Eligibility Policy Manual

Transmittal #29

Subject: New and Revised Processes

Implementation Date: May 25, 2006

Eligibility Policy Process #32 - How to Process Cases Showing Open Eligibility in PMMIS, was designed to provide instructions for processing eligibility for customer's with active status in PMMIS. This chart has been revised to provide additional information.

Revisions to this chart include the following:

• An introduction that provides an explanation and an example of why it is important to review PMMIS for cases with open eligibility.
• A link to new instructions for when and how to send Automated Referrals to DES.
• The updated chart indicates key codes for which AHCCCS automatically buys-in Medicare Part B when the customer's record shows Medicare eligibility.
• Instructions for processing both initial applications and redeterminations for customer's with active status in PMMIS.
• Additional instructions for ALTCS in special circumstances.
• Information explaining how QMB is now automatically added to customer's approved in the 371 and 372 key codes.

This chart includes significant changes to the way cases are now processed for SSI MAO and MCS cases when dual eligibility exists with the 371 or 372 key codes. Please pay close attention to these changes.

Accordingly, process instructions were added to Eligibility Policy Manual Process #66 to describe when to send automated referrals to DES.

An Automated Referral, also referred to as an Automated Inquiry (AI), is sent to the Department of Economic Security (DES) when a discrepancy is discovered for a customer who has been enrolled by both SSI-MAO and DES.

If you questions about these instructions or need assistance, please contact:

• For ALTCS, Dan McKeever, Mary Coons or Yvette Hill
• For SSI MAO and MCS, Lorena Villela and Michal Rudnick