Frequently Asked Questions

IT SUPPORT CONFERENCE CALL As of 03/01/2010

IT RELATED QUESTIONS 1. Q. A. When will the potentially-eligible individuals be loaded into the WebSphere application? All potentially-eligible individuals are being uploaded on a monthly basis.

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Will the members have an ID card issued to them? Yes, they should receive their membership card within a month after enrollment. What do we do when the WebSphere system is down? Call or e-mail Virginia Zimmer (213-240-8261 or vzimmer@ladhs.org) at HSA IT to report WebSphere issues. How do we correct patient DOB or name errors in WebSphere? Call member services to make that change after that patient appears on the enrolled members list DHS sends you on the 15th. If not yet enrolled, changes must be made through Affinity (DHS) or AIA claims (PPPs). If I enter an incorrect user name or password in the WebSphere application, and it locks me out. What do I do? The user needs to be unlocked from the system. Call Virginia Zimmer (213-240-8261) at HSA IT to have her unlock the user. There is also a wait time of approximately 5 minutes before being able to log-in. If the WebSphere system is down, are we still able to scan documents into WebSphere? If WebSphere is down, you cannot utilize any functions within that application. You will have to make copies of the documentation, and then upload them at a later time. If the picture does not show up clearly on the scanned image, do I have to scan again? Yes. Try adjusting your scanner so that it is grey scale and not black and white. When WebSphere is down, can we send the documents to DHS via email? No. No faxes or e-mails should be sent to DHS in hopes of having them uploaded.
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What is the patient eligibility date? The patient becomes eligible on the date that he/she brought in all the required documentation, regardless if the facility scans and uploads on the same date. However, to be fully enrolled, the patient must be loaded into the WebSphere scanning application. This will trigger the mailing of the membership packet for all the PPPs. If I make a mistake in scanning a document, scan the wrong document, or upload a document twice, who do I contact? Contact Virginia Zimmer (213) 240-8261, and she can assist you in that process. Can we pull up patients in WebSphere who are from other PPPs? For HIPAA/BAA reasons we only allow PPP's to search for patients that belong to the searching PPP. However, if the patient has information from another PPP/DHS facility it will be presented on the ESS.

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We tried to upload documents for a patient, but it failed. When we checked again, the status said enrolled, but there were no documents attached to the patient. What do we do in this case? Please send the clients name and DOB to Virginia, along with a short description of whats happening. Does the soft token and WebSphere work on a server? No, the HWLA application software only works on dedicated computers, not servers. When scanning my images, what setting should I use? It is recommended that you use grayscale. Do I need to scan the whole tax form for income verification? No, only the first page will suffice. If a PPP patient is not in WebSphere, who do we contact and what do we do? If the patient has all the required documentation, go ahead and scan it and check off the enrollment box. After you send the claim to AIA, then they should show up in the system within 30 days. At that time, you can scan the documentation into WebSphere. Can we add a new patient into WebSphere? If it is a PPP patient, see the question above. If it is a DHS patient, enter that patient into Affinity and add the 700 code if you have all the documentation. Within an hour, the patient should be in WebSphere, so you can upload his/her documents.
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A document was uploaded into the wrong patient file in WebSphere, and we would like to go back and delete it. Is this possible? We are working on making it possible for a supervisor or manager (from each agency) to be able to delete scanned images. A current solution to this problem is to go back and attach the correct image, and make a comment in the system stating that the other document was incorrect. This will help us in identifying the incorrect document, and deleting it off the system. Why am I receiving an error message when I try to upload documents into WebSphere? It could be an issue with the resolution of the document you are trying to upload. Try setting the resolution of the scanned images to 150-200 dpi. Also try to break the images into two separate uploaded files (this will decrease the file size for each upload). Can we submit some of the required documents while we are waiting for the rest? Yes, but be sure not to check the verification box that you check when you have scanned all the required images until you have done so. Once you check that box, the patient is enrolled. Are the Encounter Summary Sheets in production mode for PPPs? No, they are in a testing mode for evaluation purposes only. Does the WebSphere support the FireFox browser as Internet Explorer? Yes, it does. If a 700 file has been updated on the Affinity system, will it automatically update the WebSphere? No, you have to scan in all the required HWLA documents and check the box in WebSphere in order to consider the patient enrolled. Facility scanned and uploaded required documents for the patient into the Websphere. The system confirmed that uploading was successful; however, when staff tried to go back and pull the patient, no uploaded documents show on the system. Why is that? Try uploading documents again. If you still having problems, send the list of patients to DHS IT, Alice Abramyan, aabramyan@dhs.lacounty.gov How long does WebSphere take to display a patient as enrolled after entering a 700 code in Affinity? The HWLA member will show as enrolled within twenty-four (24) hours. There's a process that runs every six (6) hours (6AM, 12PM, 6PM, 12AM). If the demographics in WebSphere are not up to date, please update the demographics in Affinity prior to entering the 700
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code, then, this information will be displayed in WebSphere within 24 hrs. Thereafter, you can enter the 700 code in Affinity for each visit. 26. Q. How long does WebSphere take to display a patient as enrolled after checking the box in Websphere? The HWLA member will show as enrolled within twenty-four (24) hours. There's a process that runs every six (6) hours (6AM, 12PM, 6PM, 12AM).

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PROGRAM ELIGIBILITY AND ENROLLMENT QUESTIONS

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How will we know when a HWLA member comes into the clinic? We are sending a comprehensive enrollment list to the facility CEOs every 15th of the month. How long before the enrolled patient receives their ID card and enrollment packet? Currently about 10 working days. If a patient was assigned to our facility, but they want to change, do they have to call member services, or can we enter it into WebSphere? We recommend calling member services to make that change. If the patient has not yet been enrolled in the HWLA program, you can still make that change on WebSphere. However, once enrolled, you will not have the ability to change medical home IDs on WebSphere. A patient called and stated that they mailed an HWLA application along with the required documentation, and have obtained a membership ID and packet. Is this normal procedure? No, this is not normal procedure. We only conduct the enrollment process face-to-face and upload the required documents into WebSphere. Citizenship, Identity and Income documents must be viewed by facility staff. I received a lot of returned eligibility letters that were sent to patients, but they all have valid addresses in our system. What do we do? If your agency has returned mail with a bad address on the envelope (i.e.: missing apartment number, misspelled street name, incorrect number, etc.), please contact us. Letters sent directly to your agency (with your agencys name and address on the envelope) are for either homeless patients, patients with an invalid address to begin with, or patients that have an address which corresponds to a hospital, facility, clinic, or government office.
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If a patient, who is already enrolled in HWLA, comes into my clinic for the first time, what documentation do we need to take? Make sure that you fill out a COI (for PPPs) for your records, and check a picture ID against the HWLA membership card. Is there an Attestation Form available in Spanish? Yes. English, Spanish forms are available for download under Eligibility on the HWLA web site: http://www.ladhs.org/wps/portal/AmbulatoryCare . I cant locate the member in the WebSphere application when I entered the name, MRUN and DOB. What should I do? Try typing in the DOB and the last name to make the most matches come up. For the PPPs, if you still cant find the member, keep the documents, and go ahead and submit the claim to AIA. The new member will be added to WebSphere shortly after the billing process is complete and DHS receives the patients information from the claim form. DHS facilities should enter the 700 code in Affinity, and within an hour the patient will be loaded into the system (process of taking Affinity data and loading it into the HWLA ODS). If a patient was enrolled at another facility and comes into PPP clinic, but no documents show in WebSphere when we verify enrollment, can we still bill HWLA? Yes. As long as they have an enrollment card, or they show up as members in the system, and you verify their identity, then you may bill for that visit. Also make sure to complete a COI if it is the first visit to your facility. What do we do if a patient starts enrolling in one clinic but then finishes in another? Ask the patient which clinic he/she wants as a medical home, then choose that medical home in WebSphere before you upload the documents. Is one pay-check stub enough to verify income eligibility? If the patient has a stable income, then yes, just be sure to multiply it by the appropriate number of days or weeks (e.g., if paid bimonthly, multiply income by 2 to get monthly income). If the patient has an unstable income, have him/her bring in enough paychecks to show the income for a one-month period. Do we need to scan documents for patients who are not eligible? No. Only scan documents for patients who are eligible for HWLA. If a patient brings in military records, will that suffice for proof of citizenship or legal 5-year residency?
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We know that military records are listed as sufficient on the HWLA brochure, but in the training manual, it also states that the place of birth must be listed on the military records. We apologize for this confusion, but the U.S. place of birth MUST be included on the military records for them to be used as a verification of citizenship. A patient came to our clinic with a HWLA membership card, but her green card has been valid only since 2007. Should we take her card away Yes, the patient will not be eligible for HWLA program since he/she does not meet the citizenship/legal residency criteria. Complete a disenrollment form for the patient and submit it to HWLA Admin Office, Karen Swanson (PPP) or William Dominguez (DHS). How do we verify income for a GR patient? GR patients meet the income qualification for HWLA. To verify that they are still enrolled in GR, you may do one of three things: 1) Call DPSS' GR verification line: (877) 481-1044. On the photocopy of the GR card please note that you called and got this verification. 2) Scan the current GR Electronic Benefits Transaction (EBT) card with eligibility confirmed though a Point-of-Service (POS) device. 3) Verify enrollment with the patient's eligibility worker on the telephone. In this case, please note the eligibility worker's name and phone number and then scan it along with the GR card (if the patient has it).

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What is the process for citizenship proof documentation for patients who have been identified on the CA Born list? Complete following steps: Circle the patients name on the list Scan it into Websphere as their verification of citizenship On the Attestation form under Citizenship/Residency Section check the box Birth Record (County or State Inquiry) If a patient was referred for a specialty care to the facility that is not patients Medical Home, do we enroll them for HWLA, if they have not been enrolled in the program yet? Yes, enroll them according to the established eligibility criteria, but make sure to ask the patient the name of the Medical Home where they want to receive their primary care. In the Websphere system at the drop-down field for Medical Home Name choose the appropriate name for the Medical Home. Do we need to request a proof of income after the State new requirement effective 8/1/08. Yes, you request income verification document from the patient. Use the new attestation form to have patient sign and date when they have been instructed to provide income verification document. After two
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weeks, if they do not provide information, go ahead and enroll them with other eligibility documents. For patients enrolled before 8/1/08 and pending income verification document, scan a document showing your attempt to collect income verification from the patient (e.g., phone calls and letters sent.) 19. Q. How to calculate the patients Unemployment Insurance Benefits (UIB) and/or the Disability Insurance Benefits (DIB) income? Is it calculated on a weekly, bi-monthly or monthly basis? HWLA uses the State calculation under the Medi-Cal guidelines. First, calculate the gross weekly income by dividing the gross bimonthly income of the patient, divide by 2 and then multiply this weekly gross income amount by 4.33 to get the total gross monthly income. Are facilities allowed to make photocopies of patients federal documents for the application? Is permission needed? Is there a written procedure to show patients? Yes, it is a federal rule that the patients must have these documents for HWLA eligibility, so there is no penalty for photocopying them for HWLA. What is the requirement to convert all the back logged patient accounts from September 2007 to a 700 file. All billable accounts should be coded 700, with the exception of patient follow up visits for a LAB Testing or Nurse Visits. Are medications covered by HWLA? No, medications are not covered by HWLA; however, they are covered by ORSA. Pharmacies will honor the ORSA card. PPPs will cover the medications for their primary care patients in HWLA. If a patient comes in with a HWLA card, but ORSA has expired a month ago, can they be coded 700? The patient should be referred to reapply for ORSA first. If a patient qualifies for ORSA, then they can apply for HWLA. After the HWLA card is presented at registration, then code 700. If PPPs received a roster with possible eligible patients without SS #, are they required to show the SS#? No, SS # is not required; however, they must show proof of permanent residency and citizenship. A patient comes in with documents where his/her information varies on different identity documents, e.g. SS#, ID or utility bill for proof of income. Should the clinic update the information on the Websphere? Clinics cannot update information on the Websphere. The utility bill can serve as proof of residency; however, the patients still need to
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have proof of 5-year legal residency and citizenship. All the documents should be scanned into Websphere, so that HSA administration can identify the patient for billing or audit purposes. 26. Q. A. Are patients on the list of potential candidates provided to PPPs and DHS facilities pre-screened or clinics should verify the eligibility? They are identified as being potential candidates based on their age, number of visits, and/or chronic diseases; however, facilities should verify the eligibility based on the other established guidelines and requirements, such as citizenship/5-year legal residency and income. If a patient has been a legal resident for a year, does he/she qualify for HWLA? No, he/she doesnt qualify for HWLA; a patient must have 5 years or more of legal residency. Is IT Customer Service (Help Desk) responsible for changing the Medical Home information for the patient? No. After the patient has been enrolled, he/she must call Member Services to change medical homes. The Help Desk (IT Customer Service) is if you are having problems with WebSphere. If all the documents for patients have been scanned and are OK in the Websphere, does clinic need to maintain copies of those documents? Yes, keep copies on file until the WebSphere has been beta tested. When facilities enter patient information into Affinity, how long does it take until the information appears on the WebSphere? Can accounts be billed? It takes about an hour. Yes, OK to claim. For the PPP HSA Admin will submit the claim, depending the time it was submitted by the clinic and AIA processing. A PPP patient comes in on regular basis for primary care. If the primary doctor requests that they come in for specialty care for their next visit, e.g. Biopsy, mole removal, etc, can HWLA be billed for those procedures? No, HWLA does not cover dermatology procedures. The only specialties HWLA covers for PPPs are cardiology, podiatry, ophthalmology, and optometry IF the PPP has these specialists already on staff or has an HWLA-approved subcontract with these specialists. Is physical exam covered by HWLA? Yes, general physical exams are covered for HWLA, but those for employment or sports are not. If PPP candidate has a third party insurance, are they eligible for HWLA?

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No, patient is not eligible for HWLA if has third party coverage, such as Medical, HMO, etc. Highlight those names on the list and send it to Karen Swanson, kswanson@dhs.lacounty.gov Primary doctor referred patient to nutritionist/dietitian as a result of patients high cholesterol or diabetes results. Will HWLA cover those charges? Nutritionist services are not covered by HWLA. Same rule applies for diabetic or hypertension classes offered to the patient. HWLA will reimburse charges for cardiology, optometry, ophthalmology, and podiatry services only. A PPP clinic referred patient to another clinic for Optometry services. Is contract needed with the agency? No contract is needed. Patient has to show HWLA card, PPP will open a medical file and fill out COI (Certificate of Indigence). Visits are paid by PPP, if PPP can utilize its own money. If the agency is going to pay, then a contract is needed. Patient comes in regularly to PPP clinic and later becomes eligible for HWLA. What is the HWLA effective date for billing purposes? Is it the date on the application or the date on the COI form? The HWLA effective date is the date on the attestation form. Per memo sent out from Ambulatory Care May/June of 2007, PPPs should update the COI every April, when the FPL (Federal Poverty Level) Table changes. A Patient has a pending file because he still needs to bring in his ID card. Can the clinic go ahead and upload the patients information? Yes, go ahead and upload the documents you have, but do not check the verification box until ALL the documents are uploaded. A patient went to MLK and was turned down for HWLA enrollment. Then the patient comes in to another clinic to enroll in HWLA. Can this clinic enroll the patient? Yes. The clinic can enroll the patient, because MLK is not participating in HWLA program. However, MLK remains the Medical Home for that patient. Can homeless patients sign affidavits as a proof of Citizenship and Identity? Yes, homeless patients can use affidavits as a proof of Citizenship and Identity, however, the affidavit should be signed by 2 other witnesses approving that the statement is true. Witness must be a US Citizen, and one witness cannot be a relative. In this case, the address of Medical Home should be used on the affidavit.

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Can GR eligibility code A (Eligible US Citizen) showing on the screen print-out be used as proof of Citizenship? Yes, GR eligibility print-out can be used for Citizenship and Income Verification. Why does the Medical Home receive member packages for patients? For two reasons: a) the patient is homeless so the Medical Home address was used for the patient; b) the patient had an address change or moved. The Medical Home should retain and give the package to the patient, when they come in for their next visit or mail it to the patients more current address. A patient has been enrolled since 2007, but did not visit the clinic since then. Their ORSA expired. What should the clinic do with those patients? Clinics can consider them as HWLA patients, keep their records, and update their ORSA status the next time they have a visit. A patient is unemployed and is dependant on his/her spouses income. Can he/she show the spouses income document as a proof of income? Yes, they can submit the spouses income, but the clinic should make sure that the net family income maximum falls within the appropriate bracket of the FPL table. A patients attestation form is completed and signed. Do facilities need to keep copies of documents in a separate file for audit purposes or file them in the patients medical record? Facilities can make their own determination for how they will maintain the required documentation for HWLA patients. All required documents for the patient have been uploaded into the system, except the attestation form. Can facilities pull the patient on the Webshpere and upload missing forms later? Yes, it is OK to scan and upload any missing document later, however make sure to code the 700 and check the box when all the required documents are present including the Attestation form. Patient called the NAL (Nurse Advice Line) and was referred to the facility to schedule an appointment. What is the process for NAL? Do they have to fax the form to the facility for the appointment? Upon their medical assessment, the NAL will fax the form for the next day appointment; however, the NAL will refer patients to call their medical homes if they do not require a next day appointment. A 700 coded patient in the Mid Valley clinic was referred to OVMC. Can the clinic bill HWLA for services? Yes, OVMC including all DHS hospitals are now participating in HWLA.
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Can PPP clinics refer their patients to another PPP clinic for specialty care? Is there a form required to submit? Yes, PPPs can refer a patient to another PPP for specialty care covered by HWLA. There is no form required to fill out; however, the referring clinic must call the other clinic and make sure that they have the capacity to take additional patients in that specialty. When can the patient be coded 700? For DHS sites, a patient can be coded 700 (enrolled) as soon as all the documents are received and scanned into the system. The HWLA eligibility date is the date on the completed application or when patient became eligible for ORSA. For PPP sites, a patient is considered enrolled when clinic collects the last piece of required documentation for eligibility. HWLA can be billed on or after that day when the patient has a visit. What is the flu shot eligibility criteria for HWLA members? The flu shot is available for all members of HWLA, regardless of their age or chronic disease status. The PPP received a list of patients that belong to another clinic. Should they send the list back? E-mail the list of names to Karen Swanson at kswanson@dhs.lacounty.gov and be sure to password-protect the file. How soon will PPPs receive the list of HWLA enrolled patents, whose packets have been sent out? The listing of patients who are enrolled is being sent out to PPPs at the end of each month and the list of patients whose member packets have been mailed is being sent out on the 15th of each month. Is 911-care covered by HWLA? Only if it is provided at one of the DHS Facilities. Does the patient need to see a doctor for flu vaccine orders? Not necessarily, patient should get the flu vaccine as a visit with provider unless the clinic wants to administer the vaccine and not charge DHS for it as a visit. Does it qualify to provide specialty care through volunteer providers? Yes. If they ordinarily volunteer with your agency, then they can also provide specialty care. Who receives the reimbursement if a patient was sent to the subcontractor for specialty care? The clinic that provided the services will bill for and get the reimbursement that will come from their specialty care pot of HWLA money.
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Upon a patients request the PPP advised the patient to call member services to change the address. Does the PPP need to follow up with the patient for the address change in order to get reimbursement for a visit? No, money follows the patient. The clinic will be reimbursed for the visit. A new PPP site has been added to the existing PPP agency. Can HWLA be billed for the visits to the new clinic? Not until the contract has been amended to add the new site. A patient diagnosed with all the qualifying diseases and documents to be enrolled in HWLA. Can they be enrolled? If they have all the required documents, go ahead and enroll them; however, dont check the box in the WebSphere until all the required documents are uploaded. A patient does not speak the English language. How he/she can consent? The patient can consent through the clinic interpreter. Does the "Enrolled" status in the WebSphere mean that HWLA Admin qualifies the patient to be enrolled for HWLA? No, HWLA Admin relies on the clinic to make sure that all the required documents verified and the patient qualifies to be enrolled in HWLA. By checking the box in the WebSphere, the clinic lets the HWLA Admin to know that everything was checked, before the patient was transferred from "Potential Candidate" to an "Enrolled" status. When the patient moves to a new address after the enrolled 700 files have been uploaded into the Affinity system, should the clinic contact HWLA Administration to report the change? No, the clinic updates patients information in the Affinity; the patient calls member services. Can patients go from one site to another, for example, from PPP to DHS clinic? Yes, they can. Money will follow the patient. What needs to be done with the application/files of patients who did not submit all the required documents after follow up and 90 days has past? Can they be removed from our internal "pending" files? Many are from Sept 2007. Hold on to files, keep the records for billing purposes, they can be labeled "incomplete vs. pending" until further notice from DHS Revenue Management. However, if the Patient is only missing the income verification, the State allows the Department to still enroll the Patient into
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HWLA as long as a request for income verification is documented and the two-week waiting period has been met. 65. Q. Should facilities mail packets that were "returned to sender due to shortage of postage" to patients through county mail? The facility has called patients to pick them up; patients have also requested the facility to send them the packets via mail. These packets are not returned due to shortage of postage. These are packets that were returned to Customer Services due to incorrect addresses or addressee unknown. Since Customer Services gets a bulk rate for their postage, it does not pay for the packet being returned to them. So the facilities get these packages so they can forward them to the patients correct address or ask the patient to come in and pick them up. Can the MEDS SSI print out be used as proof of income. Is it valid? Do facilities need to collect an official document from SSI for financial eligibility? MEDS SSI print out cannot be used as proof of income. Normally, individuals receiving SSI do have MediCal and do not qualify for HWLA. However, for those patients that do not qualify for SSI and if after two weeks of requesting the income verification the patient does not provide it, the patient automatically qualifies for HWLA (as long as the other requirements have been met). How and where can facilities get more HWLA brochures? HWLA brochures can be ordered from OMC (Office of Managed Care). Facility can call and request a form to be completed and sent to OMC for number of brochures needed. The order form is also available on the HWLA website, under Training, then Introduction. How is the Medical Home site determined and which clinic gets the credit if a patient has been seen in 5 different locations? The patients Medical Home is determined by where they went the most in the prior year. If the patient initially enrolled in a different clinic than where he/she goes for health care, then the clinic providing a service will get the credit for that visit. Money follows the patient. The patient has been enrolled for HWLA by a different clinic, but chooses to go to another clinic for care. How can the Medical Home be changed? The facility will get the credit for the visit; the patient will need to contact Customer Services and request that his/her Medical Home be changed. Also, there is a form that facilities can request from Customer Services to have the patient to sign to be transferred.

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Facilities receive a monthly roster of enrolled patients from HWLA Administration. Can the roster be generated only for newly added patients? HWLA Administration currently provides the listing of all aggregated number of 700 patients in the Affinity to assist DHS clinics with their reconciliation process. The roster should be used to match the number of enrolled patients with the scanned documents in the system. Perhaps after the reconciliation process is completed, HWLA Admin will consider sending the roster of newly added patients only. Upon scanning documents in the system facilities run into patients with duplicate MRUN numbers. Should the listing be submitted to HWLA Admin with correct MRUN number? Yes, HWLA Admin will need the correct MRUN number to look for patients visits. A patient claims that he/she is born in CA, but is not listed on the roster of CA Born patients which the PPP clinic receives from HWLA Admin. How can the clinic verify that the patient is CA Born? Most probably the patient was pre-assigned to another PPP site; go ahead and send the name(s) of the patient(s) IN A PASSWORD-PROTECTED FILE to Karen Swanson at kswanson@dhs.lacounty.gov and she will look them up against the master file. If you dont know how to passwordprotect a file, then call Karen and leave the patients name, date of birth, your name, and your phone number on her voice mail. A patient claims that he/she receives SSI. Does the County have their income information? The County does not have patients SSI information.

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The Department of Public Social Services (DPSS) refers patient to the facilities as potential HWLA candidates. The first appointments are scheduled within a month. Can the patient be considered as HWLA-enrolled? No, the patient is not considered enrolled at the time of referral. He/she will be considered enrolled when he/she shows up for the first visit and has all the required documents. A patient is enrolled in the HWLA program, but later was found not having a chronic disease. Can he/she still be qualified for HWLA? A patient does not have to have a chronic disease to qualify for HWLA. As long as patient has 2 visits, he/she qualifies for HWLA. If a HWLA member is diagnosed with cancer, can he/she get services under the program? No, HWLA does not cover services provided to patients with cancer.
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HWLA patient received services at another non-County and non-PPP participating clinic with the HWLA card. Will the payment be reimbursed to the clinic? No. HWLA is a program and not insurance coverage. Services provided by a non-County Clinic are not reimbursable. Upon receiving the bill, the HWLA Administration will send a letter to the clinic, informing them that the payment will not be reimbursed for the services provided outside of the County facilities and PPPs that are participating in HWLA. A patient is born in LAC-USC; however, he/she does not have a copy of the Birth Certificate. The patient just came out of the jail and cannot afford to purchase a birth certificate. Does the County have (1) funding to purchase the birth certificate for the patient, and (2) does the patient need to sign an affidavit to purchase the certificate? Yes. The patient needs to sign an affidavit to purchase the birth certificate and DHS Finance has the funds/required forms to purchase the certificate. However, the clinic should consider checking patients name on the master list of the CA Born potential candidates, which is mailed out to the facilities. If a patients name appears on the list there is no need to purchase the certificate; highlight the name and save the page as a proof of Citizenship. If you are having difficulties finding the name on the list, e-mail DHS IT (aabramyan@dhs.lacounty.gov) for further research. A patient wants to be disenrolled and asks about the proof of disenrollment. Can the clinic provide them a documentation stating that they have been disenrolled? Yes, clinic may, but the disenrollment letter will go out from Member Services once the patient has been officially disenrolled. A patient has been told that he/she has been disenrolled due to other coverage, but claims that do not have other coverage. How should the clinic treat the patient? Treat them as you will a PPP patient. You will still need to provide the care. Will the PPP get paid for Specialty Care? Only if they have an approved subcontract with one of the four preapproved types of specialists or they have this type of specialist on staff . Is the Target Potential for the PPPs based on the member number or the dollar amount? Member number. It is based on the number of patients seen at PPP for a year with a valid SS#.

78. Q.

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79. Q.

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80. Q.

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83. Q.

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A HWLA patient goes to the clinic where he/she was not officially enrolled. Should the new clinic collect all the required documents again? No, there is no need to collect the documents again. Ask for the HWLA card and complete the COI if you work for a PPP or complete the ORSA application if you work for DHS. What type of complaints should be recorded on the Complaint Form? Should HWLA complaints be kept separately? The form is the suggested format to be used to record any type of complaints that members may have (services, NAL, etc.). It is preferred to keep the HWLA complaints separately, as it is a State requirement to be reported and HWLA Admin will request the complaint forms periodically. How will the audits be conducted for HWLA patients at the PPP clinics? The clinics will be asked to pull the medical records of 5 patients with each of the following diagnosis: asthma, dyslipidemia, diabetes, heart failure and hypertension, as well as 5 records of episodic patients. A client has children who are covered under the Healthy Families Program. However, the adult in the family does not have Health Insurance and has been denied for Medi-Cal. Can the client be enrolled in HWLA? Yes, if the client qualifies for ORSA and meet the age, income and citizenship requirements for HWLA, clinic can go ahead and enroll the client providing that the copies of required documents are uploaded in the system. A patient has not been seen for years in the PPP clinic or he/she is a first time visitor to the clinic with no medical records. In order to complete the COI, is there a need for the patient to be seen by a Provider? A patient does not need to see a provider to be enrolled into HWLA. However, according to the Office of Ambulatory Care, a patient cannot fill out a COI until they are at the clinic for a visit. How long will the HWLA program provide funding for patients? HWLA is not in jeopardy of loosing its funds. Do Medi-Cal patients qualify for HWLA? No, patients should not have any other type of medical coverage to qualify for HWLA. Can Hospitals bill Emergency Room/Urgent Care visits to HWLA? DHS Hospitals can bill HWLA for ER/Urgent Care services. This only applies to DHS Hospitals. PPP patients enrolled into HWLA would still need to apply and qualify for ATP/ORSA with no liability.
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84. Q. A.

85. Q. A.

86. Q.

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87. Q.

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88. Q. A. 89. Q. A.

90. Q. A.

91. Q.

A.

A PPP clinic received a fax from McKesson describing a patients demographics and diagnosis reported by Nurse Advise Line (NAL). However, there is no information about the outcome of the call and the action clinic should take. McKesson will forward faxes from NAL to the appropriate clinics if the nurse thinks the patient needs a next-day appointment with his/her medical home. Is the GR patient data on the MEDS indicating that the patient is a Citizen or a legal resident acceptable proof of citizenship? The statement that GR patients dont need to provide any verification of citizenship for HWLA is incorrect. When applying for GR, applicants sign a statement that they are citizens or legal permanent residents but are not required to provide proof. Proof of citizenship/legal residency must be obtained for HWLA. For DHS facilities, MEDS would serve as a proof of citizenship if data is on MEDS. The Facility will need to scan and upload a copy of the screen shot into Webshpere. Please refer to the samples provided by the Revenue Management about the fields that must be completed on the MEDS in order to satisfy the DRA requirement. During the annual re-determination process of HWLA eligibility, should the ORSA application or COI Form be uploaded into the Websphere, or will the Income Verification document satisfy the eligibility requirement? The Income Verification document will satisfy the HWLA eligibility requirement. Have the patient first sign the Income Attestation Form, that says they will bring in proof of income, and upload it with their proof of income. If they dont bring proof of income after two weeks of signing McKesson will forward faxes from NAL to the appropriate clinics if the nurse thinks the patient needs a next-day appointment with his/her medical home. The patient is pre-assigned to Olive View Medical Center (OVMC) and wants to file the HWLA application at MidValley Clinic. What is the procedure to get the patient enrolled? Keep the record of the patient. Scan all the required documents into Websphere and check the box. The patient will be enrolled; however, the HWLA card will show OVMC as a Medical Home. If patient wants to change his/her Medical Home to Valley Clinic, then on the drop down menu for Medical Homes choose MidValley Clinic before checking the box. If the patient decides to change the Medical Home after being enrolled, then have him/her to call Customer Services and request the change.

92. Q. A.

93. Q.

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95. Q.

A.

Are GR recipients entitled to receive the $10 gift certificate when income verification is not presented, but their income is verified through MEDS? Yes, once verification of current eligibility is completed and all other requirements are met and verified through MEDS, they are entitled to receive the $10 gift certificates. If I upgrade my browser to Windows Internet Explorer Version 8, will my soft token still work? Yes. But you also need to download the newly released RSA SecureID Toolbar 1.4.1. This version adds support to Microsoft IE8 with Windows XP and Windows Vista operating systems. Also, be sure to uninstall the old version of IE first. For more information and to download the product, visit http://www.rsa.com/node.aspx?id=3031 Is expired Drivers License sufficient proof of residency? Yes, expired Drivers License is acceptable proof of residency. Is spouses income acceptable proof of income verification for the patient? Yes, verify if it is the only source of income through MEDS. To be eligible for HWLA does the patient need to have already had one visit at the facility of with the primary care doctor? The patient can have one previous visit with any facility. If he/she already had a visit, then the next visit should be considered as the second visit. Is it permissible to photocopy the Naturalization Certificate even though it says Do Not Copy on it? Yes, it is OK to photocopy the Naturalization Certificate even though it says "Do Not Copy" on it. The Federal Government requires proof of naturalization for HWLA, so we are allowed to copy this federal form. If the patient is not in WebSphere, and is a PPP patient, and you have all the eligibility documents for HWLA photocopied, then you can consider him/her enrolled and begin billing HWLA for the visits. Once we get the claims data back from AIA, he/she will be electronically uploaded into WebSphere and you can scan/upload the documents. What documents should be re-uploaded during the annual Redetermination for PPP patients? A new COI must be filled out and signed again by the patient and put in the patients medical record. In addition, the new Income Attestation form must be signed and dated by the patient. If the patient does not bring in income verification in two weeks, the income re-certification requirement can be waived and patient can be considered certified for another year. Scan the Income Attestation form into the Webshpere. If they make over
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96. Q. A.

97. Q. A. 98. Q. A. 99. Q. A.

100. Q. A.

101. Q. A.

the FPL table amount and do not qualify for HWLA, then determine whether they meet the criteria for the PPP Program instead. (HWLA uses gross income and PPP uses net). 102. Q. A. When and how is it that the HWLA Administration can deny the claim for a PPP visit? A patient that lacks appropriate documentation is not an eligible HWLA patient as defined in the agreement and the County is not liable to pay a claim for that patient. When completing the attestation form is the original given to the applicant and the copy is kept in the HWLA file? If we are truly following Medi-Cal regulations for HWLA, the attestation form is like the MC13 where the applicant declares that he or she is a citizen or permanent resident alien. For Medi-Cal regulations we always have kept the original copy on file and if the patient wanted a copy, a photocopy was given to the client. For HWLA not all of the "Medi-Cal regulations" are followed. We do use the Medi-Cal income verification guidelines and to an extent the Federal Medicaid DRA Citizenship/Identity Documentation Rules. The DRA Documentation Rule does not apply to non-citizens, such as Legal Permanent Residents (LPR). However, HWLA eligibility does include the 5-year bar for LPR; Medi-Cal does not. The Attestation Form is not like the MC 13, Statement of Citizenship and Alienage. It is merely a DRA receipt given to the applicant once acceptable original documentation is received. State DRA regulations require that the recipient of the DRA records "return original documents to the applicant/beneficiary with the original copy of the DRA receipt." DRA documents only need to be presented one time, the applicant may use the DRA receipt as proof of having previously provided this documents. Therefore, the original must be returned to the patient and the copy returned retained in the file. 104. Q. For HWLA eligibility re-determination purposes, which month of income verification should be requested from the patient, the income verification for the first month of eligibility from the ORSA contract or the HWLA application month? At the time the HWLA applicant comes to apply for HWLA benefits, we request income verification within the last 30 days of the ORSA application. For example, applicant applied for ORSA on 01-01-09, his/her ORSA eligibility period is from 01-01-09 and ends on 12-31-09. Applicant applies for HWLA on 07-01-09; we request income verification for the month of January 09. What kind of Medical Records are acceptable proofs for citizenship and identity? Can the hospital birth certificate, that is given to the applicant's parent at the time of birth with all the necessary
Page 19 of 34

103. Q.

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105. Q.

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information and is signed by the doctor who delivered the baby, be a valid proof of Citizenship or identity? Medical records - (clinic, doctor, or hospital) record (excludes immunization records) are acceptable documents for citizenship and identity. These documents must be dated 5-years before the HWLA application date and show a U.S. place of birth. The hospital's "souvenir" birth certificate given to the child's mother is not an acceptable document for proof of birth. Can the woman with limited State Funded BCCTP (Breast and Cervical Cancer Treatment Program) coverage be enrolled in HWLA? Please note that full benefits (Federally Funded) are provided to individuals who are citizens and nationals. Restricted benefits are provided to individuals with unsatisfactory immigration status. Please note: The BCCTP eligibility definitions taken from the http://www.dhcs.ca.gov/services/medical/Pages/BCCTP.aspx#whoiseligiblefrbcctp? website. Who is eligible for BCCTP? You may receive full-scope Medi-Cal through BCCTP if you meet all of the following: Have been screened and found to be in need of treatment for breast and/or cervical cancer (women only), follow-up care for cancer or precancerous cervical lesions/conditions by an CDP:EWC or Family PACT provider Are a women under age 65 who has satisfactory immigration status or is a citizen or national of the United States Are a California resident Have a monthly gross family income at the time of screening and diagnosis, that is at or below 200 percent of the federal poverty level for the family size Have no other health insurance including full-scope no shareof-cost Medi-Cal or Medicare. If you do not meet the requirements for Medi-Cal through the BCCTP you may still be eligible for BCCTP (called State-funded BCCTP) if you meet the following: Have been screened and found in need of treatment for breast (men and women) and/or cervical cancer (women only), followup care for cancer or precancerous cervical lesions/conditions by an EWC or Family PACT provider Are a California resident Are a male of any age or any immigration status Are a female under 65 years of age with non-citizen or unsatisfactory immigration status Are a female 65 years of age or older; and/or
Page 20 of 34

106. Q.

A.

Have health insurance, including share-of-cost Medi-Cal and/or Medicare NOTE: If you do not have satisfactory immigration status you may be eligible for restricted Medi-Cal and the State-funded BCCTP. Restricted Medi-Cal will provide benefits for emergency services, pregnancy services and long-term care. 107. Q. A. Can the homeless patient use an Affidavit as proof of Income? Yes, Affidavit is the last source for proof of income if no other form of income verification is available. Patient must complete and sign the Affidavit and it should be scanned into the Webshpere. How do you determine income for a woman who gets paid by the State to take care of her disabled daughter when her daughter also receives disability payments from the State? Is this a family size of 1 or 2? The daughter is over 21 years of age and the mother is an IHSS worker. Do IHSS workers HAVE to apply to CHP? She would rather be in HWLA so she can continue receiving care at her current PPP. If daughter is under 21-years old, count woman and daughter as family of two. If over 21, count the women as a family of one. If daughter is under 21 and getting SSI income, SSI has Medi-Cal and SSI income is not counted for ORSA/ATP. However, if the daughter is under 21-years old and receiving State permanent disability income for herself, the disability income is counted. If income is paid to woman by the State and is income from In-Home Supportive Services (IHSS) as an IHSS worker, then the income is counted. Make sure to use the gross income less $90 to calculate income eligibility. The IHSS workers don't have to apply for CHP, it is an option that they have available. What income verification is needed to claim retro HWLA? There is no retro HWLA coverage. The HWLA effective date is the date of the ATP or ORSA application (not to exceed September 2007). We must have an ATP or ORSA application with an application date prior to the service date that covers the time period. If the application was for ATP, the income verification requirement has already been satisfied. However, if the application was for ORSA, we must request income verification for the time period of the ORSA application date. For example, applications were taken in January 2008 and March 2009; we would need to request income verification for both of these months (See income verification Guidelines). This request for these periods must be documented. If the patient does not respond within 2 weeks of the request, the income verification is considered satisfied. The documentation showing the request should be scanned. We should not
Page 21 of 34

108. Q.

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109. Q.

A.

share this with the patient but should encourage patients to provide income verification. If the patient provides verification, we should ensure the verification shows income of 133 1/3% FPL using gross income less $90, which is consistent with Medi-Cal guidelines. If so, scan income verification. If the income verification provided is in excess of 133 1/3% FPL, the patient is not eligible for HWLA but they continue to be eligible for ORSA. ORSA is declaratory and is completely separate from the HWLA process. The only time that an ORSA would be reworked would be if the patient notifies the facility that their income or other circumstances have changed. 110. Q. Is proof of child support required for income verification? And if so, should it be scanned and uploaded into WebSphere? Yes, child support must be verified to allow it as a deduction and should be uploaded to WebSphere to confirm that the income is below 133 1/3 FPL by using this deduction. If a patient's income is in-kind income, do you stop at that point on the income worksheet? Please see HWLA Income Calculation Worksheet Completion Instructions #31 through #36: In-kind income is Unearned Income and if the total net nonexempt income (Part B, #6 in worksheet) is less or equal to 133 1/3 FPL, you STOP. Patient is HWLA income eligible. The only time you go on to Part C of the worksheet is if the patient is over the 133 1/3 FPL and you need additional deductions. Is Temporary Resident Card valid proof of Legal Residency? I-688 Temporary Resident Card is not valid for HWLA legal residency verification. The patient should have applied and received a "Green Card" I-551. The patient needs to provide the new card. Do Psych ER patients with UMDAP qualify for HWLA? Is UMDAP a County or State program? All ER services provided in DHS facilities are covered. An evaluation would have to be made to see if the patient is ATP/ORSA or GR eligible and meets all of the HWLA requirements (e.g., income [133 1/3% FPL], citizenship, etc.). As to the second portion of the question, the UMDAP (Uniform Method of Determining Ability to Pay) is a program that Los Angeles County Department of Mental Health contracts with the State Department of Mental Health to provide medically-necessary specialty mental health services to County beneficiaries and contracts with County DHS for
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111. Q. A.

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113. Q. A.

mental health inpatient and emergency services provided at DHS hospitals. 114. Q. Please advise on how to calculate a patient's income based on the 2008 Income Tax Return from profit/loss of self employment on a family business. This situation is not unusual. It is common for the self employed to operate at a net loss for first 3-5 years. Please note on page 2 of the income verification guidelines: Note: "If no income is reported (net loss for self employed) for the family, clarification is required as how the family's needs are met. If patient is living off savings in bank account(s) only interest accrued on the account is counted as income." If patient's needs are being met through loans or credit card purchases it must be documented. Loans are not counted as income since they require repayment. It is also possible that last year's income tax does not accurately reflect current income. See page 4 (2b) of income verification guidelines: "If the previous year's income tax return is not representative of current income, current business records are acceptable verification." 115. Q. A homeless patient claims he/she is born in Colorado State; however, he/she does not have a birth certificate. Can SS # be used as a proof of Citizenship? SS # is not an acceptable proof of Citizenship/Identity. The patient still has to provide a proof. He/she can call the 1(800) number for Colorado State to order a birth certificate. See the listing of Vital Statistics Agencies by state in the appendix of your training manual. GR eligibility is determined in a month-to month basis. Does the patient need to attest every month? A patient will need to attest as he/she comes in for a visit using the Income Attestation form. Verify with DPSS eligibility worker or the GR Central Help Line (877/481-1044) if the patient is still GR eligible and record on the form. Patient receives an SSI pension and has a letter from Social Security Administration indicating the amount of payment. Can it be used as proof of income? Yes, if the patient provides a letter from the Social Security Administration on the official letterhead and signed by the administrator/worker, then it can be used as a proof. A patient claims that she/he receives in-kind income; however, the provider refuses to sign the In-kind form. What can be used as a proof of income? The Affidavit is the last source for the patient to proof his/her income.
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116. Q. A.

117. Q.

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118. Q.

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119. Q. A. 120. Q. A.

A patient receives GR and Food stamps. How the should the income be calculated? Use the Income Calculation worksheet for Unearned Income. Why does the age limit for HWLA begin at age 19 if they are linked to Medi-Cal until age 21? Yes, under certain situations a family may exceed the Medi-Cal property limit and may not be eligible for Medi-Cal making the 19-21 ineligible for Medi-Cal. Any person under 21 is potentially eligible for Medi-Cal. Medi-Cal defines a "child as a person under 21, married or unmarried, living with parents or a caretaker relative. Those deprived of parental support of a parent due to absence, death, unemployment or incapacity are automatically linked to Medi-Cal and cash assistance program (i.e. Cal WORKS, SSI). Those not deprived of parental support would be linked to Medical Assistance Only (MAO). Parents are responsible for applying for Medi-Cal on behalf of their "child". If an 18-21 year old patient meets the definition of child and cannot apply for Medi-Cal in his/her own behalf and parents refuse to apply for Medi-Cal, the 18-21 may apply for ORSA/ATP on his/her own behalf. Therefore, the 19-21 children may also be eligible for HWLA. Persons under age 21 not living in the home of the parent or caretaker relative (relative providing support and supervision) may be considered an adult and eligible to apply for Medi-Cal on his/her own behalf.

121. Q. A.

For social security or pension plans do we deduct the $90 from the total amount? The $90 income deduction is only allowed for earned income. Incomes from Social Security and/or pension plans are considered "Unearned Income". Social Security/pensions are to be listed in the Income Calculation Worksheet (see attachment), Part B, as Unearned Income Source, # 5. The $90 deduction is not allowed. There is a discussion/listing of other types of unearned income in page #3 of the HWLA Income Calculation Worksheet Completion Instructions. The only time you may need to allow other types of deductions (e.g., child care, insurance payments, etc.) from earned/unearned income would be when the Total Net Nonexempt Income, #6 of the worksheet is grater than 133 1/3% FPL. These additional deductions would be done on Part C.

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122. Q. A. 123. Q.

A patient has a Drivers License issued from another state as well as proof of residency in Los Angeles. Can we enroll the patient? Yes, assuming that all the other requirements are met. A patient is applying for HWLA, but is not married and has a different last name from birth. Should a Marriage Certificate be scanned into the Webshpere? No, there is no need to scan the Marriage Certificate. You can make an annotation on the Attestation form and have the patient sign and date it to keep it in her records. A patient has a CA ID and proof of Citizenship; however he/she provided income verification from Washington. Can we use the income from another state? Yes, as long as the patient resides in Los Angeles County, you can go ahead and enroll the patient. A PPP patient goes to DHS facility for care. Should their income be redetermined? There is no need to ask for verification of income and re-determine the eligibility. If the patient is already HWLA member, he/she provided a proof of the entire required documents to qualify for HWLA at the time of applying. The DHS facility will only need to complete the ORSA application, which does not require proof of income. A patient came in for specialty care, but did not show his/her HWLA Card, until later when he/she has been charged for services. Should the charges be reimbursed to the patient? Yes, HWLA patients are not financially responsible for specialty care services provided to them. Patients have no previous visits for chronic illnesses. Do they qualify for HWLA? Yes, they do. Patients do not have to have chronic illness to qualify for HWLA. Is the patient automatically assigned an enrollment number at the end of the completion of uploading all the required documents in the Webshpere? No, the system will not issue automatic enrollment number; it will only provide a confirmation number. An HWLA member is due for his/her renewal and provided a new income verification document. Under which topic should the new income verification document be scanned? Please scan it under the Income Verification. There is no penalty if all the documents are scanned under one topic field; however, for audit purposes it is recommended to scan documents under the appropriate field.
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124. Q.

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125. Q. A.

126. Q.

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127. Q. A.

128. Q.

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129. Q.

A.

130. Q.

A.

When should the HWLA patient complete the renewal process? Should the clinic call the patient to come in for a visit or wait until the patients come in for his/her next visit? Wait until the patient comes in for a visit. The best time to renew a PPP patient is in July when they sign a new COI. The patient is a Student Worker, whose monthly income fluctuate Example, the income in August was less than in September. How should the income be calculated for this patient? Please follow instructions on the Income Calculation Worksheet. A patient receives unearned income. How should we calculate the income? Please follow the rules for collecting verification of In-Kind Income and calculate the income based on the instructions of the Income Calculation Worksheet for Unearned income. A patient has visits at High Desert, but his/her Medical Home is the Harbor Medical Center. The patient does not come up with the High Desert Medical Record number, but comes up with the last name. Can the High Desert clinic upload required documents into the Websphere? Yes, look up the patient in the Websphere and scan all the required documents. If the patients status shows Potential candidate, ask the patient if he/she wants to choose High Desert as their Medical Home, and then change it. If the patient still prefers Harbor to be the Medical Home, you can still upload all the missing documents without changing the Medical Home. A patient changed her last name to her husbands last name; therefore has different last name on some of the required documents. How should the clinic verify her identity? If the patient is not enrolled, you can make necessary changes in the Affinity and it will update the information in the Websphere (DHS facilities only). Please make sure to upload a legal document that proves its the same patient. The patient was enrolled in San Fernando clinic and chose that to be his/her Medical Home, so the HWLA card shows San Fernando clinic as the Medical Home. The patient visits his/her daughter occasionally in Antelope Valley and visits the Antelope Valley clinic. Should the patient call the 1- 800 number to change his/her Medical Home? The facility name on the card does not have to match where the care will be provided to the patient. As long as the care is provided, code the visit 700; however, make sure that the ORSA application if filed. It is not required to change the Medical Home, unless patient is going to continuously visit Antelope Valley. For PPP agency, it would be
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131. Q.

A. 132. Q. A.

133. Q.

A.

134. Q.

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135. Q.

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necessary to change the Medical Home, sign a COI and start a new Medical Record. 136. Q. A patient visits the clinic to complete his renewal for ORSA. The clinic is not the Medical Home of the patient. Can the yearly income be checked for the patient, or should the patient be sent back to Medical Home to complete the renewal? No, the patient should not be sent back to the Medical Home to complete the renewal. The clinic that had the visit can complete the renewal for the Medical Home. A HWLA patient visits a PPP clinic for a TB test. Can it be billed to HWLA? No, TB test is not covered by HWLA, unless the patient has a medical visit to see a physician, then TB test can be part of the visit. There is no field on the HWLA renewal form to indicate that the patient provided Citizenship document. Why is that? The citizenship document is not required to renew patients HWLA coverage. Only the income verification is required to renew patients information; therefore, the Income Verification document is required to be scanned into Websphere. A patient is enrolled in the HWLA program; however, after a week he/she is identified to have Community Health Plan. Should the patient be disenrolled from the HWLA program? Yes, the patient will not qualify for HWLA as soon as he/she has another type of health insurance. Please submit appropriate form of disenrollment (PPP) or insert appropriate code in the Affinity (DHS). Patients I-551 residency card has been renewed to I-190 and the new issue date shows less than 5yrs legal residency. Does the patient still meet the legal residency requirement for HWLA? Yes, as long as the date of the entry is 5 years or more, they meet residency requirement. The legal residency card is asked from the patient only once when they first enrolled into the program. If grandparents use tax records as proof of income to HWLA, and in the tax records grandchildren are claimed as grandparents' dependant; is there MEDICAL LINKAGE? Should we go ahead and continue with the HWLA enrollment? Is the ORSA still good, or should ORSA be recalled? If a grandparent is claiming a grandchild (ren) for income tax purposes she/he must be evaluated for Medi-Cal as a Caretaker Relative as a condition of eligibility for ORSA (See Medi-Cal Checklist # 6). If the grandparent has ORSA, the current ORSA agreement should be voided. If the grandparent is determined
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137. Q. A.

138. Q. A.

139. Q.

140. Q.

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141. Q.

ineligible for Med-Cal for reasons other than cooperation (excess resources) she/he may, at that time, be ORSA eligible. Until ORSA eligibility is reestablished there is no HWLA eligibility. 142. Q. If an adult patient presents himself/herself without adequate proof of address, can the patient's adult son/daughter use his/her ID, as proof of address and sign an AFFIDAVIT as being the legal responsible person for his/her adult parent. (In this case the adult parent is not mentally incapacitated). At all times, affidavits are to be used as a last resource especially to verify LA County residency. If a parent is living with an adult child the parent may present a rent receipt or letter from provider (adult child) verifying inkind (free rent, etc.) and/or residential address. The adult child is never to complete the affidavit. Only the applicant may complete the affidavit if he/she is homeless, leaving in a shelter, living in the home of another (usually for the undocumented who cannot provide proof), living in rural area without Postal Service, and/or seeking specific Medical Services, (e.g., minor consent services, family planning, DHS mental health services). The issue comes from policy 515.1; policy does not clarify who is "legally responsible relative". The California Code of Regulations, Title 22 Section 50351; defines responsible relative as spouse for spouse; parent to minor child under 21; however, it does not mention responsible adult as adult child to adult parent. What can we do in this case? I was advised by my supervisor to find out if there was a more clear and specific wording for this policy. When we are talking about a person being responsible for another person, we mean financially responsible. As you mention, the MediCal definition of a responsible relative is a spouse for spouse; parent to minor child under 21. An adult child is not responsible for adult parents. Adult children may act on their parents behalf (incapacitated, disabled, etc.) but are not financially responsible for a parent. A patient qualified for ORSA, then became ORSA eligible with liability (457). Now the patient has ORSA with no liability (473). Should the patient be re-enrolled into the HWLA? No, activate the 700 code in Affinity. There is no need to re-enroll the patient. When the patient is disenrolled from the program, do his/her documents remain in the Websphere or they would need to be uploaded again when the patient is re-enrolled? No, there is no need to upload the documents again. However, make sure that the ORSA is current; upload the Income Verification Attestation form and update the 700 code in the Affinity. Affinity will automatically populate the date of ORSA.
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143. Q.

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144. Q.

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145. Q.

A.

146. Q. A.

When patients eligibility is renewed and he/she still qualifies for the HWLA, should a new card be issued to them? No, patients can use the old card. The only update that would need to be completed is to upload the Income Verification Attestation form in the Websphere. A patient is a US refugee and applied for asylum. Can he/she qualify for HWLA? No, the patient has to be a US citizen or have 5yrs of legal residency to qualify for HWLA. Asylum seekers are not legal residents of USA. According to the ID card a patients residency belongs to Ventura County. According to the mailing address, the patient is a homeless leaving in LA County. Can the mailing address be used for residency? Yes, the mailing address can be used for residency purposes, however, the patient must sign an Affidavit explaining that he/she is a homeless and resides in LA County. For DHS facilities, the address in the Affinity should reflect the LA County address. Can the Unemployment Check be used as an income document? Yes, the Unemployment Income is a source of unearned income and can be used for verification purposes. When a person comes to apply for HWLA and brings in his/her unemployment check stubs do we subtract $90 from the amount received? No, the $90 work related expense is allowed for each employed person regardless of hours of employment as an Earned Income Deduction. Unemployment Income Benefit (UIB) is a form of unearned income that is not earned through labor or personal effort; therefore, the $90 deduction is not allowed. According to the income calculation worksheet instructions unemployment is an unearned income, however taxes are taken out of the amount that they receive. Do we subtract $90? Do we do any calculations for the taxes that are taken out? Taxes are not taken out of the amount of UIB received. However, individuals must report Unemployment Compensation on Income Tax returns (1040). No, do not subtract $90 (See above). Can we accept verification from the hospital as proof of Birth Certificate? In Affinity on our new utility for HWLA Citizenship and identity window it shows U.S. HOSPITAL RECORD EST AT THE TIME OF THE PERSON'S BIRTH. It depends on the type of verification that the hospital provides. Please review Citizenship Document, Tier 3 listed as acceptable: Extract of hospital record on hospital letterhead established at the time of birth.
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147. Q. A.

148. Q.

A.

149. Q. A.

150. Q. A.

151. Q.

A.

152. Q.

A.

o Must be dated 5 years before the HWLA application o Must show a U.S. place of birth. The information should be listed in Affinity on the Utility for HWLA Citizenship and Identity Window. Note: Souvenir birth certificates are not acceptable. The documents mentioned above traditionally are signed by the hospital administrative office. 153. Q. We have some very illegible copies of birth certificates. The one we are particularly concerned about is from Riverside County. The birth certificate is just old and withered. The Registered Number however is very legible. This number is similar to the number we obtain when we go to Norwalk to obtain proof for those patients who were born in LA County. That number is then recorded on the Attestation Form as proof of citizenship. Since we have the Registered Number from Riverside County's Registrar's Office, could we record that number onto the Attestation Form and use that as acceptable proof as we do when we obtain that number from Norwalk? Or do you think it is necessary to forward to IT to search through the California Born Index. If audited, we should be able to use the registered number to get to the Birth Certificate but if you can find the proof via the CA Birth Certificate match, it would be much better. We do not have the same relationship with Riverside as we do with LA County Registrars Office. We are not sure how cooperative Riverside would be should we need to obtain the proof for an auditor. Are Royalties considered Unearned or Earned income? Royalties are unearned income source and they are calculated as one lumped sum on the Income Calculation Worksheet. When assessing income verification for HWLA, when your auditors find a paycheck stub uploaded onto WebSphere that is for one or two weeks' worth of pay only, do they assume the income is nonfluctuating or do they also require notation that the income is nonfluctuating? According to page 2 of the Income Verification Guidelines, if it is non-fluctuating income, one paycheck stub is sufficient and does not need to reflect a month's worth of pay. However, there are no directions as to how to document that the pay is non-fluctuating. Could you please give us guidance on this issue? When staff goes to facilities and completes HWLA site visits, they do not check WebSphere. Normally they are seeing the facilities' HWLA documentation/packets (e.g., Income Calculation Worksheet, comment sheets, etc). However, in the Income Verification Guidelines, page 1, it mentions that all income must be identified as "whether income is fluctuating or non-fluctuating". If WebSphere only has one copy of a check stub and the worker used this income amount to do the computations in
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A.

154. Q. A.

155. Q.

A.

the Income Calculation Worksheet, we can assume that the worker has made a determination that the check stubs do not fluctuate. Currently, the only place that a worker could document income fluctuating/non-fluctuating could be by making a notation in their comment sheet or in the Income Calculation Worksheet. We may need to add a check box on the worksheet to make it clearer. 156. Q. A. Can a Home Loan be counted as an income? A home loan is not counted as income since it is expected to be paid back. Cash payments (including funds received for the purchase of temporary housing) or in- kind replacement received from any source for purpose of repairing or replacing exempt property that is lost, damaged, or stolen is exempt property in the month of receipt. Online birth certificate orders require a notarized form to be faxed to the State Vital Records verifying the identity of a patient along with a payment of $10 or $15. Additionally, the travel time to go get it done becomes additional barrier for the homeless. Amazingly, the homeless dont know their mothers maiden name and they are born in CA. Will HWLA reimburse for online birth certificate orders? Yes, for a CA birth certificate to be ordered online, a notarized request is required. HWLA only reimburses for online birth certificate requests for states other than CA. This is because we have access to the State Vital Statistic's birth records database, which we match up with our list of HWLA potential eligible candidates, and email out to the agencies monthly. Email us or HSA IT a list of those names that you cannot find on your facilitys CA-Born list so we can check in our master database. The patient is a student with no income, except the financial aid or a student loan that he/she receives from the school. Are they eligible for HWLA? The financial aid received from school for tuition, books, etc. is not counted as an income. Student loans are not considered income, since they have to be paid back. Therefore, considering that this student meets the citizenship/ identity criteria, he/she is eligible for HWLA.

157. Q.

A.

158. Q.

A.

IT & HWLA ADMINISTRATION ANNOUNCEMENTS 1. Effective September 2008, PPP clinics are allowed to see more patients on the Websphere. Unlike previously, where PPPs were not able to find patients if they were pre-assigned to other medical homes, PPPs will be allowed to see patients who have visited a PPP clinic at least once.

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2. DHS patients entered with a 700 code will show up in the HWLA ODS within an hour. The system is being updated hourly. 3. The technical guide for WebSphere has been revised with the new enhancements and has been posted on the HWLA website for all users as a reference guide or a staff training tool. 4. Coming soon, DHS will have access to the DPSS GR eligibility system, where there would be no need for facilities to ask an income verification document from the patient. GR eligible patients will be added to the CA Born Birth Certificate Verification Listing which is now being sent to facilities monthly. 5. Effective next month the Roster of Enrolled Patients will include the name of the facility where patient was enrolled as an HWLA patient. 6. Effective February 2, 2009 the search capability for potentially eligible patients expanded in WebSphere. In the past, clinics were only able to find patients whom HWLA Administration has previously identified as being potentially eligible for HWLA. Now, if clinics search by entering patients Name and the Date of Birth, this allows the system to search both HWLA and non-HWLA databases in DHS, thus providing more ability to find patients from other DHS and PPP databases in DHS, not just those we put into our database for HWLA potentially eligible. 7. The electronic version of the Disenrollment Forms for DHS and PPPs have been added to the HWLA website under HWLA Training Manual to be completed and sent to HWLA Admin when requesting that the patients be disenrolled from the program. Please follow the instructions are on the form. 8. Effective immediately once DHS facilities enter patients address changes into the Affinity System and enter the 700 code, within an hour the Webshpere information will be automatically changed to match the new information in the Affinity. This automation will also change the information in the HWLA ODS (Operational Data Storage) which will then update the new information in the Office of Managed Care PMS (Patient Managed Care) system to support the distribution of the member packages to correct addresses. 9. Effective 6/9/09 a revised Attestation form must be used where patient will need to declare that he/she is a US Citizen or a Legal Resident. The revised Attestation forms are available at HWLA website in English and Spanish. 10. Effective 7/6/09 a new Income Attestation form must be used for HWLA renewal process. Remember, you must have proof that you asked for income verification and that two weeks have passed since the request was made. Other documentation may be used to prove that income verification has been requested (e.g., logs, copies of correspondence, etc.). The form is to be dated by the patient/responsible relative on the date the attestation form is signed/given. As a reminder to the patient enter on the form the period for which income verification is needed. For example, if we are asking the patient to sign the renewal
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attestation form in August 2009 and the patient's ORSA renewal was effective June 2009 we need to ask the patient for income verification for June 2009. The Income Attestation form cannot be back-dated or retro claimed, as there is no retro HWLA coverage. The HWLA effective date is the date of the ATP or ORSA/COI application (not to exceed September 2007). We must have an ATP or ORSA/COI application with an application date prior to the service date that covers the time period. If the application was for ATP, the income verification requirement has already been satisfied. However, if the application was for ORSA, we must request income verification for the time period of the ORSA application date. For example, applications were taken in January 2008 and March 2009; we would need to request income verification for both of these months. This request for these periods must be documented. If the patient does not respond within 2 weeks of the request, the income verification is considered satisfied. The documentation showing the request should be scanned. We should not share this with the patient but should encourage patients to provide income verification. If the patient provides verification, we should ensure the verification shows income of 133 1/3% FPL using gross income less $90 if the patient is employed, which is consistent with Medi-Cal guidelines. If so, scan the income verification. If the income verification provided is in excess of 133 1/3% FPL, the patient is not eligible for HWLA but they continue to be eligible for ORSA. ORSA is declaratory and is completely separate from the HWLA process. 11. Effective 7/22/09 the HWLA Income Calculation Worksheet is mandatory to be completed for HWLA patient to determine the income eligibility; however, it is not required to scan the worksheet into the Websphere. 12. On 7/30/09 the DHS Revenue Management distributed two PDF files (Part 1 and 2) of "WHERE TO WRITE FOR VITAL RECORDS" list (updated 7-9-09) published by the National Center for Health Statistics http://www.cdc.gov/nchs/w2w.htm. The list provides addresses and fees for obtaining a certified copy of a birth record alphabetical by State. Also, it provides additional information that each State may require, e.g., patients identification, who the check should be made payable to, telephone number to verify current fees, etc. 13. Effective October, 2009 a new form will be used for patients disenrollment requests. DHS facilities will no longer require submitting disenrollment requests due to reasons such as, Age older than 64, Relocation, Increased Income, New Health Insurance, including Medi-Cal, Access for Infants and Mothers Programs, and IHSS. For those reasons enter the appropriate Carrier Codes in Affinity .Please refer to the new form for all the other reasons that will require reporting. The PPP facilities will still submit disenrollment requests for all reasons mentioned above, except Age >64.
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