157.03 Required Verification for Redeterminations (MAM)

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Medical assistance (MA) cases are notified of any verifications that are required at redetermination/renewal via the New HEIGHTS-generated:

•         CS0006, Mail-In Rede Letter, if the MA case uses a mail-in redetermination;

•         CS0027, Online Rede Letter, if the non-passive MA case is completing an online redetermination/renewal; or

•         CS0030 Online Passive Rede, if the passive MA case is completing an online redetermination/renewal.

When verification is not sufficient or not provided in the online or mail-in redetermination process, notify the non-passive MA case in writing of any required information or verification needed to complete the redetermination and the time frame for returning the verifications. Use New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance. If New HEIGHTS is unavailable, use the paper backup BFA Form 808, Proof Needed to Determine Your Assistance. If the AE0055 is used in a non-passive MAGI MA case, the due date to provide the required verification must be altered to allow for the 90-day grace period allowed for MAGI cases.

For all categories of medical assistance, the MA case must provide verification of all eligibility factors and circumstances, if requested.

The MA case must provide the required verifications no later than:

•         the due date in the CS0006 if the MA case uses a mail-in redetermination;

•         10 calendar days after the personal interview if an interview is required;

•         10 calendar days after the required return date for BFA Form 771A, Nursing Facility Care Renewal; or

•         the due date in the CS0027 if participating in an online redetermination and receiving a non-MAGI category of MA or the case is a non-passive MAGI MA renewal.

Terminate assistance if the MA case refuses or fails to provide the required verifications within time frames.

Exceptions:

•         When a third party has not responded to a request for verification within timeframes, send a follow-up request to the third party and to the MA case. Allow an additional 10 calendar days for a response. If the verification is not provided within the second waiting period, terminate assistance unless the MA case provides other acceptable verification.

•         If assistance is being terminated due to lack of required verification and the MA case provides the required verification within the advance notice period, stop the termination action and reinstate assistance.

•         For all categories of MA that use MAGI in the eligibility determination process, if assistance was terminated due to failure to provide requested verification listed on the New HEIGHTS-generated CS0006/CS0027 and the MAGI case subsequently provides all requested verification within 90 days of the date of the termination of coverage, reinstate medical assistance back to the date of termination by the 30th calendar day following the date the last piece of verification was provided.

•         For non-MAGI categories of MA, if assistance was terminated due to failure to provide requested verification and the non-MAGI MA case provides all the required verification within 10 calendar days following the end of the advance notice period:

•       have the non-MAGI MA case fill out BFA Form 800, Application for Assistance, or BFA Form 800MA, Application for Health Coverage & Help Paying Costs, if the case is Medicaid-only, with their name, address, and signature;

•         ensure that no other changes have occurred in the case that would affect eligibility and that no new program services have been requested on BFA Form 800 other than those which were originally terminated;

•     if the non-MAGI MA case meets all program eligibility requirements, reinstate assistance based on the new application date, with no new interview required; and

•      generate medical benefits in accordance with PART 121 INITIATION OF MEDICAL ASSISTANCE , assuming the case has requested retroactive medical coverage back to the date of closing, if applicable.

References: He-W 606.01; He-W 606.100-606.101; He-W 844.01; He-W 883.01; He-W 884.01-.02; RSA 161:4-a, X(a) & (g); 42 CFR 435.914(a); 42 CFR 435.916; 45 CFR 206.10(a)(9)