Medical Cards

Temporary Medical Card

 

Medical cards are generated on a regular monthly cycle and mailed to the provider. A medical card becomes valid when the worker completes the Enter/Exit Screen in the Placement focus. (See Child Placement) However since the Medical Card is only generated monthly, the client must be able to show proof of medical eligibility until the medical card arrives. This is shown through the report Temporary Medical Card Authorization Letter which includes the client=s medical eligibility number, the name of the case worker, as well as provider information. The medical eligibility number that was previously determined by the worker using a formula and manually recorded on a preprinted form, is now determined and printed on the letter by FACTS.

 

To generate the Temporary Medical Card Authorization Letter for a client, all placement information must be entered, and approved by the worker and supervisor. The worker then selects the Temporary Medical Card report from the reports menu, selects the appropriate client and provider. The card will then become Word Perfect document and allow the worker to edit any incorrect information. Worker should PRINT the document and SAVE TO FACTS, so the card is in the case file cabinet.

 

The medical eligibility information is displayed in FACTS on the Client Medical Coverage - Insurance Screen in the window at the bottom of the screen. The medical number can also be accessed by opening a workload, selecting the Case Tab, select the appropriate case, go to the bottom of the screen (grey area) and highlight the client that you need the number for and RIGHT mouse click. The medical number will appear in a pop up box.

 

Eligibility

 

FACTS automatically reports medical eligibility when a client is placed with the following types of providers:

 

1. Agency Emergency Shelter 

2. Department Adoptive Home 

3. Family Emergency Shelter 

4. Group Residential Care 

5. Medical Hospital 

6. Permanent Foster Family Care 

7. Psychiatric Facilities (Long Term) 

8. Psychiatric Hospital (Short Term) 

9. School for children with special needs 

10. Specialized Family care-(Medley)

11. Specialized Family Care Home-(Medley)

12. Temporary Foster Family care

13. Therapeutic Foster Care

14. Transitional Living-Client

 

Special Medical Card

 

The Special Medical Card Authorization Letter is issued to clients that are in custody but not in placement but who are eligible to receive medical services specified in state policy from a specific medical provider only one time in a specific date range. The nightly batch file will pick up the clients approved by the supervisors for the Special Medical Card Authorization Letter.

 

To generate the Special Medical Card Authorization Letter the Client/Medical/Provider screen must be completed. (SEE Client Medical Screens) The worker then is able to print a Special Medical Card Authorization Letter for that client. To print the letter, select the Special Medical Card Authorization Letter from the reports menu, select the appropriate client and provider and print the Special Medical Card Authorization Letter. This document cannot be edited by the worker. In order for the Special Medical Card to be valid for payment it MUST be printed from FACTS and not generated by hand.   

The medical eligibility which is automatically determined by FACTS, is displayed on the Client/Medical/Insurance screen and automatically reported to MMIS.

 

IV-E Medical Card  

 

IV-E Medical Cards are issued for children that were determined to be eligible for IV-E in their state of residence. A IV-E Medical Card for Foster Care is generated after the ICPC process (see ICPC Desk Guides) has been completed and approved and a child placed in the approved home in West Virginia. The Removal and Placement Screens are completed along with the Adoption Subsidy screen to generate the IV-E medical card.

 

A IV-E Medical Card for Adoption is generated when a family who has adopted a child(ren) in another state and were IV-E eligible, move to West Virginia. A case is opened on the family and the Adoption Subsidy screen is completed to generate the IV-E medical card.    

The medical number is then displayed in the Client/Medical/Insurance screen and from the workload screen.

 

How It Works

 

There are two batch programs that are used to report medical eligibility to MMIS, from FACTS. MMIS picks up these files and uses them to update their automated system.

 

One batch program runs nightly to show the clients who are eligible for medical services. Then this information is reported later the same night to MMIS (Medicaid Management Information Systems).

 

This batch program picks up the client information based on two conditions:

 

  1. if there is any change in any of the fields being reported for that client, like a change in entry date, a change in the placement, a change in the address of the provider with whom the client is placed, etc., or,

  1. if there is a new client entered into placement with any of the provider types listed above.

 

On the night of the 5th working day of every month, another batch program runs to report all the clients eligible to receive a medical card in that month and this information is used to generate medical cards by us on the mainframe. The medical eligibility number on this card is the same as the number that is on the Temporary Medical Card Authorization Letter previously given to the client by the worker. The dates on the medical card are from the 16th of the current month through the 15th of the following month.

 

Medical Eligibility Exception Reports

 

The medical eligibility batch programs will not report clients when their information is missing or is not correctly entered in FACTS. Clients with missing or incorrect information are listed on the FACTS Medical Eligibility Exception Report.

 

This report is sent weekly through e-mail to the district offices and to the Office of Social Services(OSS). The FACTS Medical Eligibility Exception Report shows the reasons clients are not being reported to MMIS so that corrections can be made. Each report is only sent to the staff in the district offices and the staff of OSS who have clients appearing on that report.

 

If there are records in the file reported to MMIS through the batch program that are not reconciled, MMIS notifies FACTS via a printed exception report. As this does not occur very often, workers for these clients are contacted individually and advised of the data exception that needs correction.

 

Temporary Medical Card

Special Medical Card

 

Child Placement

Client Medical Screens

ICPC Request to Receive

ICPC Case Supervision

ICPC Request to Provide

ICPC Homestudy