Authorize a one-month only eligibility period for community or long term care spenddown cases when monthly spenddown is met. This may be done:
Do not authorize a one-month only eligibility period if:
NOTE: Send a Request for Correction/Addition to MMIS Medical Eligibility File (Form 2958) to the Exception Processing Unit in Springfield to request backdating (see WAG 17-02-05-a).
NOTE: If code 97 is entered in Item 33, the day entered here must be the first day of the month.
When code 97 is used, the action may be transmitted beginning with the day after the terminal entry cut-off date for the current month.
When code 95 is used, MMIS shows 2 split bill days. A Split Billing Transmittal (Form 2432) is required for payment of any bills incurred on either split bill day. No split bill is needed if code 97 is used. If a code 96 was previously submitted for the same month, only the code 97 shows in MMIS. A split bill is not required for any services incurred during the month.
If the client thinks they will have a medical need before MMIS is updated, update the Interim Recipient Data Base (IRDB), see WAG 22-08-18. A Form 552 is not produced. To confirm that medical eligibility is updated, access the ACID clearance in BlueZone. If the action has been completed, the last day, month, and year of the period authorized appears following "ID EXP DATE". This entry always shows the last day of the last medical eligibility period approved by the FCRC or Pay-in Unit. The action shows on the Mercury payroll.
NOTE: To provide medical coverage to a canceled case in unmet spenddown status from the date spenddown is met through the remainder of the enrollment period, see WAG 18-05-14.
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
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