116 APPLICATION PROCESSING TIME FRAMES (AAM)

116 APPLICATION PROCESSING TIME FRAMES (AAM)

SR 15-26 Dated 07/15 Previous Policy

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Generate a Notice of Decision (NOD) to the individual as soon as eligibility has been determined. Determine eligibility no later than:

. 45 calendar days from the application date for Old Age Assistance (OAA), Aid to the Needy Blind (ANB), Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135, or Qualified Disabled and Working Individuals (QDWI); and

. 90 calendar days from the application date for Aid to the Permanently and Totally Disabled (APTD), Nursing Facility (NF) services, all Home and Community-Based Care (HCBC) services including Choices For Independence (CFI) services, and Medicaid for Employed Adults with Disabilities (MEAD).

Exceptions: Eligibility must be determined within the 45 or 90 days described above except when:

. a decision cannot be reached because the applicant or an examining physician delays or fails to take a required action; or

. there is an administrative or other emergency beyond DHHS' control.

Document the reason for the delay in the case file. Generate the NOD to the individual once the decision is made.

References : 42 CFR 435.912