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UNOFFICIAL 1714.1-10 services to its residents, the state making the placement is the individual’s state of residence. (f) A resident who is eligible for medical assistance and who is temporarily absent from the State with the intent to return when the purpose of the absence has been accomplished, does not interrupt a resident’s State residency unless another state has determined that the individual is a resident there for purposes of Medicaid. Within ninety days of the day of departure, the department shall re-evaluate the individual’s intent to return to the State based on the submission of the following: (1) The intended date of the out-of-state visit and the intended date of return back to the State; and (2) The intended date of return, if an extension from the original date previously submitted was changed. (g) Medical assistance shall be provided to a resident temporarily absent from the State who: (1) Meets all conditions of eligibility for medical assistance as specified in the department rules; and (2) Requires medical services outside the State under circumstances where services were emergent or when it would be impractical to return to the State for the necessary services. (h) The department may have a written agreement with another state setting forth rules and procedures to resolve disputes involving the place of residency. (i) Where two or more states disagree on an individual’s state of residence, the state where the individual is physically located shall be the state of residence. (j) The department shall accept a self- attestation by the individual or attestation by an adult who is in the household, authorized representative, or someone acting responsibly on behalf of a minor or incapacitated individual for information to verify State residency.