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:

• Referring families to care coordination agencies and the LTCLong Term Care unit,

• Working closely with care coordinators regarding the medical eligibility decision and required paperwork,

• Making NFAcute Care Hospital, Nursing Facility, or Intermediate Care Facility-LOCLevel of Care and IPHInpatient Psychiatric Hospital-LOCLevel of Care review determinations, including notifying care coordinators and families of the annual LOCLevel of Care renewal requirement,

• Making the Support Plan and COCCost-of-care review determinations for NFAcute Care Hospital, Nursing Facility, or Intermediate Care Facility-LOCLevel of Care and IPHInpatient Psychiatric Hospital-LOCLevel of Care cases,

• Making the Support Plan and COCCost-of-care review determinations for ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care cases and maintaining a record of the LOCLevel of Care approval by DDSDisability Determination Service, and

• Emailing the DPADivision of Public Assistance LTCLong Term Care unit, the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant and Care Coordinators when LOCLevel of Care is approved or emailing the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant when LOCLevel of Care is denied.

2. The Care Coordination Agency is responsible for:

• Completing and submitting the Support Plan, COCCost-of-care, and LOCLevel of Care documentation to Comagine Health for all NFAcute Care Hospital, Nursing Facility, or Intermediate Care Facility-LOCLevel of Care and IPHInpatient Psychiatric Hospital-LOCLevel of Care cases,

• Completing the Support Plan and COCCost-of-care for ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOC cases and working with DSDSDivision of Senior and Disabilities Services in the development and completion of the Inventory for Client and Agency Planning (ICAP) assessment packet,

• Submitting all necessary information to Comagine Health and DSDSDivision of Senior and Disabilities Services,

• Explaining to parents that they must complete a DPADivision of Public Assistance application with a referral to the appropriate DPA office, and 

• Contacting parents when the annual LOCLevel of Care reassessment is due.

Note:

TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 care coordinators only receive payment for screening, initial assessment, and yearly reassessment for LOCLevel of Care and the Support Plan. TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 does not pay for monthly care coordination.

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

• Starting the disability determination process upon receiving the disability packet from the DPADivision of Public Assistance caseworker, and

• Determining if a child is disabled using Social Security Administration criteria.

It is beneficial to include copies of relevant medical, psychological, and developmental information in the DDSDisability Determination Service 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.

4. DPADivision of Public Assistance is responsible for:

• Sending the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 welcome letter (MED 16) and  TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid for Disabled Children at Home brochure (MED 15) to the parent or guardian whenever an application is received for TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid. This must be documented in the CANO,

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).

• Completing the Medicaid eligibility determination,

• Submitting the disability packet to DDSDisability Determination Service for initial applications, tracking disability review dates, and submitting a disability review at the application time,

• Making referrals to Comagine Health with the GEN 140B form once the family has interviewed,

• Pending the application until all factors of eligibility are met. TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 applications must be approved or denied within 90 days. Follow the procedures below:

• Pend new applications for 60 days from the date of application.

• Send the M320, Information Needed - TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 notice, to pend a TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 application. Send a copy of this notice to the care coordinator.

• On day 61:

1. If the LOCLevel of Care decision is missing, notify Comagine Health and request a LOCLevel of Care update. If LOCLevel of Care has not been determined and it appears the decision may go past 90 days, contact the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. The DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will work with Comagine Health to determine the appropriate action. The LTCLong Term Care unit will be notified of status.

2. If the DDSDisability Determination Service decision is missing, contact DDSDisability Determination Service 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 DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. The DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will work with DDSDisability Determination Service to determine the appropriate action. The LTCLong Term Care unit will be notified of status.

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

Refer requests for extensions to the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. 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.

• Making the final approval or denial of TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid in EISEligibility Information System. The DPA TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice,

• Issuing DE 25 disability exam coupons if the child needs additional screenings,

• Issuing WD 19 screening coupons for the care coordinator, and

• Communicating with Comagine Health any changes in status, including:

• When a TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 child is approved for HCBHome and Community-Based waiver services,

• When a child becomes eligible for and the family elects to move the child to a different category of Medicaid,

• When a Medicaid case closes for any reason, including failure to submit a DPADivision of Public Assistance renewal, and

• When a TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 application is denied.

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

• Completing the ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care assessment and making ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care determinations,

• Processing all referrals for initial ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care determinations and renewals received from Comagine Health,

• Reviewing submission of the completed ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care packet to ensure it is submitted by the care coordinator, is complete, and DSDSDivision of Senior and Disabilities Services is able to make a level of determination within specified time frames. If not, DSDSDivision of Senior and Disabilities Services will notify Comagine Health,

• Reporting ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care approvals or denials to Comagine Health, and

• Certifying all care coordinators, including TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 care coordinators.

Note:

The same regulations are used to determine level of care for IDDIndividuals with Intellectual and Developmental Disabilities waivers that are used for ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled assessments for TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248. If a child is approved LOCLevel of Care for TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 but denied LOCLevel of Care for HCBHome and Community-Based waiver services, the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant must be contacted immediately.