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MEDICAL SERVICES POLICY MANUAL,SECTION C C-200 Alternative Application Processes

C 234 Determining Appropriateness of Care for TEFRA

will be considered an individual with a disability basedon the previous SSA disability determination. Refer to MS F-120-129. C-234 Determining Appropriateness of Care for TEFRA MS Manual 07/01/20 Based on information provided on the DMS 2602, Physician’s Assessment of Eligibility, and any medical records submitted, the TEFRA Committee will determine medical necessity and if the applicant meets the Appropriateness of Care criteria. If the applicant is having difficulty obtaining the Physician’s Assessment of Eligibility, the County Office should provide assistance to obtain the required form.

C-235 Disposition of TEFRA Application MS Manual 07/01/20 If at any point in the eligibility determination the child fails to meet eligibility requirements, the application will be denied. The begin date for TEFRA Waiver eligibility will be the date of application, unless retroactive coverage is needed. If needed, the eligibility begin date can be as early as three months prior to the date of application, provided all eligibility requirements are met. A child cannot be approved for retroactive coverage before the onset of his/her disability as he/she would not meet the TEFRA disability or medical necessity requirements prior to the onset of disability. A child who had been residing in an institution would not be eligible for any retroactive coverage while still residing in the institution as TEFRA Waiver coverage is for non- institutionalized children only. For any retroactive coverage needed, it can be assumed that medical necessity and appropriateness of care have been met unless there is evidence to the contrary.

C-240 ARChoices Waiver Application Process MS Manual 07/01/20 A potential Waiver client will make application (DHS-0777) at the DHS County Office in his/her county of residence for a financial eligibility determination. Refer to Appendix I for other forms to be completed during the application process. If an applicant accepts services from an ARChoices provider while the application is pending, he/shewill be responsible for paying the provider if the application is subsequently denied.