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CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.100 Medical Services Board

80 3. Redetermination forms shall direct members to verify that the information provided on the form is accurate or to report any changes to the information. The following procedures pertain to the redetermination forms: a. A redetermination form shall be sent to the member along with any required verifications to be completed. b. The member must complete and return the redetermination with the necessary verifications and the signature form. c. If the member is unable to complete the redetermination forms due to a disability (a physical or mental impairment that substantially limits one or more major life activity) or other good cause, in response to a request from the member, the eligibility site shall assist the member in accordance with its Civil Rights Plan as described in Section 10 CCR 2505-5 1.020.7.1.d. The assistance of the eligibility site shall be recorded in the case record and CBMS case comments. d. The redetermination form shall require that a recipient and community spouse of a recipient of HCBS, PACE, or institutional services disclose a description of any interest the member or community spouse has in an annuity or similar financial instrument regardless of whether the annuity is irrevocable or treated as an asset. The redetermination form shall include a statement that the Department shall be a remainder beneficiary for any annuity or similar financial instrument purchased on or after February 8, 2006, for the total amount of Medical Assistance provided to the member. e. The eligibility site shall notify in writing the issuer of any annuity or financial instrument that the Department is a preferred remainder beneficiary in the annuity or similar financial instrument for the total amount of Medical Assistance provided to the member. This notice shall require the issuer to notify the eligibility site when there is a change in the amount of income or principal that is being withdrawn from the annuity.