Procedures to Determine Good Cause for Failure to Comply with QRF Requirements

Good Cause for untimely or incomplete submission of QRF or QRF information may be granted.

The following are examples of Good Cause. This list is not all inclusive:

The recipient did not receive the QRF or received it untimely.

The recipient or an immediate family member was ill or in the hospital.

The recipient is illiterate.

There was a serious family crisis such as death.

There was a natural disaster.

The recipient was out of town.

The return envelope was postmarked in time to reach the county department but did not. The QRF is considered timely if postmarked at least one day prior to the deadline.

The AU was ineligible for TMA when the report was due but the reason for ineligibility no longer exists. This is applicable only to AUs who were ineligible for TMA because of any of the following reasons: the AU moved out of state the only child ceases to live with the family the individual who qualified the AU for TMA ceased to live with AU.

If Good Cause exists, the reporting requirement is met. Obtain the information needed to determine continued eligibility.

Document the decision.

Use the following chart to process the QRFs due in the fourth month of TMA.

CHART 2166.1 - PROCESSING QRF DUE IN FOURTH MONTH OF TMA

IF THEN The completed QRF or QRF information is received by the 5 th calendar day of the report month Begin the additional six-month extension of TMA in the 7 th month. The QRF or QRF information is not received by the 5 th calendar day of the 4 th month of TMA (or by the following workday if the 5 th is a weekend or holiday) Send Discontinuance Due to No QRF Notice (GA Gateway sends this automatically), giving the AU until the 21 st to provide the completed QRF or QRF information. The completed QRF or QRF information is received by the 21 st Begin the additional six-month extension of TMA in the 7 th month. The QRF or QRF information is not received by the 21 st Determine if Good Cause exists. Refer to TMA Special Considerations in this Section. The completed QRF or QRF information is not received by the 21 st and Good Cause does not exist Complete a CMD and terminate TMA effective the 7 th month of eligibility. Provide adequate notice. Refer to Section 2052 - CMD . The QRF or QRF information is received by the 21 st but is not complete. Send a verification checklist requesting the missing information within 5 calendar days. Allow an additional 10 days or until the 21 st , whichever is later, to provide the information. Refer to Section 2051 - Verification . The completed QRF or QRF information is received by the second deadline. Begin the additional six-month extension of TMA in the 7 th month. The QRF or QRF information is not received by the second deadline. Complete a CMD and terminate TMA effective the 7 th month of eligibility. Allow adequate notice. Refer to Section 2052 - CMD . The QRF or QRF information is received by the second deadline but is not complete. Send another verification checklist. Allow an additional 10 days for response. If the completed QRF or QRF information is received by the extended deadline, the report requirement is met. If the completed QRF or QRF information is not received by the extended deadline, complete a CMD and terminate TMA effective the 7 th month. Allow adequate notice. Refer to Section 2052 - CMD .

Use the following chart to process the QRFs due in the seventh and tenth months of TMA.

CHART 2166.2 - TMA QRF PROCESSING PROCEDURES FOR THE SEVENTH AND TENTH MONTHS

IF THEN The completed QRF or QRF information is received by the 5 th calendar day of the report month Continue TMA eligibility. The QRF or QRF information is not received by the 5 th calendar day of the report month (or by the following workday if the 5 th is a weekend or holiday Send Discontinuance Due to No QRF Notice (GA Gateway does this automatically), giving the AU until the 21 st to provide the completed QRF or QRF information. The completed QRF or QRF information is received by the 21 st Continue TMA eligibility. The QRF or QRF information is not received by the 21 st Determine if Good Cause exists. Refer to TMA Special Considerations in this Section. The completed QRF or QRF information is not received by the 21 st and Good Cause does not exist Complete a CMD and terminate TMA effective the 8 th or 11 th month of TMA. Provide adequate notice. Refer to Section 2052 - Continuing Medicaid Determination . The QRF or QRF information is received by the 21 st but is not complete. Send a verification checklist requesting the missing information. Allow an additional 10 days or until the 21 st , whichever is later, for the AU to provide the information. Refer to Section 2051 - Verification . The completed QRF or QRF information is received by the second deadline. Continue TMA eligibility. The QRF or QRF information is not received by the second deadline. Complete a CMD and terminate TMA effective the 8 th or 11 th month. Provide adequate notice. Refer to Section 2052 - Continuing Medicaid Determination . The QRF or QRF information is received by the second deadline but is not complete. Send another verification checklist. Allow an additional 10 days for response. If the completed QRF is received by the extended deadline, the reporting requirement is met. Continue TMA eligibility. If the completed QRF is not received by the extended deadline, complete a CMD and terminate TMA effective the 8 th or 11 th month. Provide adequate notice. Refer to Section 2052 - Continuing Medicaid Determination .

Refer to TMA Special Considerations for information on determining if a QRF is complete and determining good cause for not complying with reporting requirements.