177.09 Maintaining QH/QE Certification to Determine PE (MAM)

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QHs/QEs must maintain their PE certification by applying PE eligibility requirements consistently and accurately during each PE determination, verifying that the individual is authorized for the PE period, and verifying that the individual is not already a Medicaid applicant.

QHs are further required to ensure that at least 75% of the individuals they determine eligible for PE submit applications for Medicaid before the end of the individual's PE period. QHs that fail to meet this requirement must send all their PE-certified employees to an additional PE training and/or testing session offered by DHHS.

If DHHS determines that the QH or QE is failing to adhere to the requirements of determining PE, the QH/QE:

. must participate in retraining within 30 days of the date of the notice from DHHS that the QH/QE is not meeting requirements; and

. score an 85% or higher on the written reexamination provided at the retraining.

The QH or QE will be disqualified from determining PE if:

. all certified employees do not attend the additional training and/or testing session within timeframes and achieve a score of 85% or higher on the written reexamination; or

. all certified employees attend the additional training and/or testing session, but the QH still fails to meet the requirement that 75% of the individuals they have determined eligible for PE must submit applications for Medicaid before the end of the individual's PE period.

QE/QHs are disqualified for a:

. 6-month period from the date on the disqualification notice from DHHS for the first finding; and

. 1-year period from the date on the disqualification notice from DHHS for the second and subsequent findings

References: He-W 843.04, 42 CFR 435.1110(d)