Systems Help: UpdatedPS2 Instructions – Section D (Medical Services)

Last Updated

The following are descriptions/ instructions of each Section D (Medical Services) field in IMS:

Notebook TAB FIELD PS-2 Block Instructions
ELIG Medical General Application Date D1 Pre-Entered by computer when PS-1B, Case Number Assignment is used. In all other instances, enter date of application for medical services.
ELIG Medical General Certification / Disposition Date. D2 Enter the effective date of eligibility for medical services. For ABD-related, certification may be retroactive for any qualifying medical services provided three months prior to the month of application. For Qualified Medicare Beneficiaries (QMB) without a State Supplemental Payment, the client must be added for the buy-in benefit effective the month following the month in which eligibility was determined.

NOTE: This is the date you have determined the medical eligibility starts. It should be the first day of the month of application unless they were not eligible that month.
ELIG Medical General Type Action Taken. D3 Enter the appropriate code for action taken on medical services cases. This must be completed each time new information is submitted for Section D.

  • 1 = Certified
  • 2 = Denied
  • 4 = Suspended
  • 5 = Reinstated
  • 6 = Closed
  • A = Application
  • C = Any change of information which does not affect section status
  • R = Reopened

NOTE: A case must be in closed, denied or application status for a certification to be entered. If the case is in Suspended status, and the client has corrected the reason for the suspension, the reinstated code is used. The Reopened code only works on cases that have been closed.
ELIG Medical General Reason. D4 Enter the appropriate disposition code as shown on Appendix R and U. This may be updated but is not to be deleted. A reason code is required for actions 1, 2, 6, and R.

Appendix R

Appendix U

NOTE: Reason codes are required for all certifications, reopens, denials and closures.
ELIG Medical General Effective Date. D5 The computer determines and enters the effective date using information from Blocks D1, D2, D3, D4, D9, benefits data base, and Appendix B-2 (08AX002E) for all actions except: closures due to death.  For “M” prefix cases, the effective date must be input for change actions as well.  When a case is closed due to death, the worker must enter the actual date of death. If a mistake is made in the date of death, the county may correct this using county office override on the appropriate edit. For a certification following an appeal or to correct an administrative error, the effective date is the first month for which benefits are to be paid and may be a retroactive date.
ELIG Medical General Effective Months D6 This is used for long-term care cases at certification or reopening to show that income or medical expense information needs to be updated for the next vendor payment to be correct. The computer enters code 99 unless the worker enters one of the following codes:

  • 1 = Compute one month’s vendor payment using this information
  • 2 = Compute two months’ vendor payment using this information
  • 3 = Compute three months’ vendor payment using this information
  • 99 = Compute vendor payment using this information indefinitely

Once a code other than 99 is on file, this must be entered with the appropriate code (1, 2, 3 or 99) on the next Section D or F update.
ELIG Medical General Certification Period D7 Enter the period of medical eligibility.

  • Long-Term Care (Nursing Home, ADvantage Waiver, State Plan Personal Care)- 12 months
  • Health Benefits – Categorically Needy – ABD Related – 12 months
  • Health Benefits – Categorically Needy – AFDC Related (ineligible for SoonerCare Online Enrollment) – 98 months
  • DHS Legal Custody with placement outside own home or child(ren) receiving an adoption subsidy –  99 months
  • Qualified Medicare Beneficiary Plus (QMB+) – 12 months
  • Qualified Disabled Working Individual (QDWI) – 12 months
  • Qualified Individual – Group I (QI-1s)  – 12 months
  • Phenylketonuria Child (PKU) – 1 thru 12 months
  • Refugee Medical Assistance (RMA) – 1 thru 08 months
  • Specified Low Income Medicare – 12 month
  • Optional TB coverage group – 12 months
ELIG Medical General Child Support Indicator D8 This is used only for cases where an individual is deprived of parental support (Section I is being completed). Enter a code to show whether the recipient wants full Child Support Services.

  • N = Medical Only Child Support Services Requested
  • Y = Full Child Support Services Requested
  • X = No Child Support Services Requested
ELIG Medical General Notice Indicator D9 After first deadline through second deadline, enter code to show whether advance adverse action notice is required for change being made or closure of benefits.

  • N = Advance Notice Not Required
  • Y = Advance Notice Required

NOTE:  Once entered, information can be changed, but not deleted, by the user. Advance notice is required on all negatives actions. If advance notice is not required you will not need to send this field.
ELIG Medical General Date of Last Redetermination D10 Enter the date for which eligibility was last re-determined.

  • For a Medical Benefit Reporter – if there are food benefits this will be either:
    • The food benefit Certification Date (If the current date is within the first six months of the food benefit Certification Period)
    • The food benefit Certification Date + 06 months (If the current date is in the second six months of the food benefit certification period)
  • For a non-reporter or a medical reporter without food benefits, this date will be the month for which eligibility is being reviewed:
    • For certifications this is the cert date
    • For reviews this is usually the next effective month
ELIG Medical Financial Source of Application D12 Enter the code to indicate the source of the application. Codes are:

  • CD = Department of Corrections
  • CH = Head Start
    Co = County Office
  • HT = Other Health Department – TB Only
  • LV = OKDHS Live!
  • MS = Muskogee Public Schools
  • PC = Private Contractors
  • TT = American Indian Tribe Administering TANF
  • XT = Oklahoma City/County Health Department – TB Only
  • ZT = Tulsa City/County Health Department – TB Only

OBSOLETE CODES:

  • CK = Covering Kids
  • DA = Disaster Relief – Alabama
  • DL = Disaster Relief – Louisiana
  • DM = Disaster Relief – Mississippi
  • HP = Other Health Department – Presumptive Eligibility
  • HS = Other Health Department – Short Term Medical
  • XP = Oklahoma City/County Health Department – Presumptive Eligibility
  • XS = Oklahoma City/County Health Department – Short Term Medical
  • ZP = Tulsa City/County Health Department – Presumptive Eligibility
  • ZS = Tulsa City / County Health Department – Short Term Medical

NOTE: If the Medical application is received through OKDHSLive!, the system will set this field to “OKDHSLive!” (LV).
ELIG Medical Financial Number of Persons – Child(ren) D16 The computer enters number of children included in this benefit or whose income/resources are considered in determining eligibility for others.
ELIG Medical General Number of Persons – Adults D17 The computer enters number of adults included in this benefit or whose income/resources are considered in determining eligibility for others.
ELIG Medical General Medical Evaluation Date. D26 Enter date of next medical evaluation as indicated on MDL File. If the Level of Care Evaluation Unit (LOCEU) does not specifically request further action regarding this medical evaluation, enter “9999”. If the client’s medical eligibility was based on SSA or SSI disability or blindness, enter “9999”.

NOTE: To look at the MDL file, go to IMS, type MDL (space) Case Number and press enter. To look at the individual entries, type MHI before the entry and press enter.
********* ********* Resource Transfer Begin Date. D30 Reserved for future use.
********* ********* Uncompensated Resource Value. D31 Reserved for future use.
ELIG Medical Financial Self-Employment Income. D32 Computer will enter total amount of income for all sources of self-employment.
ELIG Medical Financial Business Expense D33 Computer will enter total amount of self-employment business expense.
ELIG Medical Financial Earned Income D35 Computer will enter total amount of all gross earned income for this case. (Exclude self-employment income).
ELIG Medical Financial Work-Related Expense. D38 Computer will enter total amount of allowable work related expenses.
***** ***** Dependent Care Expense. D41 09/19/02 Note:
This field cannot be updated in FACS.  It should calculate from the total amounts in the Household Member’s Dependent Care Expense (F76).  That function is not currently working so the field must be updated through the ‘FF’ screen within FACS.
ELIG Medical Financial Net Earned Income. D44 Computer will enter the total amount of net earned income for this case.
ELIG Medical Financial Unearned Income. D47 Computer will enter the total amount of gross unearned income for this case.
ELIG Medical Financial General Income Exclusion. D50 Computer will enter the total general income exclusion for this case for individuals categorically related to ABD and not approved for nursing care.
******** ******** D53 Reserved for Future Use.
ELIG Medical Financial Total Diverted. D54 Computer will enter the total amount of diverted income for this case.
ELIG Medical Financial Total Net Income. D56 Computer will enter the total amount of net income.
ELIG Medical Financial Total Countable Resources. D59 Computer will enter the total amount of countable equity for this case.
ELIG Medical Financial Medical Application Reason. D60 Enter the appropriate reason for this medical application.

  • A = ADvantage Waiver
  • B = Breast / Cervical Cancer
  • C = Personal Care (no disability determination required – already eligible for SSP, QMBP or in Online Enrollment)
  • D = Disability to be established by SSA or TEFRA
  • E = Personal Care (Disability to be established by SSA) (obsolete)
  • F = SSP or disability has already been established by SSA
  • H = Home and Community Based Wavered Services for DDSD cases
  • K = Custody Case
  • L = SLMB only
  • N = Nursing Care
  • P = Pregnancy Related Services
  • Q = QMB Plus only
  • S = Medical benefits not otherwise listed (such as OHCA Online Enrollment)
  • T = Optional TB Coverage Only
  • V = DDSD case
  • W = Short Term, Simplified (SC-1) (obsolete)
  • X = Qualifying Individuals Group I (QI-1S)
  • Y = Family Planning Waiver (FPW)

NOTE: The processing deadline and timeliness count are set by the type of application listed in this field.

SHORT-TERM CARE

ELIG Medical Financial Spenddown Computation Period. D61 System entered as ‘01’.
NOTE: This is required for medical card issuance for cases coded (CN) in F190, Categorical Relationship
ELIG Medical Financial Standard (MN Only). D62 Enter the medical assistance standard for the spenddown computation period. (This is the monthly standard amounts added together for the period covered.) (Obsolete)
ELIG Medical Financial Total Unencumbered Income (MN Only). D65 Computer entered. This entry will be determined based on applicable program policy, net income, and the Medical Assistance Maintenance Standard from Schedule II.A on DHS Appendix C-1. (Obsolete)
ELIG Medical Financial Total Medical Expense (MN Only). D68 Enter the total medical expense for short-term care cases. (Obsolete)
ELIG Medical Financial Total Amount to Vendor Paid by Client. D71 Enter the amount of excess income to be paid to the vendor.

NURSING HOME CARE AND ALTERNATIVE SERVICES

ELIG Medical General Family Size. D79 For Medically Needy Personal Care Cases enter the number of persons in the family for whom the Own Home Maintenance Standard is based. Entry is unnecessary for any other individuals.

NOTE: This field is not currently in use as the Medically Needy program has been discontinued until further notice.
ELIG Medical General OH Standard Indicator. D80 For Medically needy Personal Care cases , enter “H” if there are spouses in separate cases and both are receiving Personal Care

NOTE: This field is not currently in use as the Medically Needy program has been discontinued until further notice.
ELIG Medical Financial Own Home Standard D81 Computer will enter the standard amount from Appendix C-1 when applicable.
****** ********* Medicare Premium Amount D83 Reserved for future use.
ELIG Medical Financial Monthly Medical Expense D84 Enter the verified monthly medical expense for the nursing home, Personal Care or waivered services individual.
ELIG Medical Financial NH Monthly Vendor Payment. D86 Computer will enter the monthly nursing home or assisted living center vendor payment for this case.
ELIG Medical Financial NTMC Monthly Vendor Payment (MN Only). D87 Computer will enter the monthly Personal Care vendor payment for this case. (Obsolete)
ELIG Medical Financial Waivered Services Vendor Payment D88 Computer will enter the monthly waivered services vendor payment.

CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN)

ELIG Medical Financial CHSCN Total Income. D92 Computer will enter the amount of CSHCN total income for this case.
******* ******* Percentage of Federal Poverty Guidelines D95 Computer will enter the percent of the federal poverty guideline that the net income on this represents.
******* ******* Benefit Review/Renewal Action D135 Enter the appropriate code for the action taken on the Benefit Review/Renewal:

  • C = Complete.
  • F = Paper app received – Not yet reviewed.
  • I = Incomplete or referred to Tier 2 Worker.
  • P = All information provided – Processing center has received all information needed for review and referred to Tier 2 Worker.
  • V = More verification required – Processing staff has requested more information.
  • X = Review/renewal submitted on OKDHS Live!, not yet reviewed by processing center.
******* ******* Benefit Report Date D136 Enter the date the Benefit Review Report (FSS-BR-1) was received in the county office.
ELIG Medical Financial Benefit Report Status D137 Computer Generated Field – the computer will set the Benefit Review Report Status based on the case record

  • A = Annual Reporter
  • S = Semi-Annual Reporter
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