to Title V have to be reimbursed. Or, just any visits after the 90 days from the January visit cannot be billed to Title V? Please clarify this because it will make a big diference in our ability to bill for Title V services.

A. The client is presumptive eligible only once in a 12-month period. (Policy Manual-pg II-11).

If client is presumed presumptive eligible and seen in clinic in January as well as sent to Mediciad, the client has up to 90 days to complete the eligibility process. The client must be instructed that they must complete the process within 90 days or they will become self-pay. During this time period of eligibility completion, TV will reimburse for services.

If client becomes Medicaid eligible, contractor is to bill Medicaid for the services provided during those 90 days. If during that 90-day period, TV reimbursed for services, money is to be returned to TV. There is a paper process in which this is done. Debbie Lewis at 512-458-7111, ext 7781 can assist with this process.

If client does not complete the eligibility process within the 90 days, they become self-pay and contractor keeps any TV reimbursement of services provided during that time period. Remember, a client can be presumptive eligible only once in a 12-month period.

Q. Can a contractor choose not to recertify clients if the contractor knows that they will be out of funds say in a month or so? Can a contractor have a set number of clients that they will see, and after they have reached that set number can they stop certifying and recertifying new and existing clients?

A. The contractor is not required to screen for new TV MCH eligible clients when they are close to running out of funds or out of funds. However, a contractor is required to continue care for the present TV MCH eligible clients, even if funds have been expended, at no expense to the client.

Monthly billing should continue and any cost over the contract amount should be included in the non-DSHS funds. (Policy Manual-pg III-7)

If a contractor knows funds will be expended within a few months, it is allowable to contact the Regional Contract Coordinator and/or Contract Manager to check whether funds are available for request.

 

Q. If all of the family's eligibility forms and documentation are kept in one folder for eligibility, is the agency required to run multiple copies of the Applicant's Rights so that there is one for each child? (10/2007)

Scenerio: An agency keeps separate client files for eligibility records and clinical records. For eligibility, the agency keeps all of the eligibility information and documentation for the entire family in one folder. In the event that several members of one family are determined to be eligible for services and are enrolling in the program, can you clarify if the forms listed below would meet the documentation requirements according to PHC and Title V MCH policy:

1) Copy of Screening & Eligibility Determination form that is signed by the husband & wife if both are enrolling in the program (a separate copy of the form for each family member with their name highlighted/circled)

2) Copy of Applicant's Rights signed by the husband

3) Copy of Applicant's Rights signed by the wife

A.
1) Yes, it is allowable to have a separate copy of the the Screening & Eligibility Determination form that is signed by the husband & wife if both are enrolling in the program for each family member with their name highlighted/circled.

2) Yes, the husband needs to sign his own Applicant's Rights.

3) Yes, the wife needs to sign her own Applicant's Rights.

If all of the family's eligibility forms & documentation are kept in one eligibility folder, it is allowable for the parent to sign only one Applicant's Rights for the family since the family is screened on the one screening and eligibility form.

 

 

 

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Last updated May 07, 2010