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CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 3-1-10 Transmittal: UP-11-01 1521.07 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Pregnant Women MA _______________________________________________________________ Subject: Qualified Providers ______________________________________________________________________________
1521.07 A. Qualified Provider Categories
A qualified provider means any provider that meets the following requirements:
eligible to receive payments under an approved State plan; and
provides services of the type provided by: (a) outpatient hospitals (see §1905(a)(2)(A) of the Social Security Act); (b) rural health clinics (see §1905(a)(2)(B) of the Social Security Act); or (c) clinics furnished by, or under, the direction of a physician, without regard to whether the clinic itself is administered by a physician (see §1905(a)(9) of the Social Security Act); and
has been designated by the Department, in writing, as a qualified provider on the basis of the Department’s determination that the provider is capable of making determinations of presumptive eligibility; and
(a) receives funds under one of the following:
the Migrant Health Centers, Community Health Centers, or Public Health Service primary care research and demonstration projects (see §329, 330 and 340 of the Public Health Service Act); or the Maternal and Child Health Services Block Grant Program (see Title V of the Social Security Act); or the Urban Indian Health Program (see Title V of the Indian Health Care Improvement Act); or
(b) participates in a program established under:
the Special Supplemental Food Program for Women, Infants and Children (see §17 of the Child Nutrition Act of 1966); or the Commodity Supplemental Food Program (see §4(a) of the Agriculture and Consumer Protection Act of 1973); or the Indian Health Service or a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act; or
participates in a State perinatal program.
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 3-1-10 Transmittal: UP-11-01 1521.07 page 2 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Pregnant Women MA _______________________________________________________________ Subject: Qualified Providers ______________________________________________________________________________
1521.07 B. Standards for Designating a Qualified Provider
The Department decides which specific qualified providers are authorized to make presumptive eligibility determinations for pregnant women. The Department is not required to authorize all providers that fall within the foregoing categories to make presumptive eligibility determinations.
The Department may limit which providers it invites to participate as a qualified provider based on the Department’s capacity to train and monitor qualified providers in the performance of their presumptive eligibility responsibilities.
The Department retains the right to determine, at any time, in its discretion, whether a qualified provider will be allowed to continue making presumptive eligibility determinations.
A qualified provider shall agree to:
accurately determine presumptive eligibility; process applications in a timely manner; and not participate in unfair, discriminatory or unequal treatment of applicants or recipients.
The Department may revoke, suspend or deny a qualified provider’s authorization to make presumptive eligibility determinations at any time for any reason deemed sufficient by the Department including, but not limited to, its failure to meet the requirements of subsection B.4. of this section.
Procedures for Designating a Qualified Provider
The Department shall contact providers that are permitted to determine presumptive eligibility as set forth in subsection A. of this section to inquire about their interest in participating as a qualified provider;
The Department shall explain the requirements for being designated a qualified provider;
The qualified provider must agree to the terms and conditions as set forth in a Statement of Agreement between the qualified provider and the Department and execute the required Statement of Agreement;
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 3-1-10 Transmittal: UP-11-01 1521.07 page 3 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Pregnant Women MA _______________________________________________________________ Subject: Qualified Providers ______________________________________________________________________________
1521.07 C. Procedures for Designating Qualified Providers (continued)
4. The Department can revoke the authority of a provider to make presumptive eligibility determinations at any time, in its discretion.