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Medical Services Table of Contents

Medical Services Record of Manual Transmittals

Medical Services Policy

MS 00-02      New and Revised Policy

MS 00-03      TEA Medicaid

MS 00-04      Revised Policy

MS 00-06      Acceptance of SSA-2853 for Verification of SSN Enumeration

MS 00-07      Look back period for Health Insurance Coverage / ARKids

MS 00-09      Revised Policy - SMB, QI-1 & QI-2

MS 01-02  New Policy - Medicaid Eligibility for the Working Disabled

MS 01-03  Medicare Savings Programs

MS 01-06  Revised Policy - Working Disabled

MS 01-08  MS Table of Contents

MS 01-09  SSI COLA Correction

MS 01-10  New and Revised Policy

MS 01-12  New Policy - Breast and Cervical Cancer Medicaid

MS 02-02  New Policy - Income - Family Medicaid Basic Eligibility Requirements

MS 02-05  Revised Policy:  ARKids First

MS 02-06  New Policy - Definition of a Resource

MS 02-09  Tuberculosis (TB) Medicaid

MS 02-10  TEFRA Waiver

MS 02-11  Assisted Living Facilities Waiver

MS 02-12  2003 Appendix S, SSI Chart

MS 03-02 ElderChoices & AAPD Waiver Policy

MS 03-03  2003 Federal Poverty Levels

MS 03-04  ElderChoices & AAPD Waiver Policy Correction  

MS 03-06  Citizenship and Alien Status

MS 03-07  Citizenship and Alien Status-Instructions for Deeming from Alien Spouse

MS 04-01  2004 Appendix S, SSI Chart

MS 04-02  2004 Federal Poverty Level

MS 04-03  ARKids First

MS 04-04 Revised Policy:  Transfer of Resources

MS 04-07 Medicaid Coverage of Pregnant Women

MS 04-08 Adding Spousal Resources Provisions to ElderChoices

MS 05-02 Appendix R, Transfer of Assets Divisor

MS 05-03 2005 Federal Poverty Levels

MS 05-04 Continuing Eligibility for Medicaid Certified Women Who are Pregnant

MS 05-06 Revised Policy: MS 3336.9 Removing Income Trust Cap

MS 06-01 2006 Appendix S – SSI Chart

MS 06-03 Appendix R – Transfer of Assets Divisor

MS 06-04 2006 Federal Poverty Levels

MS 06-05 Verification of Citizenship

MS 06-06 ARKids B 5% Co-pay Cap

MS 07-01 2007 Appendix S (SSI and Quarters of Coverage Charts)

MS 07-02 Allowable Trustee Fees

MS 07-04 2007 Federal Poverty Levels

MS 07-05 Appendix R, Transfer of Assets Divisor

MS 07-06 SSA/SSI Retroactive Payment Exclusion

MS 07-07 Pregnant Women Income Verification

MS 07-08 Creditable Coverage for the Family Planning Waiver

MS 07-09 Changes to the Alternatives for Adult with Physical Disabilities Waiver (AAPD)

MS 07-10 Family Planning Policy - Correction

MS 07-12 Earning Disregard – Nursing Facility Residents

MS 07-13 Alternatives for Adult with Physical Disabilities Waiver (AAPD)-Correction

MS 08-01 2008 Appendix S (SSI and Quarters of Coverage Charts)

MS 08-02 Life Expectancy Tables

MS 08-03 Creditable Coverage for the Family Planning Waiver

MS 08-04 Life Estate

MS 08-05 2008 Federal Poverty Levels

MS 08-06 Appendix R, Transfer of Assets Divisor

MS 08-07 SSI Lump Sum Payment Exclusion

MS 08-08 Social Security Enumeration Requirement

MS 08-10 Long Term Care Insurance Partnership Program

MS 08-12 Student Earned Income Exclusion

MS 08-13 PACE – Program of All Inclusive Care for the Elderly

MS 08-14 Pregnant Women Eligibility – Residence Requirement

Medical Services Policy Directives

MS 82-3      Beneficiary and Earnings Data Exchange (BENDEX)

MS 89-10   SSN Enumeration Procedures When A Request For An SSN For A Child Was Made At A Hospital

MS 91-28    MRT Guidelines

MS 92-6      Supplementary Insurance for Medicare Recipients

MS 92-7      Program Initiatives – Food Stamp Lawsuit

MS 92-11    The Computer Matching Act of 1988 – 30 Day Notice Requirement

MS 98-1      1988 Cost of Living Increase

MS 98-11    Medicaid Explanations

MS 98-12    TEA Medicaid and Extended (Transitional) Medicaid

MS 98-13    MRT Guidelines

MS 99-1      1999 Cost of Living Increase

MS 99-4      Ensuring Medicaid for TEA Households

MS 99-7      New Federal Poverty Levels

MS 99-11    Certificate of Creditable Coverage

MS 99-13    Transitional Medicaid - Declaration of Earnings

MS 00-1      2000 Cost of Living Increase

MS 00-5     New Federal Poverty Level Chart

MS 00-8    ARKids First and SOBRA Procedural Changes

MS 01-01  2001 Cost of Living Increase

MS 01-04  2001 Federal Poverty Levels

MS 01-05  No Resource Test for ARKids A

MS 01-07  Change in Application Procedure for AAPD Waiver

MS 01-11  Coverage for Pregnant Women with Income up to 200% FPL

MS 01-13  2002 Cost of Living Increase

MS 01-14  Medicaid Renewals at Food Stamp QR and Midpoint Review

MS 02-01  Child Support Referrals for Voluntary Cooperation

MS 02-03  2002 Federal Poverty Level

MS 03-01  Implementation of SCHIP Provisions to ARKids B

MS 03-05  Family Planning Waiver Extension

MS 04-06 Reducing Interview Requirements for Initial Medicaid Applications

MS 04-09 The Impact of Medicare Approved Prescription Drug Coverage on the Food Stamp Program and the Medicaid Program

MS 04-11 Accepting Faxed Applications

MS 05-01 2005 Appendix S, SSI Chart

MS 05-05 ARKids First Telephone Renewals

MS 06-02 Referrals for IndependentChoices

MS 06-07 Citizenship Requirement – Secondary or Lower Verification - Verification of Identity for Adult Medicaid Applicants/Recipients

MS 06-08 Procedures Developed with the Division of Health related to Citizenship Verification for Medicaid Applications Taken at Local Health Units

MS 06-09 Deficit Reduction Act of 2005 – Long Term Care Changes

MS 07-03 Citizenship Verification Requirement Exemption-SSA Disability Recipients

MS 07-11 Medical Review Team (MRT) Denials and Closures Explanation of Adverse Action

MS 07-14 Termination of ARKids First Telephone Renewal Requirement

MS 08-09 Closing ARKids A and B Cases

 

 

1000     Medical Services

1010     Legal Basis

1020     Administration

1030     Purpose of Medical Services

1040          Benefits Available Under Medicaid

 

1100     County Office Responsibilities For Services

1110     Client Representation Services Program

1120     Child Health Services Program (EPSDT)

                          1120.1    Purpose of Child Health Services Program

                          1120.2    Administration

                             1120.3    Individuals Eligible for Child Health Services

     1120.4    Eligible Providers of Child Health Services

                                           1120.4.1    Provider Participation Requirements

                                           1120.4.2    Choice of Providers

           1121    Formal Screening Services

                         1121.1    Medical Screening Services

                         1121.2    Dental Screening Services

   1121.3    Visual Screening Services

   1121.4    Hearing Screening Services

   1121.5    Initial CHS Examinations

   1121.6    Requirements for Interperiodic Screenings

   1121.7    Covered Services

1122    Informing Procedure

1123    ACES Certification Requirements for Child Health Services

   1123.1    ACES EPSDT Indicator Update Screen (WEPS)

1124    Services

   1124.1    Support Services

   1124.2    Scheduling Assistance

   1124.3    Transportation

   1124.4    Follow-up

                                         1124.4.1    Refused Services

                                         1124.4.2    Canceled Appointments

                                         1124.4.3    "No Shows"

1125    Diagnosis and Treatment

1126    Provider - Initiated Child Health Services

1127    Forms and Reports

   1127.1    DCO-694

   1127.2    Child Health Services Monthly Reports

   1127.3    Ordering Forms

1150    Children's Medical Services Program

1151    Cost Sharing Coinsurance/Copayment

1155    Expedited Services for Child Abuse Cases

1160    Head Start

1170    Hospital/Physician Referral Program

   1170.1    Hospital/Physician Responsibility

   1170.2    County Office Responsibility

1180     Hospital/Physician Referral for Newborns

1190     Primary Care Physician Managed Care Program

1191     Recipient Responsibilities

1192     County Office Responsibilities

    1192.1    System Requirements for PCP Selection

1193     Changes in Primary Care Physicians

    1193.1    PCP Changes for SSI Recipients

    1193.2  Changes in Recipient Status

1193.3    System Requirements for PCP Changes

1194     Procedures for CMS Recipients

    1194.1    CMS Responsibilities

    1194.2    County Office Responsibilities

1200     Transportation Services

1200.1    Services for Which Transportation is Paid

1200.2    Primary Care Physicians

1200.3    Freedom of Choice (Non-PCP Recipients)

1200.4    Methods of Transportation and Payment

1200.5    Loaded Miles

1200.6    Meals, Lodging and Incidental Expenses

1200.7    Domiciliary Care

1200.8    Therapeutic Visits

1200.9    Emergency Transportation

1200.10  Visits for Prolonged Treatment

1200.11  Out-of-State Transportation

1200.12  Transportation of Former Recipients for Utilization Review

1205     County Office Administration

1205.1    Case Records

1205.2    Volunteers

1205.3    Verification and Prior Authorization

1205.4    TR-1s

1205.5    Misuse of Transportation

1205.6    Lost or Stolen Checks

1205.7    Canceled Visits

1205.8    Authorizing County

1205.9    Replenishing Funds

1205.10  Preferential Treatment

1300     General Information

1310     Child Support Enforcement Services

1320     Coordination with Other Programs

1330     Disclosure of Information/Confidentiality

1331     Authorized Representatives

1332     Medical Records and DCO-109s

1333     Medical Providers/Service Organizations

1334     Collateral Information

1340     Disposition of Medicaid Case Records

1348     Inmates of Public Institutions

1350     Mandatory Assignment of Rights to Medical Support/Third Party Liabilities

1350.1    County Office Responsibility

1350.2    Recipient Responsibility

1350.3    Provider Responsibility

1350.4    Procedure for Failure to Cooperate

1360     Medicaid for the Homeless

1370     Medicaid Identification Card

1371     Reissuing of Medicaid ID Cards

1380     Medicare/Medicaid

1385     Quality Assurance

1390     Social Security Enumeration

1400     Twelve Month Filing Deadline on Medicaid Claims

2000     Individuals Eligible for Medicaid

2005     Date Specific Eligibility

2010     Supplemental Security Income (SSI) Eligibles

2010.1    National Correction Procedure

2011     Definition of Eligible Spouse

2012     Definition of Eligible Child

2013     Definition of Marital Status

2014     Definition of Living Arrangements

2020     Converted Cases Not Blind or Disabled Under SSI Criteria

2025     Essential Person (Ineligible Spouse) in December 1973

2030     Eligible Due to Disregard of Social Security COLA Increases

2031     Central Office Procedure

2032     County Office Responsibilities

2033     Eligibility Criteria for Closed SSI Cases

2033.1     Examples of Potential Eligibles

2034     Determining Eligibility

2034.1     Certification and Other System Procedures

2035     Identification of Stragglers

2036     Medicaid for Children Who Lost SSI Due to Childhood Disability Redeterminations

2036.1     Extent of Services

2036.2     Identification of Eligibles

2036.3     Continuation Procedures

2036.4     Reevaluation of Eligibility

2036.5     Changes and Closures

2040     Medicaid Eligible Due to 20% Social Security Increase in September 1972

2041    Determination of Current Eligibility

2042    Reevaluation of Eligibility

2043    Closure

2044     August, 1972 Eligibility Criteria

2044.1    August, 1972 AFDC Criteria

2044.2    August, 1972 AABD Criteria

2044.3    Public Institution Eligibles in December 1973

2045     Medicaid For Disabled Widows and Widowers

2045.1    Eligibility Criteria

2045.2    Processing Reapplications and Reevaluations

2046     Disabled Widows and Widowers

2046.1    Eligibility Criteria

2046.2    Application Procedures and Eligibility Determination