Multnomah and Deschutes County PreNatal CAWEM Expansion Pilot

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Multnomah and Deschutes County Pre-Natal CAWEM
Expansion Pilot
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This training will cover

• Overview of Pre-natal CAWEM Expansion Pilot
• New CAWEM Plus benefit package
• Eligibility
• CM system coding notices
• PCM enrollment information

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New CAWEM Plus benefit package begins April 1

• New CAWEM Plus benefit package for pregnant CAWEM
  women for pregnancy, birth and delivery
• Covers almost all OHP Plus medical services
  during pregnancy
• Medical care ID will display two benefit
  packages A- OHP Plus and E-CAWEM Emergency
  Medical

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Pilot extends pre-natal benefits to CAWEM women

• Multnomah and Deschutes County residents only for
  now
• Combines federal (CHIP) monies with county
  state funding
• Pilot funding available through June 2009

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PCM enrollment, part 1

• CAWEM Plus clients will not be enrolled in DCO,
  MHO or managed care plan
• May be enrolled in Primary Care Manager (PCM),
  but not mandatory
• PCM information may be written in managed care
  area on application

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PCM enrollment, part 2

• Most new Multnomah County pilot clients should be
  enrolled in C1XT Multnomah County Health PCM
• Deschutes County pilot clients will have various
  PCMs

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CM cases will be converted during March end of
month processing

• CAWEM Plus CWX coding will be added
• CWX case descriptor
• CWX need/resource item
• CM approval notice will also be sent

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CAWEM Plus reduced to CAWEM when DHS is notified
timely that pregnancy has ended

• CM approval notice is also a reduction notice
• No additional notice to send if DHS is notified
  timely
• Reduce to CAWEM the day after baby is born
• Baby is AEN
• 5503 will add the AEN if they are notified of the
  birth instead of the branch

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CWX coding

• CWX case descriptor and need/resource code with
  end date
• CWX coding tells MMIS to provide CAWEM Plus
• CM automatically sends 2D approval notice when
  CWX added
• Dont add on CM action with effective date prior
  to April 1
• CWX need/resource end date triggers CM close or
  reduce notice if were not notified timely that
  pregnancy has ended
• CWX need/resource end date is month in which
  10-day notice period lands

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What happens if were not notified of birth?

• CWX need/resource end date will trigger CM close
  (86B) or reduction notice (85B)
• Wont happen often
• Benefits closed end of the month if woman is OPP
  or MAA/MAF with no children
• Benefits reduced to CAWEM first of next month if
  shes MAA/MAF with other children

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Example of CWX automatic notice

• Maria is pregnant CAWEM MAA client with other MAA
  children the new baby is due April 10, 2008. DUE
  need/resource is 04/08.
• CWX end date is also 04/08
• If DHS not notified of birth, 10-day reduction
  notice will automatically be sent to reduce
  Marias medical to CAWEM for May 1

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Example, cont.

• No due process for other benefits because its
  already after when we should have been notified
  of birth
• Restore benefits if she contacts branch and shes
  still pregnant

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Another example of CWX automatic notice

• Angela is pregnant CAWEM OPP client the baby is
  due April 21, 2008. DUE is also 04/08.
• April 21 is past the 10-day notice deadline
• CWX end date is 05/08
• If DHS not notified of birth, 10-day close notice
  (86B) will automatically be sent to end her
  medical May 31
• Restore benefits when/if she contacts branch

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CM system conversion

• Pregnant CAWEM with DUE 04/08 or later will
  automatically convert to new CAWEM Plus benefits
  during March EOM processing
• CWX case descriptor and need/resource codes will
  be added automatically
• CWX need/resource end date will be added to match
  DUE end date
• Only for 051 and 017 FIPS

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Conversion issue CWX end date

• Eligibility workers will need to review cases
• 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
• Report will be available on View Direct around
  April 1

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What happens if pregnant CAWEM client moves into
pilot area?

• Will need to review CWX need/resource end date
• Report of new Multnomah and Deschutes county
  cases will be generated daily
• 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
• MEDI action cannot be effective prior to 4/1/08

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What happens if the CAWEM Plus client moves out
of pilot area?

• CAWEM Plus is for Multnomah and Deschutes
  residents only
• No longer in Pre-natal CAWEM Expansion Pilot
  Program if they move out of pilot counties
• Send CMRPTRN notice of reduction (from CAWEM Plus
  to CAWEM) and DHS 462A

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CM actions to transfer out of pilot

• Two day process
• First day enter a Compute action for the first of
  the next month to change address and remove CWX
  coding
• Next day, enter a Transfer action for the first
  of the next month to transfer out of pilot county

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CM notices

• CM 2D Pre-Natal Pilot Approval Notice
• Automatically sent when adding new CAWEM Plus
  client
• CM 85B County Pre-Natal Pilot Reduction
• Automatically send based on CWX end date for
  MAA/MAF CAWEM with other children
• CM 86B County Pre-Natal Pilot Close
• Automatically sent based on CWX end date

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NOTR notices, part 1

• CMR2CWM and SPR2CWM Reduce to CAWEM not in
  pilot
• Example Margaret is due June 15, however, were
  notified in May that she lost the baby. Send the
  10-day CMR2CWM reduction notice and compute to
  remove CWX coding the first of the month after
  the 10-day notice period.

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NOTR notices, part 2

• CMRPTRN and SPRPTRN Reduce to CAWEM moved out of
  pilot area
• Example Debra notifies us shes moving to Eugene
  to be with her mother. Send 10-day CMR2CWM
  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.

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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