Friday, June 14, 2019

ACES program code list

ACES Program Codes

Some provider groups rely on the ACES program codes to help them determine if the client is on a state-only program or is on a Washington Apple Health Medicaid program to identify their funding sources. The following table lists these program codes.

SSI and SSI Related SSI and SSI related, also called Aged/Blind/Disabled (ABD); disability is determined by SSA or by NGMA referral to DDDS 

ACES DESCRIPTION  SCOPE 

S01 SSI Recipients CN
S02 ABD Categorically Needy CN
S03 QMB  Medicare Savings Program (MSP)  Medicare premium and co-pays MSP
S04 QDWI Medicare Savings Program   MSP
S05 SLMB Medicare Savings Program. Medicare Premium only  MSP
S06 QI-1 (ESLMB) Medicare Savings Program  MSP
S07 Undocumented Alien. Emergency Related Service Only ERSO 
S95 Medically Needy no Spenddown MN
S99 Medically Needy with Spenddown MN SSI Related
Living in an alternate living facility (nonmedical institution) adult family home, boarding home or DDA group home.


SSI Related Healthcare for Workers With Disability

Institutional  HCBS Waivers (HCS/DDA) and Hospice; SSI related  G03
Non Institutional Medical in ALF CN-P Income under the SIL plus under state rate x 31 days + 38.84
G95 Medically Needy Non Institutional in ALF no spenddown MN
G99 Medically Needy Non Institutional  in ALF with Spenddown MN
S08  Healthcare for Workers with Disability CN-P Premium based program.  Substantial Gainful Activity (SGA) not a factor in Disability determination.  
L21 Categorically Needy DDA/HCS Waiver or Hospice on SSI CN  L22
L24  Categorically Needy DDA/HCS Waiver or Hospice – gross income under the SIL Undocumented Alien/Non-Citizen LTC - residential placement. Must be preapproved by ADSA program manager. Emergency Related Service Only (45 slots)
L31 PACE or hospice on SSI (effective 10/1/15) CN
L32 PACE or hospice – SSI-related (effective 10/1/15) CN
L41 Roads to Community Living on SSI (effective 10/1/15) CN
L51 Community First Choice (CFC) on SSI (effective 10/1/15) CN
L52  Community First Choice (CFC) – SSI related at home or in an ALF (effective 10/1/15)
L99 Medically Needy Hospice in Medical Institution.  With Spenddown MN Institutional  SSI  L01
SSI recipient in a Medical Institution - Residing in a medical institution 30 days or more
CN Institutional
SSI Related Residing in a medical institution 30 days or more   
L02 SSI related CN-P in a Medical Institution Income under the SIL CN  L04  L95
L99  Undocumented Alien/Non-Citizen LTC must be pre-approved by ADSA program manager. Emergency Related Service Only (45 slots)
SSI related Medically Needy no Spenddown Income over the SIL. Income under the state rate.
SSI related Medically Needy with Spenddown Income over the SIL. Income over the state rate but under the private rate. Locks into state NF rate  CN  CN
ERSO – CN scope  CN
ERSO – CN scope  MN  MN


Categorically Needy Program (CNP)

This program has the largest scope of care.  A few of the services are:doctors, dentists, physical therapy, eye exams, eyeglasses (children only), mental health, prescriptions, hospitals, and family planning for men, women, and teens. There is limited coverage for maternity case management, orthodontia, private duty nursing, and psychological evaluations.Chiropractic care and nutrition therapy are limitedto the Healthy Kids program.


Alternative Benefits Plan (ABP)

This program is available to persons eligible to receive health care coverage under Washington Medicaid’s Modified Adjusted Gross Income (MAGI)-based adult coverage.  The scope of services available is equivalent to that available to CNP-covered clients with the addition of a benefit for habilitative services.  Washington Administrative Code (WAC) program policies are applicable to this new eligibility group, as are the instructions in the ProviderOne Billing & Resource Guide and program-specific provider guides.  This client population does not include those eligible for Medicare.


Emergency Related Services Only (ERSO) –PA may be required


This program has coverage for only specific medical conditions: a qualifying emergency, end stage renal disease on dialysis, cancer actively receiving treatment, or post-transplant status on anti-rejection medications. Prior authorization for some services may be required. Services not related to the medical condition are not covered. HCA determines if the client has a qualifying condition for any of these programs in accordance with the Washington Administrate Code (WAC) criteria. For specific details please see Chapter 182 - 507 WAC


.
Take Charge –Family Planning Service Only (TCFPO)

This program is for both women and men.It covers family planning services such as annual examinations, family planning education and risk reduction counseling, FDA approved contraceptive methods such as birth control pills and IUDs, emergency contraception,and sterilization procedures.

Family Planning Services Only (FPSO)


This program is  for women. Services includecoverage for all birth control methods, sterilization, OB-GYN exams, and counselingto help with family planning.

Medical Care Services (MCS) -no out of state care

This program covered many of the most basic services such as doctor's visits, prescriptions, and hospitalizations. However, some services, such as dental and mental health treatment may have restrictions that require prior authorization or may not be covered. This benefit was previously known as General Assistance (GA) and Disability Lifeline (DL).

Alcoholism and Drug Addiction Treatment and Support Act (ADATSA) -no out of state care

This program covered many of the most basic services such as doctor's visits, prescriptions, and hospitalizations.However, some services, such as dental and mental health treatment may have restrictions that require prior authorization or may not be covered.Coverage is equivalent to Medical Care Services (MCS) below, with the addition of treatment for alcohol and drug addiction.


Limited Casualty Program – Medically Needy Program (LCP-MNP)

This program covers many medical services. A few of the services are:doctors, dentists, eye exams, eye glasses (children only), mental health , prescriptions, and hospitals, family planning for men, women, and teens.There are some services that are not covered, such as physical therapy.There are also limited services: maternity case management is one example. Chiropractic care and nutrition therapy are limited to the Healthy Kids program.


 

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