County ofSan Diego Health and Human Services Agency HHSAGeneral Relief Program Guide GRPG Number Page County Medical Services CMS 902507 1 of4 Revision Date December 1 2021 A Background This section provides information regarding the County Medical Services CMS Program as it relates to the General Relief GR Program Purpose This section has been updated to remove the requirement for the 11119 HHSA Medical Services Screening Sheet and reflect updated CMS guidance B Policy CMS and CMS Hardship are programs of last resort for San Diego Countys indigent adults An Adult requesting CMS or CMS Hardship must not have eligibility to any other health care program CMS only covers certain medical services and is not considered health insurance CMS does not pay insurance premiums deductibles or copayments CMS does not meet the Minimum Essential Coverage MEC required by the Affordable Care Act ACA CMS is the Countys safety net program covering adults who are NOT Determined linked to MediCal eligibility Enrolled in MediCal Enrolled in Medicare Enrolled in a Covered California Health Care Plan or in any health care plan that meets the MEC requirement under ACA San Diego County does not provide direct services Services are provided by primary care clinics local hospitals and physicians that contract with San Diego County to provide medical care C Initial Screening During initial screening ask the applicant if they have a Social Security or Supplemental Security Income SSI application or appeal that is pending a determination and if they have applied for MediCal Check the MediCal and SSI appeal information using CalWIN and the MediCal Eligibility Data System MEDS After verifying refer to MediCal if potentially eligible See CMSPG 090201C MediCal Pending AP for more information D CMS Benefit Card The CMS identification card is attached to the bottom of the Notice of Action NOA with a perforated seam and will be automatically mailed to the customer The certification period will no longer be printed on the card but will be stated on the NOA The customers CMS member number and Primary Care Clinic PCC site selection is printed on the CMS card Homeless Customers CMS Benefit Card The CMS system AuthMed will not automatically mail the benefit card to a homeless customer Once final approval action is taken an electronic version of the NOA and CMS card will be available in the AuthMed The Human Services Specialist HSS will be able to print the County ofSan Diego Health and Human Services Agency HHSAGeneral Relief Program Guide GRPG Number Page County Medical Services CMS 902507 2 of4 NOA and CMS card for the applicant upon request The CMS identification card is attached to the bottom of the NOA E Replacement CMS Card If a GR recipient contacts and requests a replacement for a lost or stolen CMS card take the action in the table below Step Action 1 Clear AuthMed to locate the NOA that was created when CMS was certified 2 Reprint the NOA with the CMS card 3 Give the replacement card to the customer F CMS Patient Handbooks The CMS Patient Handbooks are available in English and Spanish and are provided to all individuals approved for CMS benefits AuthMed automatically mails the CMS Patient Handbook to all beneficiaries except homeless individuals The HSS will provide homeless beneficiaries with the CMS Patient Handbook The handbook is available on San Diego Countys CMS website httpswwwsandiegocountygovhhsaprogramssspcountymedicalservicesindexhtml They may also be ordered from the Administrative Services Organization ASO The handbook provides Information on how to access care through the CMS Program Lists the CMS scope of services and contracted clinics hospitals and pharmacies Information about how to resolve problems and file complaints and appeals G CMS Certification Periods CMS has two standards for certification standard 6 months and chronic 12 months For more information see CMSPG 0801 HCMS Grant of Lien and Reimbursement Agreement Requirement As a condition of eligibility all CMS applicants are required to complete and sign the CMS Lien information form CMS123 and CMS Grant of Lien form CMS122 naming the County of San Diego as grantee to secure all real estate property of the applicant as security for repayment of all claims paid by CMS on their behalf The lien will be filed against any real property that is currently owned or real property that may be acquired in the future However the applicant does not need to sell their current principal residence to qualify Refer to CMS Program Guide CMSPG 0606 for additional information regarding liens Liens are not initiated until the customer is no longer active on CMS and CMS has paid claims of 5000 or more on the customers behalf Reimbursement Agreement Effective with applications dated on or after 712008 as a condition of eligibility CMS Hardship applicants are required to sign the CMS Reimbursement Agreement form CMS106 This repayment document requires the CMS applicant to reimburse San Diego County via the Office of Revenue County ofSan Diego Health and Human Services Agency HHSAGeneral Relief Program Guide GRPG Number Page County Medical Services CMS 902507 3 of4 Recovery ORR for CMS services provided Refer to CMSPG 0607 for additional information regarding repayment requirements and procedures I Completing the Lien Clear AuthMed and CalWIN Electronic Records Management System CERMS to see if a completed lien is on file If the recordable lien is Then On file Do not complete a new Lien Not on file Complete a new Lien See the CMS Processing Guide 02 and 02b Completion of Grant Lien Form for instructions on completing the form J Failure to Complete the LienReimbursement Agreement If the customer fails to sign the CMS Lien and the Reimbursement of Agreement if applicable then CMS eligibility will be denied GR eligibility will not be affected Continue to count the 40 Medical Expense InKind Income against the GR grant KQuestions and Answers Upon approval give the CMS112 Questions and Answers to the GR recipient The CMS112 provides additional information about the CMS program Share of Cost SOCReimbursement AgreementLiens requirements L Selecting a PCC Upon approval the HSS asks the beneficiary to pick one of the PCCs that contract with CMS as a medical home The HSS enters the PCC site in the AuthMed which will be transferred to the CMS card and mailed to the beneficiary See CMSPG 0208 for additional information on clinic assignment M Changing PCCs When beneficiaries are dissatisfied with their primary care clinic they must call the CMS Patient Information Line 800 5878118 The ASO will evaluate what is causing the dissatisfaction and will inform the HSS to change the clinic in AuthMed if appropriate Homeless customers canwalk into a CMSFamilyResource Center FRClocation to request a change N Reserved for Future Use O CMS Recertification Recertification is a determination that a beneficiary continues to meet the CMS eligibility criteria and has not had a break in aid of more than one month Recertification information shall be recorded in case comments CMS has two standards for recertification standard and chronic See CMSPG 0803 for additional information on CMS Recertifications P Reserved for Future Use County of San Diego Health and Human Services Agency HHSAGeneral Relief Program Guide GRPG County Medical Services CMS Number Page 902507 4 of 4 Q CMS Discontinuances When a GR case closes prior to the GR eligibility period ending CMS eligibility continues until the end of the certification period unless the reason for the GR case discontinuing is one of the reasons listed in CMSPG 150101A Procedure Follow the actions in the policies above to evaluate CMS eligibility for GR customers Other Program Impacts None References County Policy Sunset Date This policy will be reviewed for continuance by November 30 2024 Approval for Release Rick Wanne Director SelfSufficiency Services