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psychiatric indigent inpatient program (pii)

Revised March 10, 2008

What is PII? Who is eligible for PII? How long is the certification period for PII? How do I screen in a PII AU? How do I process a PII AU? How do I authorize a PII spenddown? How do I input medical bills to meet PII EMER and spenddown? Do I need to list the bills used to meet the PII EMER and spenddown on the approval letter? Does PII issue MAIDs? How do I process Involuntary Treatment Act (ITA) clients?

What is PII? The Psychiatric Indigent Inpatient (PII) Program became effective July 1, 2003 to provide emergent medical care to indigent individuals who voluntarily admitted themselves for inpatient psychiatric treatment with Regional Support Network (RSN) approval. See E-Z Manual - WAC 388-865-0217 Psychiatric Indigent Inpatient Program - for more information about the PII program. Who is eligible for PII? See E-Z Manual - WAC 388-865-0217 Psychiatric Indigent Inpatient Program - for more information about the PII program. How long is the certification period for PII? PII AUs will have a 3-month certification with an additional $2000 EMER. An approval for PII where the client has received PII in the last 12 months and has an exception to rule will not have an additional $2000 EMER. See E-Z Manual - WAC 388-865-0217 Psychiatric Indigent Inpatient Program for more information about PII certification periods. How do I screen in a PII AU? To screen a PII AU, take the following steps: From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window. In the Applicant page, enter the applicant's information and continue with the screening process until you reach the Programs page. From the Programs page select Medical then click Next. Continue the screening process until you get to the Finalize page. For an adult applicant under age 65 without a dependent child, the system will default to SSI Related Categorically Needy - Disabled (S02 D). If your applicant is not under age 65 without a dependent child you will need to select the PII program by clicking on the Specify Program button. From the Program drop down menu select Medical Assistance (MA). From the Medical Coverage Group drop down menu, select Psychiatric Indigent Inpatient (PII) then click Next. You will then be back at the Finalize page where the Psychiatric Indigent Inpatient (PII) program will have a green check mark next to it. Enter the date of application in the Application Date field which should be the same as the applicant's admittance date to the psychiatric inpatient facility then click Commit. From the Commit Status page, click the Exit Screening button. How do I process a PII AU? To process a pending PII AU take the following steps: From the AMEN, access the pending AU via Option O - Interview. On the AREP screen enter the hospital the applicant has entered for voluntary psychiatric inpatient treatment as Authorized Representative type [HO] - Hospital Representative, Receives Letters - Use for MA. If an AREP type [HO] is not entered the user will encounter Edit 2184 - PII/M99 REQUIRES HOSPITAL (HO) AS THE AUTHORIZED REPRESENTATIVE on the APP2 screen and will not be able to finalize the PII AU in Option Q - Finalize until an AREP type [HO] is added. The STAT screen will only allow one [RE] - Recipient. The only enterable financial responsibility codes for PII are: [IP] - Ineligible Person [PN] - Applicant for the person applying. [SC] - Child of SSI Related Parents/Child used to determine household size for dependent children living with the applicant. [SP] - Ineligible Spouse for the spouse of the applicant [NM] - Not Related and Not Financially Responsible to the Applicant [RE] - Recipient and [SI] - SSI Parent cannot be entered on STAT screen but may be changed by the system to these values during eligibility processing. The ALAS screen requires four entries for the PII Program: Regional Support Network (RSN) Authorization Code A Mandatory field which requires an entry of [RV] - RSN Authorization, Voluntary or [NO] - No RSN Authorization RSN Authorization Number A mandatory field if [RV] - RSN Authorization, Voluntary is entered in the RSN Authorization Code field. Client Admittance Date A mandatory field for applicants that have [RV] - RSN Authorization, Voluntary entered. It cannot be a future date. RSN Exception to Rule Code This is a mandatory field when the client has received RSN approval for Voluntary Admission and reapplies more than once during a 12 month period. Entry choices are [F] - Fair Hearing, [E] - Exception to Rule and [N] - No. An [N] will result in denial. One of these codes must be reentered for multiple extensions. On the MISC screen enter the actual date the application was received by the CSO in the Appl Override Date field. This will identify applications that are submitted greater than three months after the admit date. Complete Option O - Interview. See Interview chapter. Process all months through Option P - Process Appl Months. See Process Application Month chapter. Complete Option Q - Finalize Application. See Finalize Application chapter. If a PII AU is added to a case that already includes an Active Cash or Medical AU, the PII AU's financial responsibility code changes to [OS] - CL Inc/Assets/Exp Treated as Recipient but Active in Another AU in finalize and will deny with Reason Code 245 - No Eligible Household Members. If a PII AU is screened and processed to [M] status, a related cash or medical AU can be added. If the related cash or medical AU becomes active and then the PII AU goes to active from Option V - Spenddown Authorization, it will close in overnight batch with Reason Code 245 - No Eligible Household Members and the financial responsibility code changes to [OS] - CL Inc/Assets/Exp Treated as Recipient but Active in Another AU. If a PII AU is screened and approved to Active [A] status, a related Cash or Medical AU can be added and finalized to active. The PII AU will close for Reason Code 245 and the financial responsibility code will change to [OS] in overnight batch. If the applicant entered Washington State specifically to obtain medical care, the user should use the value [T] - Temporary Resident for Medical Treatment in the Washington Resident field on the DEM1 screen. The PII AU will deny for Reason Code 210 - Failed Residency Requirement in finalize. Inmates of a federal or state prison are coded on DEM1 with [PR] - State/Federal Prison in the Living Arrangement field which will cause the PII to close/deny with Reason Code 201 - Living Arrangement. How do I authorize a PII spenddown? To authorize PII spenddown, take the following steps: From AMEN Select Option [V] - Spenddown Authorization using the PII AUID. If authorizing a spenddown in a historical month you must input the Benefit Month (MM YY) when selecting Option V. The Spenddown Base Period - SPBP screen displays. This screen is protected for PII and will only display the three month certification period for PII. Press Enter, which will then display the Spenddown Authorization - SPAU screen. See ACES User Manual - Screens in ACES for more information about the SPAU screen. Press Enter again and the Non-Financial Eligibility Results - ELIG screen displays. The PII AU Stat field will display in [M] - Spenddown Status. Press Enter again and the MA Financial Eligibility - MAFI screen displays. Enter [N] in the Letter Override field to generate Letter 020-05 (PII with Spenddown) to inform the client and the hospital of the spenddown and EMER amounts. Repeat for all months. The Spenddown Authorization - SPAU screen displays next. Enter [Y] in the Confirm field and press Enter. How do I input medical bills to meet PII EMER and spenddown? To input medical bills, take the following steps: From AMEN select Option T - Spndwn Med Exp Update using the PII AUID. The Spenddown Medical Expenses - SDME screen displays. Input the client's medical expenses on the SDME screen. EMER can only be reduced by medical expense type [PH] - Psychiatric Indigent Inpatient Hospitalization. There are two types of PH expenses: Prior PH - This is defined by using a [N] in the Curr Ind field and is deducted first to meet EMER. If the date of service (incurred date) on any prior PH bills is within the current spenddown base period users will encounter Edit 2188 - INCURRED DATE ON PREVIOUS PH BILL MUST BE PRIOR TO THE SPENDDOWN BEGIN DT. Current PH - This is defined by using a [Y] in the Curr Ind field and is deducted next to meet EMER. If more than one current PH bill is entered on the SDME screen the user will encounter Edit 2187 - ONLY ONE CURRENT PH BILL IS ALLOWED. When entering bills on the SDME screen for a household that may include an [SP] - Ineligible Spouse and/or [SC] - Child used to determine Family Size, the system will only allow a PH medical expense to be entered on the [RE] - Recipient client's SDME screen. If a PH bill is entered on anyone else's SDME screen the user will encounter Edit 2189 - ONLY A RECIPIENT CLIENT CAN HAVE PH EXPENSE WITH CURRENT INDICATOR AS 'Y'. If a [Y] or an [N] is entered into the Curr Ind field for bills other than PH bills, the user will encounter Edit 2186 - ONLY PH BILLS CAN HAVE CURRENT INDICATOR AS 'Y' OR 'N'. If medical expense type [PH] - Psychiatric Indigent Inpatient Hospitalization is used for any other medical assistance program type to reduce spenddown the user will encounter Edit 2185 - THE MEDICAL EXPENSE 'PH' IS APPLICABLE TO THE M99 (PII) PROGRAM ONLY. Spenddown is reduced after EMER by the following expense types and in the following order: CO - Health Co-Ins/DE - Health Deductible/PR - Medicare Premium MU - MA Uncovered PB - Prior Bills Still Owing HO - Hospital PP - Paid by Public Program MC - MA Covered Prior PH (amount not used to reduce EMER) Current PH (amount not used to reduce EMER) After inputting all the medical expenses on the SDME screen, press Enter. The SDDE screen displays showing the Total Medical Expenses Applied to Spenddown and any Remaining Spenddown Liability. The SDDE screen also displays the PII EMER Liability, the Total Medical Expenses Applied to EMER and any Remaining EMER Liability. If you are finished inputting medical expenses, press Enter. If you forgot to enter a medical expense and need to go back to the SDDE screen, press <F7>. After inputting all medical expenses, select Option V - Spenddown Authorization from AMEN and repeat the Spenddown Authorization process. When you get to the ELIG screen the PII AU will now be in [A] - Active status. See How do I authorize a PII Spenddown? Do I need to list the bills used to meet the PII EMER and spenddown on the approval letter? Letter 002-31 (Approval for PII) will auto fill with the bills that were used to meet the PII EMER and spenddown. Does PII issue MAIDs? The PII program does not produce MAIDs to the clients. When the client is approved for PII, they receive Letter 002-31 (Approval for PII). Letter 002-31 (Approval for PII) contains the client's name and PIC code for billing purposes. A copy of Letter 002-31 (Approval for PII) is also sent to the hospital identified with the AREP value code of [HO]. Since no MAID is produced with PII: The Is Initial Issuance OTC? field is not enterable and does not display for PII Aus. The daily issuance process does not generate requests for PII Aus processed during the day. The on-going issuance process does not generate requests for PII AUs at monthly issuance. How do I process Involuntary Treatment Act (ITA) clients? Coverage is provided to individuals who are involuntarily admitted for inpatient psychiatric treatment under the Involuntary Treatment Act (ITA). ITA's are not processed thru ACES and payment is made to hospitals for ITA admissions outside of ACES.

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Modification Date: March 10, 2008

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