177.07 Certification Process to Determine PE (MAM)

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A hospital or entity that furnishes health care services and is enrolled with DHHS to receive Medicaid payments as a Medicaid provider, must do the following if they wish to be certified by DHHS to determine presumptive eligibility (PE):

. notify DHHS of their interest in determining PE by completing DFA Form 820, Request to Determine Presumptive Eligibility (PE), and submitting the completed form to DHHS;

. all of the organization's employees who want to determine PE must attend a PE training session provided by DHHS; and

. at least 1 of the organization's employees must score 85% or higher on a written exam provided by DHHS after the PE training session.

Only the employees who attend the DHHS PE training and score 85% or higher on the written exam can be certified to determine PE. Entities and hospitals who are successfully certified by DHHS are referred to as qualified entities (QEs) and qualified hospitals (QHs) and are certified to make PE determinations for a limited period of temporary medical assistance coverage.

As part of the certification process, QH/QE workers must provide DHHS with a signed and dated document that includes:

. his or her name, title, and contact information;

. the name and address of the hospital or organization where he or she is employed,

. an agreement to meet and maintain all required PE certification criteria;

. an agreement to meet and consistently apply every PE eligibility determination requirement; and

. if a QH, an agreement to ensure that 75% of the individuals for which the QH has determined PE submits an application for full Medicaid before the end of his or her PE period.

References: He-W 843.03, He-W 843.04(b), 42 CFR 435.1102(b)(3), 435.1110