+ Where can I find a list of training and courses?

+ How do I know when I’ve been registered in the Absorb Learning Management System?

+ What is the difference between a webinar, an instructor-led training, and a computer-based training?

+ Will I have access to the course materials from training?

+ What if I need to cancel or reschedule my training date?

+ What if I forgot my Absorb password?

+ How can I reach you for assistance?

+ What is the process for booking my hotel accommodations? (Applicable to LDSS employees attending Instructor-Led courses only)

+ How do I get reimbursed for my mileage, parking and tolls? (Applicable to LDSS employees attending Instructor-Led courses only)

+ Can you explain why we cannot pull SOLQ to verify income on an MSP?

Effective April 1, 2022, the State On Line Query (SOLQ), may be used to access Social Security Income information and Medicare eligibility information for purposes of determining eligibility for Medicare Savings Plan (MSP) applications and renewals. Please continue to follow all SOLQ guidelines (attached) for accessing information for purposes of determining Medicaid or MSP eligibility.

+ What is the advantage of a MIPP eligibility as opposed to an MSP?

The main scenarios are clients in the MBI-WPD program and those with full Medicaid under MAGI-like budgeting who have income above the SLMB level. Since clients in these scenarios cannot have full Medicaid and QI, they are given full Medicaid coverage and MIPP reimbursement. Also, there are clients who need a partial MIPP to reimburse them up to the MA level. Additionally, LDSS staff will see recipients being referred from NYSOH to the district who are in receipt of MIPP. These clients may be eligible for MSP going forward at the district but would be receiving MIPP at the time of referral.
Additionally, LDSS staff will see recipients who are being referred from NYSOH to the District who are in receipt of MIPP. These clients may be eligible for MSP going forward at District but would be receiving MIPP at the time of referral.

+ What is the eligibility timeline for QMB?

QMB starts the month after the month of determination.

+ Does a client have to be an M suffix to have Part A paid for by QMB?

No. While the instances of paying for Part A on a non-M HIC client are rare, they do occur.

+ Should it be assumed the frequency in which a client receives income is verified by SSA?

No, while the file contains a dollar amount for income, it does not show the frequency at which the income is received and the income frequency on the file can vary.

+ When would an SSI recipient not be eligible for QMB and need to apply for a Spenddown eligibility instead?

When a client resides in a Congregate Care Facility. An individual who does not qualify for QMB may be enrolled in the Medicare Buy-In through a different path (if he or she qualifies) but it is all the Medicare Buy-In.

+ Can LDSS staff use SOLQ for proof of income with MSP clients? on renewals or new applications?

Effective April 1,2022, the State On Line Query (SOLQ), may be usedto access Social Security Income information and Medicare eligibility information for purposes of determining eligibility for Medicare Savings Plan (MSP) applications and renewals. Please continue to follow all SOLQ guidelines (attached) for accessing information for purposes of determining Medicaid or MSP eligibility.

+ When someone owns a business, how do they pay into their Medicare?

Through taxes paid, FICA and Medicare. The only difference is, they pay the entire cost, not just the employee cost.

+ Where does the end date for HC come from? E.g. the end date for the HIC number when switching to the MBI.

HC is still required for MBI, so it is left as open.

+ Are children’s waiver A/Rs are exempt from managed care?

No, the only exempt waiver populations are OPWDD, TBI and NHTD. Children’s waiver is mandatory.

+ If a bill or combination of bills linked together to form a 6-month accounting period, should IP coverage be authorized even if there isn't a need?

Yes

+ What do we need to accept a transportation bill? and what type of proof do we accept?

Transportation expenses can be applied toward a spenddown liability if the transportation was to and/or from a medically necessary appointment. Proof that the recipient attended the appointment , including date and time (could be written by the provider) is required, as well as receipts for any tolls, parking, and bridges. In order to apply the cost of mileage, a map with trip mileage between the recipient’s home and the medical appointment is also required. Current reimbursement rates established by the IRS should be used when calculating mileage costs.

+ Is a prescription needed for over-the-counter drug receipts to be accepted?

In general, unless the district has a reason to question the bills, over-the-counter receipts are sufficient documentation.

+ For the accounting period, does the six months start from when the bill was paid or when it is being used?

Paid expenses are “anchored”/deducted from the income in the accounting period in which it is paid. Exception: An exception is made for expenses incurred and paid in the three-month retroactive period. When no part of the retroactive period is included in the first prospective accounting period, expenses incurred and paid during the retroactive period, which have not been used previously to establish eligibility can be deducted from income in the first prospective accounting period.

+ Are Part D summaries of Rx's usable to meet a spenddown?

Yes, if the Part D summary lists the drugs that were purchased and the amounts the recipient paid for their Part D prescription co-pays.

+ How is Medically Necessary defined?

Per NYS SSL, Part 365-a “Medically necessary medical, dental and remedial care, services and supplies, as authorized in this title or the regulations of the department, which are necessary to prevent, diagnose, correct, or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with such person's capacity for normal activity, or threaten some significant handicap and which are furnished an eligible person in accordance with this title and the regulations of the department.”

+ Would the morning after pill be a medical expense that could be used to meet an excess?

Yes, whether the individual presents a script or purchases it over the counter, the cost can be applied toward a spenddown liability.

+ Is a script needed for Adult Diapers to be able to use towards an excess?

Yes, along with a note from the treating physician indicating medical need.

+ Are all over the counter medications considered "Medically Necessary"?

In general, over-the-counter medications can be considered medically necessary; unless the individual is presenting receipts for medicine that is much more than one individual could use safely and according to instructions on the label or directed by a physician.

+ Can someone utilize the Pay In program, and pay more than six months in advance?

The individual may elect to pay-in for periods of one to six months. When the pay-in period is longer than one month, the individual may pay the full excess income amount at the beginning of the period or they may pay in monthly installments.

Our interpretation is that an individual can pay-in for one or six months at a time and at the beginning of each period, they can pay in again for the prospective time period.

+ Who decides who gets the HIPP payment?

Generally, the policyholder should be the one receiving the HIPP payment (which is DOH preference). Occasionally the employer can be paid if they will accept payment.

+ If a client is paid bi-weekly, is it assumed that the premiums are also paid bi-weekly (and multiply by 2.16666)?

No, you should always verify with the employer how many premium deductions per year to determine the yearly premium and divide that by 12 months to get the monthly premium.

+ Is there a way to determine if a Medicare Part C is cost effective?

There is not a cost effectiveness test for Part C, a Buy-In determination must be done.

+ Does an address change entered in WMS automatically change the address in eMedNY?

It will update in eMedNY, but the payee address must be updated manually.

+ Does reimbursement go to the consumer or to the insurance company or to the employer?

For MIPP, only the consumer can be reimbursed. For HIPP, generally the policyholder would be reimbursed unless the employer will accept reimbursement and not charge the policyholder up front. Insurance provider can also be reimbursed, in rare cases.

+ Which tables are used to determine maximum periodic payments for married couples?

590b tables are always used for married couples.

+ In an SSI-R 04 budget; is a non-applying or ineligible spouse required to maximize a retirement account?

No, a non-applying or an ineligible spouse is not required to maximize his or her retirement account.

+ Can a small retirement fund be used as part of a resource allowance if in addition to other resources available the A/R would still be under the resource limit?

No, all retirement funds must be evaluated for penalty free periodic payments or principal even if the A/R is below the resource allowance.

+ How do we calculate what the maximum payments should be for an Annuity?

Maximum payments would be based on life expectancy using the current life expectancy tables.

+ What is considered an annuity transaction?

Any action by the individual that changes the course of payment from the annuity or that changes the treatment of income or principal of the annuity.

+ What was the ADM that closed a lot of loopholes for annuities?

The Deficit Reduction Act (DRA) of 2/8/06

+ What is a balloon payment?

Large lump sum payment scheduled at the end of a series of considerably smaller periodic payments.

+ Is there anything that can be changed or cancelled on an Irrevocable trust?

The beneficiary is the only thing that can be changed.

+ Can income from an Irrevocable trust be budgeted if the trustee has “discretion” to make income available?

No, only if the wording is “must or shall”.

+ Who establishes a pooled trust?

The individual, parent, grandparent, legal guardian of the individual or a court.

+ Can income contributions to an exception trust be excluded if individual is subject to chronic care post eligibility?

No income contribution to an exception trust cannot be excluded if individual is subject to chronic care post eligibility.

+ What is a bypass trust and its Medicaid implications?

A bypass trust is one that might be used for wealth planning by spouses to preserve an estate tax exemption. Regardless of the type of trust, the terms of any trust must be reviewed in accordance with Medicaid rules to determine if the provisions of the trust have an impact on Medicaid eligibility. Districts should contact their LDSS attorney or Local District Liaison for guidance with any specific questions or cases.

+ What happens when a disabled individual has a large SNT and now is back working and no longer is disabled and the SNT calls for early termination if no longer disabled?

A Medicaid beneficiary with an exception trust (a “special needs trust” or “supplemental needs trust”) who is no longer disabled as that term is defined under Section 1614(a)(3) of the Social Security Act is no longer entitled to have exception trust assets disregarded under Medicaid rules. If the terms of the trust call for the trust to be terminated should the individual no longer meet the required disability criteria, the payback requirement is triggered and the Medicaid program must first be repaid from the trust assets up to the amount of Medicaid paid before remaining trust assets are distributed under the termination. Districts are reminded to seek guidance from their LDSS attorney on such issues, and may also contact their Local District Liaison for guidance with specific cases - this response is not meant to direct an outcome in an actual case given full case details that the LDSS must review, which are not presented in the question here. It is also important to remember that many disabled individuals work and the fact that a certified disabled individual is working does not in and of itself render that individual no longer disabled as defined under Section 1614(a)(3) of the Social Security Act. In addition, Medicaid rules are applied uniformly regardless of the amount of assets in a trust.

+ If the only CIN assigned to a A/R originated from NYSOH, and no other CIN exist, can the LDSS then use that CIN, or should a new CIN be assigned by LDSS?

Yes, when there is only one CIN found even if it was only used in NYSOH the LDSS should use it.

+ Do the districts still use EEC codes P or I?

No, the EEC code M is the only one that should be used.

+ How long does the A/R have to select a plan when they move county to county before being auto enrolled?

Per the Luberto LCM from 2008 that states, “If a recipient advises the district of a move, in advance of his or her actual relocation, the district is responsible for providing coverage through the month of actual move and the following month.” Generally, though, the closing in the previous county should be the transaction month plus one day (so it begins the first day of the following month). The new county should be putting up the enrollment if the same plan is present, and no A/R selection is required. If the A/R does need to make a choice, however, the new county should do outreach. Oftentimes, the county relies on Maximus for this, but Maximus will not catch that a new enrollment is needed until the day there is no enrollment in the system, so it results in a gap in enrollment.

+ Should LDSS store income changes (updated budget) that would render children under 19 ineligible for coverage under CSD, or is the directive to not store budget changes for MAGI Adults, also pertain to children?

Income changes should be stored if rendering ineligible.

+ Are children’s waiver A/Rs exempt from managed care?

No, the only exempt waiver populations are OPWDD, TBI and NHTD. Children’s waiver is mandatory.

+ Does managed care cover respite care?

Respite care falls under hospice per Appendix K of the MMC Model Contract. MMC covers hospice for A/Rs that are already enrolled, but if the A/R is newly applying, then hospice would be an exclusion and they could not enroll.

+ How do self-employed business owners pay into Medicare?

Medicare is paid through taxes paid, FICA and Medicare. The only difference is, they pay the entire cost, not just the employee cost.

+ Can the districts use SOLQ for proof of income with MSP clients?

Effective April 1,2022, the State On Line Query (SOLQ), may be used to access Social Security Income information and Medicare eligibility information for purposes of determining eligibility for Medicare Savings (MSP) applications and renewals. Please continue to follow all SOLQ guidelines (attached) for accessing information for purposes of determing Medicaid or MSP eligibility.

+ Where does the end date for HC come from? E.g., the end date for the HIC number when switching to the MBI.

HC is still required for MBI, so it is left as open.

+ Does verification of property that has an impediment for selling need to be notarized? i.e., if the A/R has property with sisters, but sisters refuse to sell, is that verified through letter and does that letter need to be notarized?

No. Verification of the impediment should be in the form of a written letter/statement from the individual (s) who owns the property jointly with the Applicant/Recipient. The letter/statement does not require notarization. Districts are reminded to consult their LDSS attorney or Local District Liaison for guidance with any specific questions or cases on this subject.

+ Regardless of client request (client does not want a reimbursement) is a reimbursement processed?

If the payment is for HIPP, the client can refuse the reimbursement, however, if it is cost effective, they must enroll in the coverage. If the payment is for MIPP, the client must enroll in Medicare if eligible. If the client is eligible, the MIPP payment must be processed. The client can refuse to cash the check.

+ Does the notes tab have a limit on characters? And if so, what is the process if there isn’t enough space to complete a note

Yes, there is a limit to the notes, however in eMedNY if you right click on the notes it has historic records as to what was changed. If space is needed, simply delete from the oldest notes in the record (Not entire note, but enough to make room to add the new note) and then save and then the system should allow the entry of the additional notes.

+ If a client requests retroactive coverage and determined eligible at QMB level, is a MIPP processed for the retro period or denied

This answer would depend on the Category of eligibility prior to the QMB determination and if the person is fully Medicaid eligible. It also would depend on if they were eligible based on a spenddown. Therefore, this may be something that they would consult with DOH TPL if and when the situation arises.

+ A HIPP payment can be made directly to the insurance carrier, the client, the policyholder- if different than the client, the employer, another entity such as the client’s representative or even to a union. Why does DOH prefer the policyholder when it comes to creating a HIPP Payee?

The payee is determined based on who pays the premium and whether or not a carrier/employer/union will accept payment on behalf of the recipient. In most cases, these other entities will not accept payment directly from NYS.

+ Some MIPP lines are very aged. Is there a process for “cleaning” them up or removing them?

Currently we do not remove/archive any pay lines to our knowledge. This allows us to view and follow all MIPP payments made to a client. In researching information, the pay lines are often reviewed. As for answering if they are “cleaned” up, that still is not clear, but if the question is do we archive them on a scheduled basis, they are not currently archived.

+ Is Life Alert a bill type that is covered for Excess Income? Monthly premiums and/or installation?

The cost of life alert cannot be used towards a spenddown liability.

+ Are expenses for witch hazel and CBD products an acceptable medical expense? Or do they fall under herbal remedies?

Witch hazel products are considered herbal remedies. The cost of CBD Epidiolex is approved for treating rare forms of epilepsy.

+ If an air conditioner is prescribed by a physician is it an acceptable expense to use to meet a spenddown?

Air conditioners are not medical equipment, so the cost of such cannot be applied toward a spenddown liability.

+ In the reconciliation process, if a bill that is submitted for one month (ie: April) and would be used to grant coverage for that month (April), but the client does not utilize Medicaid services for APRIL…How is the client compensated for coverage for the un-paid bill in the reconciliation process? Is the answer the same for Paid Bills?

The reconciliation process is limited to the Pay-In Program. There is nothing to reconcile if an individual’s spenddown is met by applying paid or incurred bills.

+ Is the cost paid for liners for a sleep apnea machine an allowable expense to use to meet a Spenddown or does this fall under "filters for any equipment" definition and is therefore not an allowable expense?

The liners would be considered a filter and cannot be applied toward a spenddown liability.

+ Will each person listed get an enrollment confirmation email and instructions?

Yes. Once enrolled, each trainee will receive an auto generated e-mail from our Learning Management System, Absorb informing them that they have been enrolled into Presumptive Eligibility – Family Planning Benefits Program (FPBP) training. This e-mail will come from “noreply@myabsorb.com.” Please be sure to have you employees check their spam or junk folder if they do not receive the e-mail.

+ Once enrolled in the training, how long will learners have to complete it?

All trainees will have 30 days to complete this training from the date that they are enrolled, this includes both holidays and weekends. For example, if a trainee is enrolled into the training today, then their expiration date would be 30 days from today.

+ How do we know if our staff has completed this training? Will we be notified?

Each trainee will receive a course completion e-mail from Absorb and a Certificate of Completion (from their Absorb dashboard under “Transcript”) once they have completed the training. Supervisors will not be notified once a learner has completed the training, but learners can forward this email and/or certificate to their supervisor.