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IX. Requirements for Annual SAIH Eligibility Recertification

Eligibility for the SAIH Program must be recertified annually. The LME/MCO

transition coordinator may have transferred the coordination to another care

coordinator. The DSS IMC and the LME/MCO care coordinator MUST coordinate

early in the redetermination process to ensure that the ongoing eligibility for

SAIH is correct.

Notify the LME/MCO care coordinator that a DSS-8191 is being sent and must

be completed for recertification. Ex parte redeterminations are not allowed.

Failure to give the LME/MCO care coordinator sufficient notice of the SAIH

eligibility redetermination due date could jeopardize successful completion of the SAIH beneficiary’s recertification. Utilize the DSS-0033 Appendix E, Supplement 1 to inform the LME/MCO care coordinator of the information needed to process the redetermination.

A valid FL-2 is required for ongoing eligibility. Therefore, whenever an FL-2

expires because the health care provider’s signature is over 12 months, a new

FL-2 must be obtained prior to the expiration. Communicate to the LME/MCO,

the need for a current and valid FL2 in sufficient enough time for the LME/MCO

care coordinator to assist with getting it.

(Reference SA-3100 VII. A. 3. for the requirements that must be met for an FL-2

to be considered valid for SA and SAIH.)

The payment review period for SAIH eligibility begins with the month of

application and ends on the last day of the twelfth month. When the DSS IMC is

notified of the upcoming eligibility redetermination, the DSS IMC MUST

immediately notify the LME/MCO transition coordinator and all other appropriate

authorized representatives, power of attorneys, legal guardians, etc. of the

redetermination due date(s) for the SAIH beneficiary.

X. When an active SAIH Individual approved for TCL

moves to another county in PLA

Contact the DSS in the new county of eligibility by phone and in writing to inform

the Special Assistance Supervisor and or the DSS IMC that a new case is being

transferred to them and that the new case is an individual approved for TCL who

is eligible for both Medicaid (CN) and SAIH.

A. The active SAIH case of an individual approved for TCL

can be transferred to another county using the NC FAST SA-5250 IX-X.