Pre-Natal CAWEM Expansion (CWX)

Overview of Pre-natal CAWEM

Expansion Program

“CAWEM Plus” benefit package

Eligibility

CM system coding & notices

This training will cover

Began 04/01/2008 in Multnomah and Deschutes

counties

Five additional counties added 10/01/09: Benton, Clackamas, Hood River, Jackson, Lincoln*

Lane County added 01/01/11

*Due to budget constraints, the program was ended in Lincoln County in December 2009.

CWX History

Columbia, Crook, Douglas, Jefferson, Morrow,

Union and Wasco counties were added to the program July 1, 2011

Umatilla County added to the program April 1, 2012

CWX History

10/01/2013: CWX Expanded to every County in Oregon

CWX History

Combines federal (CHIP) monies with county & state

funding

CAWEM Plus benefit package for pregnant CAWEM women

CAWEM Plus is primarily to benefit the unborn child

CAWEM Plus benefits end the day after the baby is born

Note: Consumer still has 60 days protected CAWEM eligibility based on the DUE N/R date

Pre-Natal CAWEM Expansion Program (CWX)

Covers almost all OHP Plus medical

services during pregnancy

Services not covered: Death with dignity Sterilization Therapeutic abortion Hospice

Pre-natal CAWEM Expansion Program

CAWEM Plus consumers are not enrolled in

a CCO

CAWEM Plus consumers will remain on an open card

CAWEM Plus consumers can still see their regular doctor if they accept an open card

CWX Consumers not Enrolled

C/D of both CWM and CWX

CWX coding tells MMIS to provide CAWEM Plus CM automatically sends an approval notice

when CWX added (2D)

N/R of both CWX and DUE the CWX date is the month in which 10-day

notice period lands the DUE date is the month that the

consumer is due to deliver

CWX coding

If the Consumer’s expected due date is

on or before the 15th: Code a CWX of that month

If the Consumer’s expected due date is after the 15th: Code a CWX of the following month

CWX N/R Coding

Henriquetta is due to deliver her baby on 10/09/13. She is eligible for OSIPM CWM. What coding will you have on the case and what dates will you use?

Coding Example

CWX coding for 10/09/2013 DUE date

CWX coding for 10/09/2013 DUE date

Maritza is expected to deliver her child on

10/16/13. She is eligible for OSIPM CWM. What coding will you have on the case and what dates will you use

Coding Example

CWX coding for 10/16/13 DUE date

CWX coding for 10/16/13 DUE date

CM approval notice is also a reduction notice

Mother’s benefits reduced to CAWEM the day after the

pregnancy ends

Baby is an AEN

5503 will add the AEN when they are notified of the

birth

If the agency is not notified timely that the pregnancy

has ended, the CWX N/R date triggers a reduction

notice (86B)

When notified timely that pregnancy ended, CAWEM Plus reduced to CAWEM

Use a “MEDI” action on the CM case and

reduce the mother to CAWEM. The effective date will be the newborn’s DOB

Change mom’s start date to match the newborn’s DOB. Her benefits will reduce to CAWEM the next day

Remove CWX C/D and N/R coding

Send a MEDC form to 5503 to notify them of the birth of the baby

Coding changes when baby is born

CWX N/R end date will trigger CM

reduction notice (84B)

Benefits are reduced to CAWEM on the first of next month

What if the agency is not notified of the birth?

Maria is a pregnant CWX consumer; the

new baby is due May 13, 2013 DUE and CWX N/R date is 05/13 If the agency is not notified of birth:

10-day reduction notice will automatically be sent to reduce Maria’s medical to CAWEM for June 1

Example of CWX automatic reduction notice

Consumers still have 60 days protected

CAWEM eligibility based on the DUE N/R date

Restore benefits to CWX and update coding if she contacts the branch and is still pregnant

Example, cont.

The worker ends the consumer’s CWX

benefits for the 1st of the month after the 10-day notice period and sends the CMRCWXR or SPRCWXR notice of reduction through NOTM

The consumer remains on CWM through their protected 60-day post partum eligibility period

What if the consumer’s pregnancy ends before their

DUE month?

Enter a “COMPUTE” action for the first of

the month following 10-day notice period Remove the CWX C/D and N/R codes Update the DUE N/R to match the

month/year the pregnancy ended Update the medical start date to the first

of the next month Send the CMRCWXR or SPRCWXR notice

of reduction

System actions when pregnancy ends early

CMR2CWM and SPR2CWM: Reduce to

CAWEM; not in pilot

Example: Margaret is due December 15. However, we’re notified in November that she lost the baby. Send the 10-day CMR2CWM reduction notice and compute to remove CWX coding the first of the month

after the 10-day notice period.

NOTM notices

CM 2D Pre-natal Approval Notice

- Automatically sent when adding new CAWEM Plus consumer

CM 01G CWX Benefits End – Advance Notice- Automatically sent the month before the DUE need/resource end date (8th month of pregnancy)

CM 84B County Pre-natal Reduction - Automatically sent based on CWX need/resource end date when DHS/OHA is not notified timely of pregnancy ending

CM notices