§ 2070.36. Determinations or redeterminations of eligibility.
Counties and prime contractors shall establish procedures for the determination and redetermination of eligibility to ensure that the following requirements are met:
(1) Initial eligibility determinations. Counties and prime contractors shall:
(i) Require medical assistance eligibles to display a currently valid Medical Services Eligibility Card.
(ii) Record the applicants medical assistance identification number and maintain it with the applicants files.
(iii) Record the applicants eligibility code and maintain it with the applicants files.
(iv) Determine the applicants need for services and the mode of service which is appropriate for the applicants physical and mental capabilities.
(v) Inform the applicant of the results of the need determination and instruct the applicant how to arrange for the particular mode of service.
(vi) Inform the applicant of the applicants right to appeal.
(vii) Inform the applicant of the applicants responsibility to notify the provider of changes which may affect eligibility for service.
(viii) Require that the applicant or the person or agency so authorized by the client sign the Public Assistance Transportation Block Grant Eligibility Form.
(2) Redetermination of eligibility. Counties and prime contractors shall:
(i) Ensure that where continued services are provided, a verification of a persons eligibility for medical assistance is done immediately after the date the clients Medical Services Eligibility Card expires. However, counties or prime contractors may verify a persons eligibility for medical assistance more frequently at their discretion.
(ii) Ensure that clients found ineligible as a result of redetermination of need are notified in writing. Notice from the county, prime contractor, or their providers is not required for clients who become ineligible as a result of their loss of eligibility for medical assistance.
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.