DATE: September 14, 2015
SUBJECT: Certification Periods
Federal Regulations require a periodic review for all Medicaid beneficiaries. The review must be completed at least once every 12 months.
In an effort to align with other eligibility programs the certification period for Long Term Care (LTC), Community Alternatives Program (CAP) and Programs of All Inclusive Care for the Elderly (PACE) will move from a 6 month certification period to a 12 month certification.
This change includes CAP deductible cases.
Beginning September 28, 2015 NC FAST will require a 12 month certification period for LTC, CAP, and PACE cases. All applications and redeterminations processed effective September 28th will require a 12 month certification period.
A. Determine eligibility for all new applications and activate the case with a 12 month certification period beginning with the month of eligibility.
B. Determine eligibility for all re-determinations for 12 months.
When a beneficiary has LTC/CAP/PACE and a MQB product; a re-determination must also be completed for the MQB. This will allow and provide aligned certification periods for both products.
If you have any questions regarding this information, please contact the Operational Support Team at firstname.lastname@example.org.
Deputy Secretary for Medical Assistance
(This material was written and researched by Pam Cooper, Medicaid Eligibility Unit)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.