Renewals

Complete a review of eligibility annually and document any anticipated change in resources, income or potential SSI eligibility.

At renewal if not already present in case, add the parent to the applicant group, list the parents as authorize representatives, and add their income to the case.

See Procedures to complete Steps 3, 4 – 9, and 14 - 16. If the Form DMA 6A - Physician’s Recommendation for Pediatric Care indicates that a psychological evaluation is required, see Step 5 for procedures. A psychological is only valid for 3 years from the date of the evaluation. If the Care Plan indicates the A/R receives therapy, follow procedures in Step 6. If the Care Plan indicates IFSP, IEP or both, follow procedures in Step 7.

Children Currently Eligible for Katie Beckett but Do Not Have a Disability Determination:

When a Katie Beckett COA is due for eligibility renewal with an approved LOC but no disability decision, request an updated letter from AHS to include disability.

Complete the following if the LOC is denied :

If the family or caregiver receives a letter of “Initial Denial of Admission” and submits additional clinical information timely to AHS, leave case open pending “Final Determination Denial of Admission” or LOC approval.

If the family or caregiver receives the “Final Determination Denial of Admission” from AHS, the family or caregiver has 30 days to appeal. The MES should close the case effective the end of the month in which the 30-day appeal time falls. DO NOT waive notice.

The Katie Beckett Unit will notify DCH if the family or caregiver has requested an appeal of the LOC. If the family or caregiver appeals and requests that the case remains open pending the appeal or provides additional medical information to AHS, the caregiver should reinstate the case. Add the following text to the reinstatement notice: “Case is reopened pending the outcome of the appeal or reconsideration based on additional medical information.”

If the family or caregiver appeals the denial and the LOC denial is overturned, reinstate the case, if not already reinstated.

If the family or caregiver appeals the denial and the hearing upholds the LOC denial, close the case, if reinstated, and waive the notice. If the family or caregiver wishes to appeal the upheld LOC denial, they should make this appeal in writing to the DCH Commissioner. See Step 13.

If the family or caregiver does not appeal, the case remains closed The end date of the LOC is two years from the date that the LOC determination was completed by AHS, unless the LOC letter indicates otherwise. Never allow the LOC to expire before a new one is obtained. Best practice is to send the Katie Beckett packet with the Form DMA 6A - Physician’s Recommendation for Pediatric Care to the family or caregiver at least a month prior to the expiration of the LOC.

Anytime the A/R becomes ineligible for Katie Beckett Medicaid, terminate the COA and complete a CMD considering all Medicaid COA’s (Waivers, etc.). Refer to Section 2052 - Continuing Medicaid Determination .