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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 100 Non Financial Eligibility Requirements

3. A recipient finds his relationship with the physician unacceptable If there is an allegation of substandard care, the recipient may report it to the Utilization Review Section, Division of Medical Services (501-682-8340). In this situation, no change in physician will be made until the County Office is authorized to do so by the Utilization Review Section. 4. A physician finds his relationship with the recipient unacceptable; the recipient is abusive to the physician; or the recipient fails to comply with medical instructions

F-170 TEFRA Premium MS Manual 07/01/20 TEFRA households with annual income after allowable expenses above 150% of the Federal Poverty Level for their household size will be required to pay monthly premiums as described in the sections below.

F-171 Determining Monthly Premiums MS Manual 01/01/22 The amount of the premium will be determined based on the custodial parent(s) total gross income as reported on the applicable Federal Income Tax Return (for example, line six of the 2018 version of form 1040) less the following deductions:  Six hundred dollars ($600) per child, biological or adopted including the waiver child, who lives in the home of the waiver child and is listed as a dependent child on the applicable Federal Income Tax Return of the parents; and  Excess medical and dental expenses as itemized on Schedule A of the Federal Income Tax Return of the parents (for example, line four (4) on the 2018 version of Schedule A). EXAMPLE 1: Family consists of five (5) people – mom, dad, TEFRA child, and two (2) minor siblings, living in the home. Total income on last year’s Federal Income Tax Return showed sixty-five thousand four hundred seventeen dollars and forty-eight cents ($65,417.48). Excess medical and dental on Schedule A showed nine thousand four hundred sixty-three dollars and twenty-five cents ($9,463.25). All children in the home were included on the return. • $65,417.48 - $1,800.00 ($600 x 3) - $9,463.25 = $54,154.23 Compare the adjusted income to Chart 1 in Appendix P. The income is above the limit for a family size of five. Go to Chart 2. The premium range for the adjusted income is from fifty-two dollars ($52.00) to seventy-eight dollars ($78.00).