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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL D-430 Division of Welfare and Supportive Services REDETERMINATIONS Medical Assistance Manual TREATMENT FOR BREAST AND CERVICAL MTL 01/13 01 Oct 13 D-430 TREATMENT FOR BREAST AND CERVICAL A redetermination is to be completed every 12 months. Complete a desk audit by contacting Access to Health Care case manager to confirm the recipient is still residing in Nevada and is still receiving treatment.
Access to HealthCare Network can be reached at 775-284-1904.
Document the information in the case file and complete the redetermination. D-430.1 Termination of Breast and Cervical Medicaid eligibility ends when her course of treatment is completed, or she no longer meets the criteria for this eligibility category. D-435 TRANSITIONAL MEDICAID A redetermination will be completed to determine potential eligibility for other medical coverage groups after the end of the TR period. Evaluate current circumstances and all household members for any other category of eligibility. D-440 REDETERMINATION BASED ON CHANGES
Information received between redeterminations, which may affect eligibility must be evaluated and acted on when applicable. Limit any request for additional information to verification related to the change only.
When processing the change if the case manager has enough information available to re-evaluate eligibility, complete a redetermination and approve an additional 12 months, even if the redetermination was not due.
Exception: Nevada Check Up provides 12 months continuous eligibility and clients are not required to report changes. Only act on changes listed in D-535 for Nevada Check- Up. D-445 OTHER INSURANCE AFFORDABILITY PROGRAMS
When processing a redetermination and the recipient is determined not eligible due to excess income an electronic referral is sent to the Silver State Health Insurance Exchange (SSHIX) upon posting of the denial. The individual will be provided contact information in their denial notice regarding where to apply for Advanced Premium Tax Credit (APTC) and Qualified Health Plans (QHP).
D-450 TERMINATIONS When processing a redetermination and the recipient no longer meets the criteria of one of the eligible categories or has failed to cooperate in providing information, the case must be terminated allowing for adverse action. When posting a termination, two future months must be posted in order to ensure closure in the MMIS system. Adverse actions taken after cutoff will not be reflected in the MMIS (Medicaid billing) system. If done, an additional month of Medicaid billing will take place and capitation fees will be charged.