533 C. Referral and Interagency Communications

533 C. REFERRAL AND INTERAGENCY COMMUNICATIONS

Communication is essential to ensure a quick and timely determination. The agencies and individuals involved in a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid eligibility decision and their roles are outlined below.

Comagine Health is responsible for:

Referring families to care coordination agencies and the LTC Long Term Care unit,

Working closely with care coordinators regarding the medical eligibility decision and required paperwork,

Making NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care review determinations, including notifying care coordinators and families of the annual LOC Level of Care renewal requirement,

Making the Support Plan and COC Cost-of-care review determinations for NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care cases,

Making the Support Plan and COC Cost-of-care review determinations for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care cases and maintaining a record of the LOC Level of Care approval by DDS Disability Determination Service , and

Emailing the DPA Division of Public Assistance LTC Long Term Care unit, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant and Care Coordinators when LOC Level of Care is approved or emailing the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant when LOC Level of Care is denied.

The Care Coordination Agency is responsible for:

Completing and submitting the Support Plan, COC Cost-of-care , and LOC Level of Care documentation to Comagine Health for all NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care cases,

Completing the Support Plan and COC Cost-of-care for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled -LOC cases and working with DSDS Division of Senior and Disabilities Services in the development and completion of the Inventory for Client and Agency Planning (ICAP) assessment packet,

Submitting all necessary information to Comagine Health and DSDS Division of Senior and Disabilities Services ,

Explaining to parents that they must complete a DPA Division of Public Assistance application with a referral to the appropriate DPA office, and

Contacting parents when the annual LOC Level of Care reassessment is due.

Note: TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 care coordinators only receive payment for screening, initial assessment, and yearly reassessment for LOC Level of Care and the Support Plan. TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 does not pay for monthly care coordination.

The Disability Determination Service (DDS) is responsible for:

Starting the disability determination process upon receiving the disability packet from the DPA Division of Public Assistance caseworker, and

Determining if a child is disabled using Social Security Administration criteria.

It is beneficial to include copies of relevant medical, psychological, and developmental information in the DDS Disability Determination Service packet in order to speed up the disability process. This may include Infant Learning Assessments, Individual Education Plans, current medical records (from within the past year), counseling reports, etc. See APA MS 425-3(C) and Admin Procedures MC 115-9 for policy and procedures on disability determinations.

DPA Division of Public Assistance is responsible for:

Sending the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 welcome letter (MED 16) and TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid for Disabled Children at Home brochure (MED 15) to the parent or guardian whenever an application is received for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid. This must be documented in the CANO,

Note: The MED 16 is not the same welcome letter that Comagine Health sends the child's parent as described in MS 533(D)(2) .

Completing the Medicaid eligibility determination,

Submitting the disability packet to DDS Disability Determination Service for initial applications, tracking disability review dates, and submitting a disability review at the application time,

Making referrals to Comagine Health with the GEN 140B form once the family has interviewed,

Pending the application until all factors of eligibility are met. TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 applications must be approved or denied within 90 days. Follow the procedures below:

Pend new applications for 60 days from the date of application.

Send the M320, Information Needed - TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 notice, to pend a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application. Send a copy of this notice to the care coordinator.

On day 61:

If the LOC Level of Care decision is missing, notify Comagine Health and request a LOC Level of Care update. If LOC Level of Care has not been determined and it appears the decision may go past 90 days, contact the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will work with Comagine Health to determine the appropriate action. The LTC Long Term Care unit will be notified of status.

If the DDS Disability Determination Service decision is missing, contact DDS Disability Determination Service and request an update on the disability decision. If a disability decision has not been determined and it appears the decision may go past 90 days, contact the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will work with DDS Disability Determination Service to determine the appropriate action. The LTC Long Term Care unit will be notified of status.

Exceptions to the 90-day Processing Time Frame for Initial Applications: Refer requests for extensions to the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. When an extension is needed 90 days after date of initial application, the person making the request will need to provide the reason(s) for the extension. Extensions will only be approved when the parent submits a written request stating the reason for the extension and acknowledging and accepting the delay in processing. Although not required, they may use the Initial Application Extension Request Form (MED 36) to make the request.

Making the final approval or denial of TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid in EIS Eligibility Information System . The DPA TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice,

Issuing DE 25 disability exam coupons if the child needs additional screenings,

Issuing WD 19 screening coupons for the care coordinator, and

Communicating with Comagine Health any changes in status, including:

When a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child is approved for HCB Home and Community-Based waiver services,

When a child becomes eligible for and the family elects to move the child to a different category of Medicaid,

When a Medicaid case closes for any reason, including failure to submit a DPA Division of Public Assistance renewal, and

When a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application is denied.

The Division of Senior and Disabilities Services (DSDS) is responsible for:

Completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care assessment and making ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care determinations,

Processing all referrals for initial ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care determinations and renewals received from Comagine Health,

Reviewing submission of the completed ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care packet to ensure it is submitted by the care coordinator, is complete, and DSDS Division of Senior and Disabilities Services is able to make a level of determination within specified time frames. If not, DSDS Division of Senior and Disabilities Services will notify Comagine Health,

Reporting ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care approvals or denials to Comagine Health, and

Certifying all care coordinators, including TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 care coordinators.

Note: The same regulations are used to determine level of care for IDD Individuals with Intellectual and Developmental Disabilities waivers that are used for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled assessments for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 . If a child is approved LOC Level of Care for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 but denied LOC Level of Care for HCB Home and Community-Based waiver services, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant must be contacted immediately.

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