533 D. Case Processing

533 D. CASE PROCESSING

Initial Applications

An initial application can come in the following forms:

MED 4 application or referral from denied MAGI Modified Adjusted Gross Income Medicaid application. If a MED 4 application is submitted or a referral from a denied MAGI Modified Adjusted Gross Income Medicaid case is received, send notice M320, Information Needed - TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 .

Referral from MAGI Modified Adjusted Gross Income Medicaid when there is no MAGI Modified Adjusted Gross Income Medicaid eligibility and the application includes a disabled child.

If the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 process starts from a denied or closed MAGI Modified Adjusted Gross Income case, send notice M322, PEND TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Disabled Child Denied DKC Denali KidCare . The family is allowed 15 days to:

Contact Comagine Health to be connected with a care coordinator for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 and begin the LOC Level of Care assessment process,

Return the MED 1, MED 2, and any accompanying medical information for a disability determination, and

Complete an interview.

The caseworker must follow procedure outlined in MS 533(C)(4) .

Actions for NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care

After receiving a referral from DPA Division of Public Assistance by the receipt of the GEN 140B, Comagine Health will send the child's parent or guardian a welcome letter and ask the parent to contact Comagine Health within 30 days for care coordinator referrals. This letter also instructs the parent to contact DPA Division of Public Assistance if needed.

If the parent contacts a care coordinator and begins the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 assessment process, Comagine Health will:

Receive ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care applications and make appropriate referrals to DSDS Division of Senior and Disabilities Services (refer to step below for further ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled processing) and track the process to ensure the care coordinator provides a completed assessment for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care , completed COC Cost-of-care , and completed Support Plan within required time frames . The care coordinator's failure to provide these documents will result in denial.

Track the process to ensure the care coordinator provides a completed assessment for NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care , completed COC Cost-of-care , and completed Support Plan within required time frames . The care coordinator's failure to provide these documents will result in denial.

If the care coordinator follows through and provides all documentation in the required time frames, Comagine Health will make a LOC Level of Care decision and notify DPA Division of Public Assistance of approval or denial.

If LOC Level of Care is denied, Comagine Health notifies the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant with the following information:

Name of child,

The child's care coordinator, and

Rationale for denial.

The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant issues the denial letter and sends a copy to the LTC Long Term Care unit. The LTC Long Term Care unit completes all actions in EIS Eligibility Information System .

Actions for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care

If an application for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care is received, Comagine Health will make a referral and provide the following information to DSDS Division of Senior and Disabilities Services for all new applications and ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled renewals:

Child's name, date of birth, and SDS Senior Disability Services ID number,

Date required for LOC Level of Care determination to meet DPA Division of Public Assistance time frames, and

Care coordination agency and main contact person.

After the initial referral, the following steps occur:

Step 1:

DSDS Division of Senior and Disabilities Services sends the care coordinator an email requesting the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet be forwarded to DSDS Division of Senior and Disabilities Services .

Step 2:

The care coordinator has 30 days to send the ICAP Inventory for Client and Agency Planning Evaluation packet to DSDS Division of Senior and Disabilities Services .

If the packet is not completed and a level of care determination cannot be made within 90 days, Comagine Health will issue a denial due to not completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet.

If DSDS Division of Senior and Disabilities Services receives all documentation and determines the child does not meet LOC Level of Care , DDS Disability Determination Service notifies Comagine Health that LOC Level of Care is denied and provides the reason(s) for the denial. Comagine Health notifies the DPA Division of Public Assistance Project Assistant who then issues the denial letter to the parent and notifies the LTC Long Term Care unit of the denial. The LTC Long Term Care unit must close or deny the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case in EIS Eligibility Information System .

Step 3:

The care coordinator will contact DSDS Division of Senior and Disabilities Services if there is difficulty completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet within the 30-day period and explain any problems being encountered. If an extension is needed, DSDS Division of Senior and Disabilities Services will refer the care coordinator to Comagine Health. Comagine Health will work with the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant to provide guidance in completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet.

Step 4:

DSDS Division of Senior and Disabilities Services will notify Comagine Health with the results of the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination. If the LOC Level of Care determination results in an approval, Comagine Health will notify the care coordinator, DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant, and the LTC Long Term Care unit of the approval.

If the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination results in a denial, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will:

Send a letter to the parents with copies to the care coordinator, Department of Law, and DSDS Division of Senior and Disabilities Services notifying them of the LOC Level of Care denial, and

Notify the LTC Long Term Care unit of the LOC Level of Care denial to either close or deny the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid.

Getting Adequate Documentation for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care Processing

The ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination may require information that is not readily available such as a current IQ test or psychological evaluation.

The care coordinator will assist new applicants in scheduling an appointment with a Medicaid provider. After the appointment is scheduled, the parent must contact the LTC Long Term Care unit and request a disability exam coupon (DE 25) for the month the appointment is scheduled.

The care coordinator will assist current TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 recipients in scheduling an appointment with a Medicaid provider. The evaluation or testing will be billed to Medicaid.

Previous Section Next Section MC #61 (12/22)