UPM 1523.10 - Processing Requirements

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 11-1-05 Transmittal: UP-06-03 1523.10 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Children FMA _______________________________________________________________ Subject: Processing Requirements ______________________________________________________________________________

1523.10 A. Standard of Promptness

Once all required information is supplied, assistance is authorized by the qualified entity no later than the close of business of the next working day.

Period of Eligibility

Beginning Date of Eligibility

The beginning date of eligibility is the date that the qualified entity determines presumptive eligibility for Medicaid.

Ending Date of Eligibility

If the Department determines that the assistance unit is eligible, the ending date for Presumptive Eligibility is the date the Department makes the determination of ongoing Medicaid eligibility. If the Department determines that the assistance unit is ineligible, the ending date for Presumptive Eligibility is the last day of the month that the Department makes the determination of ineligibility for Medicaid. In the event the qualified entity does not submit a completed application form to the department or the submitted application form does not meet the minimal requirements for an application (cross reference 1505.10), the ending date of eligibility is the last day of the month following the month the presumptive eligibility determination is made.

Subsequent Periods of Presumptive Eligibility

The Department shall limit the number of times an individual may receive presumptive eligibility to twice in a calendar year.

Verification Requirements

The qualified entity considers all factors of eligibility to be verified by the self-declared statements made by the applicant or recipient on the application form that is completed and signed by the applicant or recipient.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 11-1-05 Transmittal: UP-06-03 1523.10 page 2 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Children FMA _______________________________________________________________ Subject: Processing Requirements ______________________________________________________________________________

1523.10 D. Additional Requirements for the Qualified Entity

Within five (5) days of making the determination of presumptive eligibility for children, the qualified entity shall do the following:

notify the Department that they have granted presumptive eligibility and refer a complete application form and any available verification to the Department for processing; and

2. inform the parent or custodian of the child that in referring the granted presumptive eligibility application to the Department the family has initiated an application for ongoing Medicaid benefits and that follow-up by the family will be necessary to remain Medicaid eligible.

E. Fair Hearing Rights

Applicants for and recipients of presumptive eligibility for children are not entitled to appeal any case action or inaction of presumptive eligibility through a fair hearing or any other administrative appeal.

Notice Requirements

Applicants for and recipients of presumptive eligibility for children are not entitled to advance notice of a presumptive eligibility discontinuance or continued benefits based on the filing of a fair hearing request.

Managed Care

Recipients of presumptive eligibility for children are not enrolled in managed care. Instead, medical services are provided via fee-for-service.