Alcohol and Drug Related Programs

Alcohol and Drug Related Programs - DETOX

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Alcohol and Drug Related Programs - DETOX

Revised April 25, 2008

Purpose:

DETOX is one of the special programs for which ACES issues benefits but does not determine eligibility. Benefits, in this case, are payments to hospitals in counties that do not have a direct DETOX contract with the Division of Alcohol and Substance Abuse (DASA). See EAZ Manual - Chemical Dependency - B. - Detoxification Services.
The user must determine eligibility for DETOX before the case is entered into ACES. ACES issues benefits for DETOX after the user has determined program eligibility.

The SPEC is used to enter and confirm eligibility results. This screen is used rather than confirming the system determined eligibility results on the ELIG, CAFI, FSFI, or MAFI.

To open a DETOX AU after determining eligibility:

On the AMEN enter Option [J] - Screening - for a new application, or Option [L] - Add-A-Program if the client is already active in another AU. See Screening and Add-A-Program.

Select [Medical Assistance] by entering a [Y] in the field to the left of the assistance type, on the KIND.

Press <TRANSMIT> and process the case through the Screening process until you get to the INCH.

Since DETOX is a program that does not display on the INCH automatically, enter [Y] in the IND COLUMN field and the valid values for the DETOX medical program in the following fields:

Program field = [MA]

Type field = [I]

Medical Cvrg Grp field = [W03]

Appl Date field = Date client entered DETOX

Complete the interview and process the AU through Option [P] - Process Application Months - and Option [Q] - Finalize Application. See Process Application Month and Finalize Application.

In Finalize Application, a SPEC, instead of CAFI or MAFI, displays the financial eligibility results. There is one SPEC for each month of application through the ongoing month. If eligible, enter [Y] in the Confirm field in the application month.

The application month will be active and ACES denies the ongoing month with Reason Code 243 - DETOX AUTO CLOSURE. The user is responsible for determining eligibility for any other pending month. Enter Reason Code [543] - DETOX FW CLOSURE - in the AU Stat Reasons field on the STAT for all ineligible months.

Confirm the denial for these months and finalize the application.

The begin date that displays on the SPEC is always the first day of the application month.

The system - generated notice will be wrong unless the date of application happens to be the first of the month. The user may have to override the notice, and send an ACES Letter A02M, Notice of Approval For Medical Benefits - Non - Long Term Care Medically Needy / Medically Indigent / No Medicare Cost Sharing, to the hospital. See Letters.

Alcohol and Drug Related Programs - DETOX
Revised April 25, 2008

Purpose:
DETOX is one of the special programs for which ACES issues benefits but does not determine eligibility. Benefits, in this case, are payments to hospitals in counties that do not have a direct DETOX contract with the Division of Alcohol and Substance Abuse (DASA). See EAZ Manual - Chemical Dependency - B. - Detoxification Services. The user must determine eligibility for DETOX before the case is entered into ACES. ACES issues benefits for DETOX after the user has determined program eligibility. The SPEC is used to enter and confirm eligibility results. This screen is used rather than confirming the system determined eligibility results on the ELIG, CAFI, FSFI, or MAFI.
To open a DETOX AU after determining eligibility: On the AMEN enter Option [`J`] - Screening - for a new application, or Option [`L`] - Add-A-Program if the client is already active in another AU. See Screening and Add-A-Program. Select [`Medical Assistance`] by entering a [`Y`] in the field to the left of the assistance type, on the KIND. Press <`TRANSMIT`> and process the case through the Screening process until you get to the INCH. Since DETOX is a program that does not display on the INCH automatically, enter [`Y`] in the `IND COLUMN` field and the valid values for the DETOX medical program in the following fields: `Program` field = [`MA`] `Type` field = [`I`] `Medical Cvrg Grp` field = [`W03`] `Appl Date` field = Date client entered DETOX Complete the interview and process the AU through Option [`P`] - Process Application Months - and Option [`Q`] - Finalize Application. See Process Application Month and Finalize Application. In Finalize Application, a SPEC, instead of CAFI or MAFI, displays the financial eligibility results. There is one SPEC for each month of application through the ongoing month. If eligible, enter [`Y`] in the `Confirm` field in the application month. The application month will be active and ACES denies the ongoing month with Reason Code `243` - DETOX AUTO CLOSURE. The user is responsible for determining eligibility for any other pending month. Enter Reason Code [`543`] - DETOX FW CLOSURE - in the `AU Stat Reasons` field on the STAT for all ineligible months. Confirm the denial for these months and finalize the application. The begin date that displays on the SPEC is always the first day of the application month. The system - generated notice will be wrong unless the date of application happens to be the first of the month. The user may have to override the notice, and send an ACES Letter A02M, Notice of Approval For Medical Benefits - Non - Long Term Care Medically Needy / Medically Indigent / No Medicare Cost Sharing, to the hospital. See Letters.