Overview of Pre-Natal CWX Expansion Program

 
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 15
th
:
Code a CWX of that month
 
If the Consumer’s expected due date is after
the 15
th
:
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
 
- A
utomatically 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
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This training provides an overview of the Pre-Natal CWEM Expansion Program, detailing the history, benefits, eligibility criteria, and coding process. It covers the expansion of CWX to various counties in Oregon, the combination of federal and state funding, covered medical services during pregnancy, consumer enrollment details, and coding instructions for providing benefits automatically.


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  1. Pre-Natal CAWEM Expansion (CWX)

  2. This training will cover Overview of Pre-natal CAWEM Expansion Program CAWEM Plus benefit package Eligibility CM system coding & notices

  3. CWX History 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.

  4. 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

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

  6. Pre-Natal CAWEM Expansion Program (CWX) 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

  7. Pre-natal CAWEM Expansion Program Covers almost all OHP Plus medical services during pregnancy Services not covered: Death with dignity Sterilization Therapeutic abortion Hospice

  8. CWX Consumers not Enrolled 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

  9. CWX coding 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

  10. CWX N/R 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

  11. Coding Example 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?

  12. CWX coding for 10/09/2013 DUE date

  13. CWX coding for 10/09/2013 DUE date

  14. Coding Example 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

  15. CWX coding for 10/16/13 DUE date

  16. CWX coding for 10/16/13 DUE date

  17. When notified timely that pregnancy ended, CAWEM Plus reduced to CAWEM 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)

  18. Coding changes when baby is born 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

  19. What if the agency is not notified of the birth? CWX N/R end date will trigger CM reduction notice (84B) Benefits are reduced to CAWEM on the first of next month

  20. Example of CWX automatic reduction notice 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

  21. Example, cont. 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

  22. What if the consumers pregnancy ends before their DUE month? 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

  23. System actions when pregnancy ends early 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

  24. NOTM notices 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.

  25. CM 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

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