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UPDATED: JUNE 2011

495.6

OTHER ELIGIBILITY REQUIREMENTS RETROACTIVE PERIOD

PAYMENT OF UNPAID MEDICAL BILLS

Description: Payment of unpaid medical expenses may be made to Medicaid enrolled providers for covered care and services obtained during the recipients’ retroactive eligibility periods (pre and post -application periods).

Policy: Social services districts must authorize appropriate periods of eligibility for Medicaid eligible individuals who incurred qualifying medical expenses during the three-month retroactive eligibility period.

References: ADM

10 OHIP/ADM-9

Dept. Regs. 18 NYCRR 360-7.5 (a)

GIS

03 MA/025

03 MA/019

02 MA/033

98 MA/011

95 MA/032

Interpretation: Retroactive Period:

Payment may be made for unpaid bills that are: • Incurred during the retroactive eligibility period, which begins on the first day of the third month prior to the month in which the individual applied for Medicaid and ends on the date the individual applies for Medicaid; • medically necessary; • covered by the Medicaid Program ; • within Medicaid requirements for amount duration and scope, AND • provided by Medicaid enrolled providers.

Post-Retroactive Period:

Payment may be made for unpaid bills that are: • incurred during the post-retroactive eligibility period, which begins on the date of application and ends on the date the individual receives a CBIC card; • medically necessary; • covered by the Medicaid Program ; • within Medicaid requirements for amount duration and scope, AND • provided by Medicaid enrolled providers.

(MRG)