Page 278

MRG

UPDATED: JUNE 2010

704

OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY

NURSING FACILITY, HOSPICE OR HOME HEALTH CARE SERVICES

if there is no authorized representative), the hospital, and the proposed provider, if presumptively eligible. In addition, the provider is advised of the client’s liability toward the cost of care, if applicable.

NOTE: See 97 ADM-10 for copies of the Notices.

(4) authorizes the applicant for up to sixty days of presumptive eligibility from the date of discharge from the hospital if the stated conditions are met; and

(5) processes a routine, complete and fully documented eligibility determination.

Documentation: The DOH-4220, completed by the applicant or authorized representative, is submitted to the local social services district, with the physician’s statement that the patient no longer requires care in an acute care hospital, but does require nursing facility, CHHA, LTHHCP, or hospice services. Included with the application package is the completed Screening Checklist (Attachment I to 97 ADM-10), the medical documentation from the hospital of the type of care and, in the case of CHHA services, the amount of care required.

Upon receipt of the application for presumptive Medicaid eligibility, the local social services district must review the application package, including the Screening Checklist, to determine if the applicant meets the basic qualifying conditions to participate in the presumptive Medicaid eligibility program.

The local social services district may ask questions to resolve conflicting information, particularly for items on the Screening Checklist. However, documentation cannot be required to determine presumptive Medicaid eligibility. Attestation of facts is sufficient to determine if an individual is presumptively eligible for assistance.

The local social services district or its agent must agree that the CHHA or LTHHCP services recommended are appropriate. The local social services district agent providing the evaluation of medical need might be a Community Alternative Systems Agency (CASA) or staff in the Medicaid or Long Term Care Unit. The local