Sanctions

If the NH is under a Medicaid sanction resulting in a “ban on admissions”, no DMA-59 should be sent to DFCS until such time as the ban is lifted. Until the “ban on admissions” is lifted, no A/R should be approved for the NH COA if the A/R is admitted to the NH on or after the effective date of the ban on admissions. A ban on admissions has no effect on A/Rs who are already Medicaid recipients in the NH or who were admitted to the NH prior to the imposition of the ban.

If an application is received on an A/R who was admitted during the time the “ban on admissions” is in place, hold the case until either the ban is lifted and the case can be approved under the NH COA or the standard of promptness (SOP) is reached. If the case cannot be approved under the NH COA by the SOP date, determine eligibility under another COA such as regular AMN. Do not determine eligibility under any LA-D COA. If the “ban on admissions” is subsequently lifted, historically close the other Medicaid case and approve under the NH COA back to the first month of eligibility.

The “Denial of Payment” notification letters will come to the Medicaid Policy Unit from DCH’s Member Services. The Medicaid Policy Unit will forward the letters to the appropriate Field Program Specialist who will then forward to the county DFCS office. When the Denial of Payment ban is lifted this same process will take place.