66.02 In general

Basic rule. Medicaid will be provided during a presumptive eligibility period to an individual who is determined by a qualified hospital, on the basis of preliminary information, to be presumptively eligible in accordance with the policies and procedures established by AHS consistent with this section. (b) Qualified hospital. A qualified hospital is a hospital that: Participates as a Medicaid provider; notifies AHS of its election to make presumptive eligibility determinations under this section; and agrees to make presumptive eligibility determinations consistent with state policies and procedures; Assists individuals in completing and submitting the full Medicaid application and understanding any documentation requirements; and Has not been disqualified by AHS in accordance with paragraph (d) of this subsection. (c) Scope of authority to make determinations of presumptive eligibility. Hospitals may only make determinations of presumptive eligibility under this section based on income for: 104 42 CFR § 435.1110. Eligibility-and-Enrollment Procedures Part 7 – Page 48 (Sec.66.00, Sub.66.03) Children under § 7.03(a)(3); Pregnant women under § 7.03(a)(2); Parents and caretaker relatives under § 7.03(a)(1); Adults under § 7.03(a)(5); Former foster children under § 9.03(e); Individuals receiving breast and cervical cancer treatment under § 9.03(f); and Individuals receiving family planning services under § 9.03(g). (d) Disqualification of hospitals AHS may establish standards for qualified hospitals related to the proportion of individuals determined presumptively eligible for Medicaid by the hospital who: (i) Submit a regular application before the end of the presumptive eligibility period; or (ii) Are determined eligible for Medicaid based on such application. AHS will take action, including, but not limited to, disqualification of a hospital as a qualified hospital under this section, if it determines that the hospital is not: (i) Making, or is not capable of making, presumptive eligibility determinations in accordance with applicable state policies and procedures; or (ii) Meeting the standard or standards established under paragraph (d)(1) of this section. AHS may disqualify a hospital as a qualified hospital under this paragraph only after it has provided the hospital with additional training or taken other reasonable corrective action measures to address the issue.