Article 13 Section 04 Changes to Share Of Cost SOC
Table of Contents
TITLE PG CITE
General 130401A
SOC Increases 130402
Changes Reported in a Timely Manner 130402A
Changes Not Reported in a Timely Manner 130402B
Changes Reported Before The 15th 130402C
Changes Reported After The 15th 130402D
SOC Decrease 130403
Change Reported Within 30 Calendar Days 130403A
Change Not Reported Within 30 Calendar Days 130403B
Married Couples With A SOC 130404
Both Spouses are on CMS with a SOC 130404A
One Spouse on CMS with a SOC and the Other Spouse on MediCal with SOC 130404B
SOC Verifications Not Received 130404C
130401 Changes to SOC
130401A Changes in income may require an adjustment to the monthly General SOC The SOC may need to be increased or decreased according to income level
130402 SOC Increase
130402A When a change in income or other circumstances which results Change in an increase in the shareofcost is reported timely Refer to Reported In A 0201 by the beneficiary the worker shall change the shareof
Timely
cost either in a future month or immediately
Manner
Future Recomputation
can be given month following the month that the change was reported
cannot be given second month following the month in which the change was reported
130402B Change Not Reported In A Timely Manner
Immediate Recomputation If the increase is due to the voluntary inclusion of a family member who has income which results in a SOC increase for the household the households SOC cannot be increased without timely notice of action
The worker will recompute the SOC immediately and follow the appropriate steps detailed below
a If the individual being added to the case will be included in the MFBU with other household members the individual will receive benefits through a separate FBU for the first month of aid or until a 10 day notice can be given to increase the households SOC When timely notice can be given the individual will be discontinued from hisher separate FBU and added to the households MFBU
b If the individual being added to the case will be in a
separate FBU from other household members the
individual will receive benefits through that FBU with the
recomputed SOC
c Issue a NOA approving benefits for the newly added family member with the correct SOC for that individual Issue a second NOA effective the first of the following month indicating the increased SOC for the entire MFBU as long as timely notice can be given
When a change in income or other circumstances which results in an increased SOC is not reported timely the worker will
Increase the SOC in the month following the month in which the change was reported or the first of the second month following the month in which the change was reported if 10day notice cannot be given and
Evaluate for a potential overpayment Refer to 1104 beginning the month following the month the change should have been reported
130402C When a change in income or other circumstances is reported Change before the 15th of the month which results in an increase to the
Reported SOC the worker will follow the actions in the table below Before the 15th
Step Action
1 Request all verifications needed to accurately calculate the change by sending the CMS34 Informing Letter
2 Recompute the CMS budget and the CMS Hardship budget once all verifications are received
3 Increase the SOC effective the following month that the change was reported and send the CMS39S NOA notifying the individual of the change This NOA is part of the case record
4 Notify the ASO of the SOC change via CMS4 Registration Information form The CMS4 must include the new SOC amount and the effective date The CMS4 is part of the case record
5 Note in the comment section of the CMS4 the new SOC amount and the effective date
MPG Letter 662 209
130402D When a change in income or other circumstances is reported
Change after the 15th of the month which results in an increase to the
Reported After the 15th SOC the worker will follow the actions in the table below
Step Action
1 Request all verifications needed to accurately calculate the change by sending the CMS34
2 Recompute the CMS budget and the CMS Hardship budget when all verifications are received
3 Increase the SOC effective the second month following the month in which the change was reported and send the CMS39S NOA notifying the individual of the change This NOA is part of the case record
4 Notify the ASO of the SOC change via CMS4 form The CMS4 must include the new SOC amount and the effective date The CMS4 is part of the case record
5 Note in the comment section of the CMS4 the new SOC amount and the effective date
130403 SOC Decrease
130403A Change Reported Within 30 Calendar Days
When a change in income or other circumstances is reported which results in a decrease to the SOC and the change was reported within 30 calendar days of the change the worker will follow the actions in the table below and change the SOC as follows
Step Action
1 Request all verifications needed to accurately calculate the change by sending the CMS34
2 Recompute the CMS budget and the CMS Hardship budget when all verifications are received
3 Decrease the SOC for the month that the change has occurred and send the CMS39S NOA notifying the individual of the change This NOA is part of the case record
4 Notify the ASO of the SOC change via CMS4 form The CMS4 must include the new SOC amount and the effective date The CMS4 is part of the case record
5 Note in the comment section of the CMS4 the new SOC amount and the effective date
130403B If the change is not reported within 30 calendar days of the
Change Not change the worker will follow the actions in the table below Reported Within 30 Calendar Days
Step Action
1 Request all verifications needed to accurately calculate the change by sending the CMS34
2 Recompute the CMS budget and the CMS Hardship budget when all verifications are received
3 Decrease the SOC for the month following the month in which the change was reported and send the CMS39S NOA notifying the individual of the change This NOA is part of the case record
4 Do not change the SOC amount for the month reported unless the beneficiary had good cause for failure to report within 30 calendar days of the change
5 Notify ASO of change via CMS4 form The CMS4 must include the new SOC amount and the effective date The CMS4 is part of the case record
6 Note in the comment section of the CMS4 the reason for not changing the SOC in the current month and
NOTE Changes to the budget which cause a decrease to the monthly SOC will change the SOC in the current month if the change is reported with 30 calendar days of the change The worker must send the CMS39S NOA notifying the individual of the change
130404 Married Couples with a SOC
130404A Both spouses must read and sign the SOC Process
Both Spouses Information Sheet CMS111 which informs them of their on CMS with a
SOC payment responsibilities SOC The SOC amount shall be applied to the couple
The worker must take the following steps to link and apply the SOC amount to the married couple in IDX
Step Action
1 Complete CMS4 form and state the SOC amount for the CFBU Note on the comment Line that this is a married couple with a SOC and both spouses Social security Numbers EXAMPLE Married couple both on CMS wSOC Identified SSN xxxxxxxxx and SSN xxxxxxxxx
2 Scan the CMS4 form into both spouses case records in the CMS IT System
3 Send the completed CMS4 to the ASO at MS 0557B
130404B One Spouse on CMS with a SOC the other on MediCal with SOC
Both spouses must read and sign the CMS111 which informs them of their SOC payment responsibilities and gives the County authorization to add the MediCal spouses information to IDX for billing if needed
The entire CMS SOC amount shall be applied to the CMS spouse
The CMS individual shall be advised that monies spent to meet the MediCal spouses SOC may be applied to reduce the CMS SOC amount using CMS rates as long as the services are within CMS scope of services
It is the CMS patients responsibility to provide the County ASO with an itemized statement and proof of the amount
130404C SOC Verification Not Received
paid towards the MC SOC amount along with their CMS SOC
payment statement
The ASO has been instructed to forward all statements received for the MediCal SOC payments to HCPA HCPA will
o Review MEDS for verification of that the MediCal SOC
has been met and
oSend the statement back to ASO for processing
The worker must take the following steps to identify that this is a married couple one on CMS with a SOC and the other on MediCal with a SOC in order for the paid MediCal SOC amount to be applied to the CMS spouse in IDX
Step Action
1 Verify that the CMS111 has been signed by the applicant and the spouse
2 Complete CMS4 form and state the SOC amount for the CFBU Note on the comment Line Married couple with a CMS and MediCal SOC EXAMPLE Married couple wCMS MediCal SOC identified Spouse on MediCal
3 The CMS4 is part of the case record
4 Send the completed CMS4 to the ASO at mail stop 0557B
When verifications are not received within the first 10 days the worker sends another CMS34 giving the beneficiary an additional 10 days to comply If the verifications are not received after the extended 10 days there are no changes to the CMS budget The worker must note in case comments no verifications received no changes made and the SOC remains the same
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