Retro Cancel Reinstate

Occasionally, a customer on an existing case may report an income, resource or expense change from a prior month. This change could potentially make them eligible for a higher benefit group. The VaCMS provides the ability to change previous eligibility determinations by running eligibility for past months.  

Retroactive changes will only be made when the level of coverage improves (no coverage to limited/full coverage, or certain limited coverage to certain full coverage categories). If the Aid Category (AC) changes and the level of coverage remains the same or decreases (moving from a full coverage AC to another full coverage AC or moving from full coverage AC to a limited coverage AC) for a prior month, then no action is required.

For Example: An individual applies for assistance in September 2015, and the customer is approved for a QMB in September.  In May 2016, the customer calls to report a change that took effect in October 2015.  The worker updates the case details and effective begin date accordingly, then runs Retro Cancel Reinstate for the month of October 2015 onwards.  The new eligibility results show that the customer is eligible for ABD 80, instead of QMB, starting in October 2015. In this scenario, the worker would Certify / Authorize the change in coverage for past months, and send an MMIS transaction because ABD 80 provides a higher level of coverage than QMB.  

However, if the scenario is reversed, and the customer went from being eligible for ABD 80 to QMB in past months, the VaCMS would update the coverage for future months, but not past months, because the change results in a lower coverage level for the customer.

Follow the steps below to perform a Retro Cancel Reinstate:

1. Navigate to the Case Action page and enter the case number you want to modify.

2. Choose Case Change from the Which Action to you want to perform? dropdown menu.

3. Enter the new customer information on the appropriate pages.
   Note: Be sure you enter the correct Effective Begin Dates (and End Dates when applicable) on the data collection pages so eligibility reflects the actual date of change.

4. Navigate to the Wrap-Up – Run Eligibility page.

5. Enter the date from which you want to run eligibility in the Run EDBC From field.

6. Enter the date you want the eligibility run to end in the Run EDBC Until field (if necessary).
   Note: The Run EDBC Until field is optional. It can be used to narrow the range of the eligibility run. You may consider entering a date in this field when the change involves a pregnancy or a temporary job, or if the customer is a seasonal worker or temporarily laid off.

7. Click Next to re-run eligibility.

8. The eligibility dates display on the Eligibility Summary page.

1. • If the Retro Cancel Reinstate resulted in a change in the AC code, you will see a new EDG record. Certify/Authorize the results and send the new results to MMIS.

   • If the Retro Cancel Reinstate did not result in a change, the Eligibility Status will read No Action Needed.
     Note: The Certification / Authorization page does not display No Action Needed EDGs

   • If the Retro Cancel Reinstate resulted in a lower level of coverage for prior months, the status will read No Action Needed.  

9. Complete MMIS transactions
10. Certify and Authorize
11. Navigate to the pending forms page to take the appropriate action based on the print mode

Important Items

1. • You can perform a Retro Cancel Reinstate during Case Change case action

   • Customers cannot receive a reduction in prior benefits as a result of reporting a change. They can only transition into a lower coverage level for current and future months. Changes for current/future months go into effect differently depending on when you perform the Retro Cancel Reinstate.

   • • If you run the Retro Cancel Reinstate prior to cutoff, the current month is the next calendar month (For example: you run a Retro Cancel Reinstate on December 2, any change in current benefits will go into effect on January 1st.)

     • If you run the Retro Cancel Reinstate after cutoff, the current month is the month after next. (For example: if you run a Retro Cancel Reinstate on December 20, any change in current benefits will go into effect on February 1st.)

   • Retroactive updates are applicable up to 12 months (including the current month) in the past from the date you run eligibility.  

   • You can make changes and re-run eligibility only back to the conversion month for converted cases. For non-converted cases you can re-run eligibility back to the most recent application date (including retro application months).

   • Retro Cancel Reinstate will not re-open benefits for past months on any case that was automatically closed in MMIS, such as for MMIS closure reason 12. It will issue benefits for current and future months.

   • • For any months determined that no authorization is required, select Override.

     • Then add the specific EDG that needs a MMIS transaction sent but has been determined no action needed.

     • Select the Eligibility / Service Period, then enter the Override Begin Date and End Date (if applicable).

     • Click the checkbox for Reinstate Eligibility for Past Months.

     • Enter the Override Reason, then click Approve.

   • For Patient Pay adjustments, the VaCMS will recalculate past patient pay amounts and apply the net effect of patient pay changes to patient pay amounts for future months. For Example:  A customer’s patient pay amount is $300. After completing a case change and running retro cancel reinstate, the recalculated patient pay amount is $500. The customer had already paid two months of patient pay at $300, so the total underpayment is $400 ($200 + $200). The VaCMS will automatically adjust the following month’s patient pay to $900 ($500 + $400) to recoup the amount owed.

   • • If a change results in an underpayment less than $1500, the VaCMS will adjust future patient pay amounts to recoup the amount owed

     • If the change results in an underpayment greater than $1500, DMAS will handle recoupment. A message will appear on the Notice Reason referring the individual to DMAS RAU

     • If a change results in an overpayment, the VaCMS will adjust future patient pay amounts to credit the overpaid amount. Once the credit is fully applied, the recalculated patient pay amount will begin

   • Retro Cancel Reinstate will incorporate Spenddowns

   • • If the Run EDBC From month is not entered and the future month is part of spenddown period, then eligibility will automatically run from spenddown begin date of that period.

     • If the Run EDBC From month is entered and that month is part of spenddown period, then eligibility will automatically run from spenddown begin date of that period.

     • For an institutionalized individual with one month Spenddown periods, enter the Run EDBC From month and eligibility will run from the month entered.

Updated: 05/31/2016