§ 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 applicant’s medical assistance identification number and maintain it with the applicant’s files.

     (iii)   Record the applicant’s eligibility code and maintain it with the applicant’s files.

     (iv)   Determine the applicant’s need for services and the mode of service which is appropriate for the applicant’s 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 applicant’s right to appeal.

     (vii)   Inform the applicant of the applicant’s 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 person’s eligibility for medical assistance is done immediately after the date the client’s Medical Services Eligibility Card expires. However, counties or prime contractors may verify a person’s 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.



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