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1. If continuing need of CAP participation is established, recertify for the appropriate certification period, not to exceed 12 months; 6 months if the beneficiary has a monthly deductible.
2. If there is no continuing need of CAP participation, evaluate for all other programs/categories.
SSI beneficiaries do not require a recertification of Medicaid eligibility. However, SSI beneficiaries still require a CNR to determine CAP participation.
VIII. CHANGES IN SITUATION
A. Hospital/Nursing Facility Stays
The local agency will receive DHB-2193, Memorandum of CAP Waiver Enrollment Status for Hospital/Nursing Facility stays.
1. Stays less than 30 Days
a. Continue CAP budgeting, and
b. Follow procedures in MA-2360, Medicaid Deductible, for instructions on applying hospital charges to the deductible.
2. Stays 30 Days and over
a. Send a timely DSS-8110, Notice of Modification, Termination, or Continuation of Public Assistance, to terminate CAP services effective the first day of the month following the 31st day.
b. Evaluate eligibility for Medicaid by applying MA-2270, Long-Term Care Need and Budgeting.
c. Compute a patient monthly liability (PML) no earlier than the first day of the month in which the 31st day falls, subject to timely notice requirements.
d. If discharge occurs between 30 and 90 days and the beneficiary resumes CAP services, the local agency will receive the DHB-2193, Memorandum of CAP Waiver Enrollment Status, and Plan of Care Summary from the CAP case management entity.
e. For stays over 90 days, a new referral must be made to the CAP Lead Agency for redetermination of CAP eligibility before CAP services can resume.