|
|
MEDS Update 2025-1 High Priority and Performance Standards Alerts processing
MEDS High Priority and Performance Standards Alerts processing
| Date | References | Clerical | Implementation |
| 01/21/2025 | ACWDL 23-14; ACWDL 24-17 | N/A | Immediately |
Background
Historically, DHCS allowed counties to self-certify performance standards. Upon implementation of the Affordable Care Act, DHCS suspended performance standards and planned to lift the suspension in early 2020, however, due to Novel Coronavirus Disease Public Health Emergency and the Continues Coverage Unwinding, the suspension remained in effect.
Changes
Effective June 2024, DHCS lifted performance standards suspension policy and will transition to data driven performance monitoring. DHCS will be monitoring total of 37 High Priority and Performance Standards MEDS Alerts compared to previously established 21. The following Daily, Renewal and RECON MEDS Alerts have been added: 1082, 1505, 1515, 2047, 2144, 2165, 2182, 4351, 4355, 4806, 4807, 4808, 4810, 4823, 4824, 6001, 6015, 9003, 9004, 9005, 9038, 9043, 9060, 9070, 9073, 9535, 9554, 9555, 9559, 9584, and 9827. And the following Daily, Renewal and RECON MEDS Alerts remain the same: 9532, 9546, 9548, 9550, 9585, and 6005.
DHCS requires that counties process MEDS Alerts that affect eligibility and share of cost, and records that exist on the county's file but not in MEDS.
- Ninety percent on non-reconciliation MEDS Alerts should be processed by the timeframes indicated below.
- Ninety-five percent of reconciliation MEDS Alerts should be processed by the timeframes indicated below.
DHCS will use data generated by MEDS, and the CalSAWS generated MEDS Alerts dataset to monitor the processing of MEDS Alerts. The data reports are received monthly. MEDS Alerts received by the 10-working day of the month shall be processed in time for the change to be effective the beginning of the following month. Any worker alert received after the 10th working day of the month shall be processed in time for the change to be effective the beginning of the month after the following month.
Handbooks
The following MEDS HB Chapters have been revised to include a list of the existing and the additional MEDS alerts that will be included in the performance standards monitoring:
MEDS HB Chapter 5, RECON MEDS Alerts Tracking Reports topic.
MEDS HB Chapter 6, Renewal MEDS Alerts Tracking Reports topic.
MEDS HB Chapter 7, Daily MEDS Alerts Tracking Reports topic.
MEDS HB Chapter 8, MEDS Alerts 1082 and 1505.
MEDS HB Chapter 9, MEDS Alerts 2047, 2165, and 2182.
MEDS HB Chapter 10, MEDS Alerts 4351 and 4355.
Data Systems
The EW may take one or more actions to resolve MEDS Alerts. Once the alerts are corrected and tasks completed, EW must update alerts status in CalSAWS, and document corrective actions taken in the CalSAWS Journal Detail page. This action will reflect the processing rates of MEDS Alerts more accurately.
Steps on how to disposition MEDS alerts in CalSAWS are outlined in MEDS HB Chapter 5 and Chapter 6.
Department of Employment & Benefits Services
Contact Person(s): Milena Novakovic, SSA BPIS, 408-755-7540.