FAA1.A Background and Introduction : 07 Handling Special Cases - Overview : A Handling Special Cases – DBME Employees
Handling Special Cases – DBME Employees
(01/01/22 – 12/31/22)
The Employee Benefit Unit (EBU) maintains all current Division of Benefits and Medical Eligibility (DBME) employee program case files(g). This includes employees of the following administrations:
Disability Determination Service Administration (DDSA)
Family Assistance Administration (FAA)
Quality Management Administration (QMA)
An active or inactive FAA program case file of a current DBME employee is locked and can only be accessed by the following:
Staff designated by DBME Administration
Human Resources
The EBU staff completes all eligibility actions on locked case files. This includes, but is not limited to, the following:
Completing the application process (new and renewal).
Processing all changes, including NA Mid Approval Contacts.
Responding to inquiries from employees, contractors, volunteers, and temporary employees.
Completing reports of potential overpayments.
Writing overpayments. (See Overpayments Overview for policies and procedures.)
Accepting and processing appeal hearing requests. (See Appeals Overview for policies and procedures.)
Attending hearings for employees who request an appeal
DBME employees must complete the application process for their own case and cases in which they are a representative during nonwork time(g).
Designated break time is considered State work time. DBME employees are not permitted to complete the following during break time:
Submit verification or complete other activities for their own benefit case.
Submit verification or complete other activities for cases in which they are the Authorized Representative.
DBME employees must not have any case involvement(g) with their own case or any case that may result in a conflict of interest. This includes, but is not limited to, the following:
Accessing, viewing, or making changes to the case file
Determining eligibility of benefits
Registering applications
Interviewing the participant
Case-specific discussion with another DBME employee about the employee’s case
Issuing EBT cards
Submitting verification on behalf of a participant with whom a conflict of interest exists
All AZTECS, HEAplus, and OnBase(g) inquiries are recorded and monitored. Actions that display on a case for which there may be a conflict of interest could be considered suspicious or potentially fraudulent activity.
DBME employees may contact the EBU for information on their own case.
When information is needed on their own case file or a case in which they are a representative, an employee may consider accessing one of the following personal accounts during nonwork time(g):
MyFamilyBenefits account
HEAplus account using the customer portal
DBME employees must not be given special privileges and must be treated as all other program participants.
Additional policy and procedures regarding employee case handling are outlined as follows: