533 C        REFERRAL AND INTERAGENCY COMMUNICATIONS

 

Communication is essential to ensure a quick and timely determination. The agencies and individuals involved in a TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid eligibility decision and their roles are outlined below.

 

  1. Comagine Health is responsible for:

 

 

 

 

 

 

 

  1. The Care Coordination Agency is responsible for:

 

 

 

 

 

 

Note:

TEFRA care coordinators only receive payment for screening, initial assessment, and yearly reassessment for LOC and the Support Plan. TEFRA does not pay for monthly care coordination.

 

  1. The Disability Determination Service (DDS) is responsible for:

 

 

 

It is beneficial to include copies of relevant medical, psychological, and developmental information in the DDS packet in order to speed up the disability process. This may include Infant Learning Assessments, Individual Education Plans, current medical records (from within the past year), counseling reports, etc. See APA MS 425-3(C) and Admin Procedures MC 115-9 for policy and procedures on disability determinations.

 

  1. DPA is responsible for:

 

 

Note:

The MED 16 is not the same welcome letter that Comagine Health sends the child's parent as described in MS 533(D)(2).

 

 

 

 

 

 

 

 

  1. If the LOC decision is missing, notify Comagine Health and request a LOC update. If LOC has not been determined and it appears the decision may go past 90 days, contact the DPA TEFRA Specialized Medicaid PAA. The DPA TEFRA Specialized Medicaid PAA will work with Comagine Health to determine the appropriate action. The LTC unit will be notified of status.

 

  1. If the DDS decision is missing, contact DDS and request an update on the disability decision. If a disability decision has not been determined and it appears the decision may go past 90 days, contact the DPA TEFRA Specialized Medicaid PAA. The DPA TEFRA Specialized Medicaid PAA will work with DDS to determine the appropriate action. The LTC unit will be notified of status.

 

Exceptions to the 90-day Processing Time Frame for Initial Applications:

Refer requests for extensions to the DPA TEFRA Specialized Medicaid PAA. When an extension is needed 90 days after date of initial application, the person making the request will need to provide the reason(s) for the extension. Extensions will only be approved when the parent submits a written request stating the reason for the extension and acknowledging and accepting the delay in processing. Although not required, they may use the Initial Application Extension Request Form (MED 36) to make the request.

 

 

 

 

 

 

 

 

 

  1. The Division of Senior and Disabilities Services (DSDS) is responsible for:

 

 

 

 

 

 

Note:

The same regulations are used to determine level of care for IDD waivers that are used for ICF/IDD assessments for TEFRA. If a child is approved LOC for TEFRA but denied LOC for HCB waiver services, the DPA TEFRA Specialized Medicaid PAA must be contacted immediately.

 

 

 

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