B-8450 Special Reviews when Facility Contract Closure or Cancellation Occurs

Revision 21-3; Effective September 1, 2021

When a facility’s Medicaid contract is terminated, the facility notifies the recipient and provides them with the option to move to a Medicaid covered facility.

If the Medicaid recipient continues to live in an uncontracted facility, deny Medicaid eligibility and send Form TF0001, Notice of Case Action, to the recipient and or authorized representative (AR) and TF0001P, Provider Notice of Case Action, to the facility. The person will then be responsible for the full vendor payment for that facility.

If the recipient relocates to a Medicaid contracted facility, process a change of address, verify the person continues to meet all Medicaid eligibility criteria and send out a new TF0001 to the recipient and or AR and TF0001P to the new facility.