533 E. TEFRA Reviews

533 E. TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 REVIEWS

Each TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 recipient is subject to the following reviews:

DPA Division of Public Assistance annual review,

LOC Level of Care annual review, and

Periodic disability reviews by DDS Disability Determination Service .

Note: The LOC Level of Care , DSDS Division of Senior and Disabilities Services , and DPA Division of Public Assistance review dates often occur at different times during the eligibility period. If a LOC Level of Care or DSDS Division of Senior and Disabilities Services denial occurs in the middle of an ongoing eligibility period, the caseworker must review for twelve-month continuous eligibility before closing the case. Refer to MS 515 for policy on continuous eligibility.

DPA Division of Public Assistance Reviews

At the time of renewal, the DPA Division of Public Assistance caseworker must:

Check for current LOC Level of Care status,

Check for current disability status,

Review the child's income and resources, and

Check the child's age. If turning 18 years old, they must be referred to apply for SSI Supplemental Security Income . Send notice M315 Application for SSI Supplemental Security Income - TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 .

If LOC Level of Care , disability, and the child's income and resources are within APA Adult Public Assistance standards, approve the Medicaid case.

If LOC Level of Care is not current, contact Comagine Health for current status, and take the following actions:

If LOC Level of Care has been denied, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice and inform the LTC Long Term Care unit to close the Medicaid case, or

If the parent failed to complete LOC Level of Care reassessment, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice and inform the LTC Long Term Care unit to close the Medicaid case, or

If LOC Level of Care has not been renewed, but it is determined by the LTC Long Term Care caseworker that there were extenuating circumstances and the care coordinator or parent has requested an extension, approve Medicaid.

If a DPA Division of Public Assistance review is denied for any reason, including failure to renew, notify Comagine Health and the care coordinator of the case closure.

If the DDS Disability Determination Service review is due, assume continued disability until a new decision is received (see below).

DDS Disability Determination Service Review Processing

When a DDS Disability Determination Service file is returned with an approved disability decision, document this in the case notes and set an alert with a due date 60 days prior to the next disability review.

When a child is due for a disability review, send the parent the MED 1 and MED 2 forms and EIS Eligibility Information System notice M025, Disability Review Needed, requesting these forms be returned with current medical information within 30 days. The notice must explain that failure to respond to this request will result in case closure.

The TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case remains open until a new DDS Disability Determination Service decision is received, unless LOC Level of Care is denied or the parent fails to renew while waiting for a new DDS Disability Determination Service decision.

If the DDS Disability Determination Service decision is an approval, document the new Continued Disability Review ( CDR Continuing Disability Review ) date in the CANO Case Notes .

If the DDS Disability Determination Service decision is denial of disability, the caseworker must email a copy of the DDS Disability Determination Service denial letter to the DPA Division of Public Assistance Policy email address hss.dpa.policy@alaska.gov and the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will issue a closure letter to the parent, the care coordinator, Comagine health, DSDS Division of Senior and Disabilities Services , and the Department of Law. The LTC Long Term Care unit will close the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case in EIS Eligibility Information System . Before case closure, check for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 twelve-month continuous eligibility. See MS 515 for policy on continuous eligibility.

LOC Level of Care Renewal Process

Comagine Health has the primary responsibility for tracking all LOC Level of Care renewal dates for all three LOC Level of Care standards. Comagine Health will maintain a database of open TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid cases. The database will include the LOC Level of Care , current renewal date, and other identifying information.

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

Comagine Health will send a letter 90 days prior to the month the renewal is due notifying the care coordinator that a child's LOC Level of Care is due and request renewal paperwork. When the care coordinator submits the Support Plan, COC Cost-of-care , and LOC Level of Care documentation, Comagine Health will approve or deny continued LOC Level of Care . Comagine Health will email the DPA Division of Public Assistance caseworker with the approval decision for the caseworker to take appropriate action. Comagine Health will email the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant with the denial decision. The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice and notify the LTC Long Term Care unit to close the Medicaid case.

For ICF Intermediate Care Facility / IDD Individuals with Intellectual and Developmental Disabilities - LOC Level of Care :

Ninety (90) days prior to the month of renewal, Comagine Health will make a referral to DSDS Division of Senior and Disabilities Services for an ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination. Comagine Health will also notify the care coordinator indicating that an ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care referral has been made.

When the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination is completed and a LOC Level of Care decision rendered, DSDS Division of Senior and Disabilities Services will forward the results to Comagine Health. Comagine Health will review COC Cost-of-care and Support Plan status and notify DPA Division of Public Assistance of the LOC Level of Care determination. If the child does not meet LOC Level of Care , the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will issue a closure notice to the parent. The LTC Long Term Care unit will take appropriate action to close the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case in EIS Eligibility Information System .

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