The Centers for Medicaid and Medicare (CMS) recently completed an audit of ABD-Related benefits. (both Short Term and Long Term) Federal and state policy requires that these benefits be reviewed every 12 months or less but many case reviews took longer than that. If our error rate exceeds 3%, CMS can require us to focus on particular types of cases in future audits and/or increase how many reviews we complete. To avoid this and other actions by CMS, staff should follow these best practices.

• Reviews must be completed within 12 months of the date in D.10/B.7
  • If the client does not provide everything needed to complete the review; the case needs to be closed effective the end of the 12th month. Example: The review date in D.10 is 01/2021 . The annual review must be completed in 12/2020. If the review is not completed by negative action deadline in December, the case is closed.
  • Do not change the D.10/B.7 date without completing a review of the ABD-related programs except for very limited reasons such as the establishment of a MIPT. The date change can cause a case to be reviewed in less than 12 months but never more than 12 months.
• When an application or review is submitted through OKDHSLive, it should display on the CWA as Report (20) OKDHS LIVE! Mid-Certification Renewal Initiated.
  • Send a request for verification of resources if needed
• Policy does say programs should be synchronized so clients do not fill out several reviews or applications throughout the year

NOTE: Never change the D.10/B.7 date without completing a review of the ABD-Related programs.