533 D.         CASE PROCESSING

1. Initial Applications

An initial application can come in the following forms:

• MED 4 application or referral from denied MAGIModified Adjusted Gross Income Medicaid application. If a MED 4 application is submitted or a referral from a denied MAGIModified Adjusted Gross Income Medicaid case is received, send notice M320, Information Needed - TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248.

• Referral from MAGIModified Adjusted Gross Income Medicaid when there is no MAGIModified Adjusted Gross Income Medicaid eligibility and the application includes a disabled child.

If the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 process starts from a denied or closed MAGIModified Adjusted Gross Income case, send notice M322, PEND TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Disabled Child Denied DKCDenali KidCare. The family is allowed 15 days to:

• Contact Comagine Health to be connected with a care coordinator for TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 and begin the LOCLevel of Care assessment process,

• Return the MED 1, MED 2, and any accompanying medical information for a disability determination, and 

• Complete an interview.

The caseworker must follow procedure outlined in MS 533(C)(4).

2. Actions for NFAcute Care Hospital, Nursing Facility, or Intermediate Care Facility-LOCLevel of Care and IPHInpatient Psychiatric Hospital-LOCLevel of Care

After receiving a referral from DPADivision of Public Assistance by the receipt of the GEN 140B, Comagine Health will send the child's parent or guardian a welcome letter and ask the parent to contact Comagine Health within 30 days for care coordinator referrals. This letter also instructs the parent to contact DPADivision of Public Assistance if needed.

If the parent contacts a care coordinator and begins the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 assessment process, Comagine Health will:

• Receive ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care applications and make appropriate referrals to DSDSDivision of Senior and Disabilities Services (refer to step below for further ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled processing) and track the process to ensure the care coordinator provides a completed assessment for ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care, completed COCCost-of-care, and completed Support Plan within required time frames. The care coordinator's failure to provide these documents will result in denial.

• Track the process to ensure the care coordinator provides a completed assessment for NFAcute Care Hospital, Nursing Facility, or Intermediate Care Facility-LOCLevel of Care and IPHInpatient Psychiatric Hospital-LOCLevel of Care, completed COCCost-of-care, and completed Support Plan within required time frames. The care coordinator's failure to provide these documents will result in denial. 

If the care coordinator follows through and provides all documentation in the required time frames, Comagine Health will make a LOCLevel of Care decision and notify DPADivision of Public Assistance of approval or denial.

If LOCLevel of Care is denied, Comagine Health notifies the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant with the following information:

• Name of child,

• The child's care coordinator, and

• Rationale for denial.

The DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant issues the denial letter and sends a copy to the LTCLong Term Care unit. The LTCLong Term Care unit completes all actions in EISEligibility Information System.

3. Actions for ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care

If an application for ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled-LOCLevel of Care is received, Comagine Health will make a referral and provide the following information to DSDSDivision of Senior and Disabilities Services for all new applications and ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled renewals:

• Child's name, date of birth, and SDSSenior Disability Services ID number,

• Date required for LOCLevel of Care determination to meet DPADivision of Public Assistance time frames, and

• Care coordination agency and main contact person.

After the initial referral, the following steps occur:

Step 1:

DSDSDivision of Senior and Disabilities Services sends the care coordinator an email requesting the ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care packet be forwarded to DSDSDivision of Senior and Disabilities Services.

Step 2:

The care coordinator has 30 days to send the ICAPInventory for Client and Agency Planning Evaluation packet to DSDSDivision of Senior and Disabilities Services.

• If the packet is not completed and a level of care determination cannot be made within 90 days, Comagine Health will issue a denial due to not completing the ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care packet.

• If DSDSDivision of Senior and Disabilities Services receives all documentation and determines the child does not meet LOCLevel of Care, DDSDisability Determination Service notifies Comagine Health that LOCLevel of Care is denied and provides the reason(s) for the denial. Comagine Health notifies the DPADivision of Public Assistance Project Assistant who then issues the denial letter to the parent and notifies the LTCLong Term Care unit of the denial. The LTCLong Term Care unit must close or deny the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case in EISEligibility Information System.

Step 3:

The care coordinator will contact DSDSDivision of Senior and Disabilities Services if there is difficulty completing the ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care packet within the 30-day period and explain any problems being encountered. If an extension is needed, DSDSDivision of Senior and Disabilities Services will refer the care coordinator to Comagine Health. Comagine Health will work with the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant to provide guidance in completing the ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care packet.

Step 4:

DSDSDivision of Senior and Disabilities Services will notify Comagine Health with the results of the ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care determination. If the LOCLevel of Care determination results in an approval, Comagine Health will notify the care coordinator, DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant, and the LTCLong Term Care unit of the approval.

If the ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care determination results in a denial, the DPADivision of Public Assistance TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will:

• Send a letter to the parents with copies to the care coordinator, Department of Law, and DSDSDivision of Senior and Disabilities Services notifying them of the LOCLevel of Care denial, and

• Notify the LTCLong Term Care unit of the LOCLevel of Care denial to either close or deny the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid.

4. Getting Adequate Documentation for ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care Processing

The ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled LOCLevel of Care determination may require information that is not readily available such as a current IQ test or psychological evaluation.

The care coordinator will assist new applicants in scheduling an appointment with a Medicaid provider. After the appointment is scheduled, the parent must contact the LTCLong Term Care unit and request a disability exam coupon (DE 25) for the month the appointment is scheduled.

The care coordinator will assist current TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 recipients in scheduling an appointment with a Medicaid provider. The evaluation or testing will be billed to Medicaid.