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3100 Eligibility Determination

3110 Medicaid Eligibility for the Initial Application

3110.1 Medicaid Buy-In and Medicaid Buy-In for Children

3110.2 Coordination of Disability Determinations

3111 Qualified Income Trust (QIT)

3111.1 Determination of Copayment

3111.2 Refusal to Participate

3111.3 Refund of Copayment

3111.4 Refusal to Pay the Copayment

3120 Medical Necessity

3121 Medical Necessity Determination for Applicants Residing in Nursing Facilities

3122 Medical Necessity Determination for Applicants Recently Discharged from Nursing Facilities

3123 Medical Necessity Inquiry through the Online Portal

3130 Individual Plan of Care Development

3130.1 Setting Funds Aside in the IPC

3130.2 Coordinating IPC Development with the Provider

3131 Determining Cost Effectiveness

3132 The Individual Plan of Care Service Initiation Date and Effective Period

3132.1 Determining the Number of Weeks in the Initial IPC Period

3133 Notifying MEPD of Approved IPC and MN

3134 Other Resources and Services

3135 Coordinating with IDD Services During the Development of the Initial IPC

3135.1 Access to the CARE System

3136 Individual Residing in Dual Households

3200 Personal Care Services (PCS)

3200.1 PCS Data Reports

3200.2 Using the PCS Data Reports

3210 Procedures for the MDCP Applicant Who Receives PCS

3220 Procedures for the MDCP Applicant Who Does Not Receive PCS

3230 FMS for the MDCP Applicant Accessing CDS

3240 Coordination of Services in the MDCP IPC and Personal Care Assessment Form

3300 Targeted Case Management (TCM)

3300.1 Coordination of TCM and MDCP Services

3400 Reserved for Future Use

3500 Money Follows the Person Option

3500.1 Individuals Without Medicaid

3500.2 Individuals With Medicaid

3510 Individuals Currently Residing in a Nursing Facility

3520 Limited Nursing Facility Stay for Medically Fragile Individuals

3520.1 MFP Procedures for Requesting a Limited Nursing Facility Stay

3520.2 Case Manager Receipt of Form 2406

3520.3 Regional Nurse Approval

3520.4 Submission of Form 2406 to the DADS Physician

3520.5 Determination of Medical Fragility by the DADS Physician

3520.6 Initial Home Visit for Individuals Approved for a Limited Nursing Facility Stay

3520.7 Coordination of the Limited Nursing Facility Stay

3520.8 Delay in Limited Nursing Facility Stay

3530 Money Follows the Person Demonstration (MFPD)

3530.1 MFPD 365-Day Entitlement Period

3540 Closing NF Authorizations for Individuals Transitioning to Community Services

3550 Accessing Relocation Services

4100 Medically Dependent Children Program (MDCP) Services

4110 Respite

4111 Out-of-Home Respite

4112 Respite Service Limits

4113 Respite Service Authorizations

4114 Respite Service Schedule Changes

4120 Flexible Family Support Services

4121 Flexible Family Support Services in Child Care

4122 Flexible Family Support Services for Independent Living

4123 Flexible Family Support Services in Post-Secondary Education

4124 Flexible Family Support Services Limits

4125 Flexible Family Support Services Authorizations

4126 Service Schedule Changes to Flexible Family Support Services

4130 Adaptive Aids

4131 Individual Role in Adaptive Aids

4131.1 Third-Party Resources for Adaptive Aids

4131.2 Adaptive Aid Bidders

4131.3 Specifications for Adaptive Aids

4131.3.1 Specifications for Adaptive Aids with Individual Personal Costs

4131.4 Special Requirements for Van Lifts/Vehicle Modifications

4131.5 Bids for Adaptive Aids

4131.5.1 Bids for Adaptive Aids with Individual Personal Costs

4132 Service Limits on Adaptive Aids

4133 Bid Verification for Adaptive Aids

4134 Individual Personal Costs for Adaptive Aids

4135 Adaptive Aids Service Authorization

4135.1 Approval of Adaptive Aids Not Listed in Section 4132, Service Limits on Adaptive Aids

4136 Adaptive Aid Delivery Time Frames and Confirmation

4140 Minor Home Modifications

4141 Individual Role in Minor Home Modifications

4141.1 Minor Home Modification Bidders

4141.2 Specifications for Minor Home Modifications

4141.2.1 Justifications for Minor Home Modifications Less Than $1,000

4141.2.2 Specifications for Minor Home Modifications with Individual Personal Costs

4141.3 Bids for Minor Home Modifications

4141.3.1 Bids for Minor Home Modifications Less Than $1,000

4141.3.2 Bids for Minor Home Modifications with Individual Personal Costs

4141.4 Home Owner Approval of Minor Home Modifications

4142 Service Limits on Minor Home Modifications

4143 Bid Verification for Minor Home Modifications

4144 Individual Personal Costs for Minor Home Modifications

4145 Minor Home Modification Repairs and Maintenance

4146 Minor Home Modification Service Authorization

4147 Minor Home Modification Time Frames and Completion Confirmation

4150 Transition Assistance Services (TAS)

4151 Transition Assistance Services (TAS) Description

4151.1 Deposits

4151.2 Essential Furnishings

4151.3 Moving Expenses

4151.4 Site Preparation

4152 Limits on Transition Assistance Services (TAS)

4153 Authorizing Transition Assistance Services (TAS)

4153.1 Changes to Transition Assistance Services (TAS) Authorization

4154 Transition Assistance Services (TAS) Delivery Time Frames and Confirmation

4155 Failure to Leave the Nursing Facility

4160 Financial Management Services

4170 Employment Assistance (EA)

4171 Process to Authorize EA Services

4180 Supported Employment (SE)

4181 Role of the Case Manager

4200 Notification and Service Authorization System

4210 Applicant/Individual Eligibility Notification

4220 Provider Notification 4230 Service Authorization System (SAS)

4231 Service Authorization System (SAS) Data Entry

4232 Service Authorization System (SAS) Data Entry for Service Reductions, Suspensions, Denials and Case Closures 4233 SAS Data Entry Procedures for FMSA Provider Transfers

9100 Notification Forms for Service Reductions, Suspensions, Denials and Case Closures

9110 Exceptions to the 30-day Notification Time Frame

9200 Service Reductions

9300 Denying Requests for Specific Services

9400 Service Suspensions

9410 Notification of Service Suspensions

9420 Extension of Suspension

9430 Resuming Services

9440 Procedures for Temporary Nursing Facility Admissions

9500 Service Denials and Case Closure

9510 Ineligibility

9520 Failure to Maintain Enrollment

9530 Death of Individual

9540 Institutional Placement

9541 Additional Procedures for Permanent Nursing Facility Admissions

9550 Aging Out

9551 Aging Out to the Community Based Alternatives (CBA) Program

9552 Aging Out to the STAR+PLUS Waiver Program

9560 Interest List Releases to Other Waiver Programs

9570 Transfer of an Individual to Another Service Area

9571 Procedures for the Original Case Manager

9572 Procedures for the New Case Manager

9600 Appeals and Fair Hearing Procedures

9610 Appeals Process

9611 Case Manager and Designated Data Entry Representative Procedures

9611.1 Procedures for Loss of Medicaid

9611.2 Procedures for Medical Necessity (MN) Denials

9611.3 Procedures for Utilization Review Findings

9612 Sending Additional Information

9613 Request to Withdraw an Appeal

9614 Appeals and Continuation of Services

9620 Fair Hearing

9621 Fair Hearing Decision

9621.1 Action Taken on Fair Hearing Decision

9621.2 Procedures for Sustained Decisions

9621.3 Procedures for Reversed Decisions

9621.4 Procedures When Denied Medical Necessity (MN) is Overturned

9621.5 Procedures When a New Assessment is Required by a Fair Hearing Decision

9622 Fair Hearing Exception

9622.1 Fair Hearing Exception Process

9622.2 Community Services Policy Staff Actions

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