OHP-OPC P2 No new eligibles OPC with DOR 1/1/14 or later OHP-OP6 P2 No new eligibles OP6 with DOR 1/1/14 or later OHP-OPP P2 No new eligibles OPP Use OPP workaround with “PWO with DOR 1/1/14 WRKARND” coding when required or later to add PWO eligibility to CM OHP-OPU P2 Program closes OPU OPU eligibles were converted to the 12/31/13 MAGI Adult program effective 1/1/14 OSIPM or N/A SBI 5503 will not determine eligibility OSIPM related for OSIPM SBI OSIPM N/A N/A 5503 will not determine OSIPM services related service eligibility QMB-BAS P2 No changes QMB QMM if also eligible for OCCS medical QMB-SMB P2 No changes SMB QMB-SMF P2 No changes SMF REFM N/A OCCS medical is N/A 5503 will not determine eligibility prior resource to REFM Substitute Care C5 Effective 1/1/14 SCP, SFC, CR1, SCP, SFC replaced by: (replaces CR2 CR1: Title XIX residential treatment (new c/d indicates new “SAC”) policy that income is excluded) OCCS only CR2: XIX residential treatment (new c/d indicates new policy that income is excluded) Substitute and C5 Effective 1/1/14 SAC, SCH, CR3 SAC: out of state foster care or adoption assistance residing in Adoptive Care (SAC) Oregon SCH: Chafee medical: no new CW only Chafee clients effective 1/1/14 CR3: Former Foster Care Youth Medical Applies to multiple programs: 12E & associated date Eligibility based on 12-month continuous eligibility policy for children; children receiving medical based on 12-month CE policy should have CMO (pending implementation) coding ADM Eligible for Administrative Exam AEN & associated date Deemed eligible for Medicaid based on mother’s Medicaid/CHIP status
OHP-OPC P2 No new eligibles with DOR 1/1/14 or later OPC OHP-OP6 P2 No new eligibles with DOR 1/1/14 or later OP6 OHP-OPP P2 No new eligibles with DOR 1/1/14 or later OPP Use OPP workaround with “PWO WRKARND” coding when required to add PWO eligibility to CM OHP-OPU P2 Program closes 12/31/13 OPU OPU eligibles were converted to the MAGI Adult program effective 1/1/14 OSIPM or OSIPM related SBI N/A SBI 5503 will not determine eligibility for OSIPM OSIPM services N/A N/A 5503 will not determine OSIPM related service eligibility QMB-BAS P2 No changes QMB QMM if also eligible for OCCS medical QMB-SMB P2 No changes SMB QMB-SMF P2 No changes SMF REFM N/A OCCS medical is prior resource to REFM N/A 5503 will not determine eligibility Substitute Care (replaces “SAC”) OCCS only C5 Effective 1/1/14 SCP, SFC, CR1, CR2 SCP, SFC replaced by: CR1: Title XIX residential treatment (new c/d indicates new policy that income is excluded) CR2: XIX residential treatment (new c/d indicates new policy that income is excluded) Substitute and Adoptive Care (SAC) CW only C5 Effective 1/1/14 SAC, SCH, CR3 SAC: out of state foster care or adoption assistance residing in Oregon SCH: Chafee medical: no new Chafee clients effective 1/1/14 CR3: Former Foster Care Youth Medical Applies to multiple programs: 12E & associated date (pending implementation) Eligibility based on 12-month continuous eligibility policy for children; children receiving medical based on 12-month CE policy should have CMO coding ADM Eligible for Administrative Exam AEN & associated date Deemed eligible for Medicaid based on mother’s Medicaid/CHIP status
OCCS%20%20Coding%207-14.docx