MA Ex-Parte (Step A & B)
Step A Scenario
- Renewal due May 2023
- Interface call starts (Equifax/Fed Hub) on March 7, 2023. A 6-month look back from the Renewal due month will be made to verify if a case has up to date information (income & resources).
- One of the following steps will occur when Step A has been initiated:
- Approved without Discrepancies - approval NOA is sent; or
- Approved with Discrepancies - NOA and Income Discrepancy letter sent; or
- New Renewal Packet is generated and sent to the household.
Step B Scenario
- Member provides Renewal Packet to Eligibility Site.
- The signature page from the packet is required, the packet itself is not required to be returned.
- Eligibility Site starts Renewal prior to April 20th which is the month prior to the due month. If started prior to the 20th and all necessary verifications have been provided and entered, no VCL will be sent.
- If not started prior to the 20th, or if verifications are missing, a VCL will be sent.
Flowchart Description
Step 1
Continuous Coverage and Active Verified Members start here. Step A Initiated.
90 days (3 months) prior to Renewal due date on the 1st of the month, the renewal is updated to Initiated Status and the interface call begins on the 7th.
CBMS will check 6 months back for current information (income & resources).
Go to Step 2.
Step 2
Medical Assistance (MA) Renewal runs on the 12th of the month. Is the member eligible?
- If yes: Go to Step 3
- If no: Go to Step 9
Step 3
Approved without income discrepancies.
- If yes: Go to Step 4
- If no: Go to Step 5
Step 4
Approval Notice of Action (NOA) sent. Stop at Step 4.
Step 5
An approval Notice of Action (NOA) and Income Discrepancy Letter is sent.
Additional Information: An Income Discrepancy will receive a Reasonable Opportunity Period (ROP) of 30 days.
Proceed to Step 6.
Step 6
Is the member still eligible based on Reasonable Compatibility Response?
- If yes: Go to Step 4
- If no: Go to Step 7
Step 7
CBMS terminates eligibility with 10 day noticing. Stop at Step 7.
Step 8
New Renewal Packet with signature page will be generated between the 12th and 15th of the 3rd month prior to Renewal due month and is sent to the member.
Go to Step 9.
Step 9
Did the member provide a Renewal signature before the 20th of the month prior to the renewal due month?
- If yes: Go to Step 10
- If no: Go to Step 13
Additional Information: The signature form is sent out on the day the end-user enters the signature is missing. The form will have its own due date.
Step 10
The eligibility worker must update CBMS with the information and verifications provided by the 20th of the month prior to the Renewal due month.
Go to Step 11.
Additional Information: If an eligibility worker processes the Renewal packet before the 20th of the month prior to the Renewal due month, the Renewal will not advance until CBMS runs on the 15th of the Renewal due month.
Step 11:
Verification Checklist (VCL) will not be sent to members if verifications are not needed.
Go to Step 12.
Step 12:
Final Review: On the 15th of the Renewal due month, CBMS runs the final check. MA should approve or terminate the member.
Step 13:
Step B initiated.
A Verification Checklist (VCL) will be sent to a member for any needed verifications on the 20th of the month prior to the renewal due month.
Additional Information: At Step B CBMS will still perform a check for outstanding verifications. A VCL will be sent on the 20th of the month before the Renewal month for necessary verifications.
Go to Step 12.
Key Trigger Dates for MA
Identify Renewal Due Month
Renewal Due Month is May.
Step A Initiated
Renewal status in CBMS will be updated to “Initiated” 90 days prior to the Renewal due.
Step A begins March 12th.
Step B Initiated
Verification checklist is sent on April 20th.
Final Review
On May 15th, CBMS runs the final check-MA should approve or terminate the member.
Additional Information on Renewal Status
Initiated Status (I)
Renewal status in CBMS will be updated to “Initiated” 90 days prior to the Renewal being due. This will trigger the interfaces to be called during the MA process.
Generated Status (G)
Renewal status in CBMS will be updated to “Generated” once a Renewal packet is generated to be sent to the household. This will occur as early as the 12th of the month, 90 days prior to the Renewal due month.
Started Status (S)
Renewal status in CBMS will be updated to “S”once a Renewal packet is started in the View RRR Detail window within CBMS.
Colorado Department of Human Services (CDHS) Combo Renewal Ex-Parte
COVID Unwind Definitions
Active Verified Members
Active Verified members are members who have met all eligibility criteria and are not locked into Medical Assistance
Continuous Coverage Members
Continuous Coverage members are members locked into the Medical Assistance benefit due to the continuous coverage requirement mandated during the public health emergency.
Information for processing MA/CDHS Combo Ex Parte Renewals
- If a member is on MA Continuous Coverage (i.e. Locked In), the MA renewal cannot be pulled into the CDHS Combo Ex-Parte process. For combo cases with a member on MA Continuous Coverage, the MA Ex-Parte process will be initiated and Eligibility workers will need to process these renewals separately to allow the MA Ex-Parte process to be performed by CBMS.
- If the CDHS Renewal is returned by the active verified member and started by the eligibility worker after MA Step A initiates (on the 12th), Combo will not occur, and the CDHS Renewal will be started separate from the MA Renewal.
- If the MA renewal packet has been sent out (Step A) on a MA/CDHS combo RRR, the eligibility worker will need to complete the MA Renewal and the CDHS Renewal separately.
- If the MA Ex-Parte (Step A) has started, the eligibility worker must allow Step B to be performed by CBMS. This will allow for CBMS to request required verification if needed.
CBMS Data Entry Information
- When processing a MA/CDHS combo Renewal the eligibility worker must check and update the “Data Entry Complete” field to “Yes” for MA programs.
- For a MA/CDHS combo Renewal the "RRR Signature Provided" radio button is not mandatory, if the MA (Step A) has not started. If the MA Ex-Parte (Step A) has started this radio button is required.
- A CDHS Combo renewal signature is acceptable for a MA renewal.
- “MA only” Renewals require the signature form to be signed and returned.
Flowchart Description
Step 1
Active Verified Members start here.
CDHS Sends out Renewal.
Go to Step 2.
Step 2
Has Medical Assistance (MA) Ex-Parte (Step A) began?
- If yes: Go to Step 3
- If no: Go to Step 4
Additional Information: For the MA Ex-Parte (Step A) not to begin the eligibility worker must start the CDHS combo Renewal before MA sets to Initiated status which happens on the 1st of the 3rd month (90 days) prior to the MA Renewal due month.
Scenario: Renewal Due month is May. For MA Ex-Parte (Step A) not to begin the eligibility worker must start the CDHS combo Renewal before March 1st.
Step 3
Follow CBMS Step A and Step B logic outlined in section MA Ex-Parte (Step A & B) above. After Step 3, stop.
Step 4
An eligibility worker will process CDHS combo Renewal for the CDHS/MA program. After Step 4, stop.