AS OF: 07/01/2009 07:01
0300 MEDICAL ASSISTANCE PROGRAM OVERVIEW
0300.05 MEDICAL ASSISTANCE PROGRAM PURPOSE
0300.10 PROGRAM ADMINISTRATION
0300.15 CATEGORIES OF MEDICAL ASSISTANCE
0300.15.05 Categorically Needy
0300.20.05 Medical Services Provided
0300.20.05.05 Emergency Room Co-Payment Required
0300.20.05.15 Abortions, Rape, or Incest
0300.20.05.20 Abortions, To Save the Life of the
Mother
0300.20.05.25 Organ Transplant Operations
0300.20.05.30 Transportation Services
0300.20.05.35 Pharmacy Services
0300.20.05.35.05 Pharmacy Services Cost Sharing
Requirements
0300.20.30 Provider Deficiencies/Plan of
Correction
0300.20.40 Pharmacy Lock-In Program
0300.20.40.05 Enrollment in Pharmacy Lock-In Program
0300.20.40.10 REVS Identification of Lock-In
Recipients
0300.20.40.15 Primary Pharmacy of Choice
0300.20.40.20 Primary Care Physician
0300.20.40.25 Change in Primary Pharmacy/Physician
0300.20.40.30 Change in Recipient Status
0300.25 OVERVIEW OF MA ELIGIBILITY REQUIREMENTS
0300.25.05 Technical Eligibility Requirements
0300.25.10 Characteristic Eligibility
Requirements
0300.25.15 Cooperation Requirements
0300.25.20 Financial Eligibility Requirements
0300.25.20.05 Income Flex-Test and Spenddown
0300.30 METHODOLOGY FOR DETERMINING COVERAGE GROUP
0300.35 ORGANIZATION OF THE MANUAL
0300.40 Procedure for Imposing Admin Sanctions
0300.40.05 Statutory Authority
0300.40.15 Sanctionable Violations
0300.40.25 Notice of Violations and Sanctions
0300.40.35 Administrative Hearing
0300.40.40 Appeal for Judicial Review
0300.40.45 Administrative Actions
0300.45.05 EXPEDITED SERVICES PROVISION for H.C.B.S.
0300.45.10 HOME & COMMUNITY BASED SERVICES
COVERED
0300.45.15 PROVISION FOR RECEIVING EXPEDITED
SERVICES
0300.45.20 REQUIREMENTS FOR REIMBURSEMENT
0302.05 THE REQUEST FOR MEDICAL ASSISTANCE
0302.05.05 Request for a Medicare Part D
Application
0302.10 CONTENTS OF THE APPLICATION PACKET
0302.10.05 Assistance in Completing the
Application
0302.10.10 Who Must Sign the Application
0302.15 DECISION ON ELIGIBILITY
0302.25 CERTIFICATION OF ELIGIBILITY
0302.30.05 MA as Payor of Last Resort
0302.30.10 Direct Reimbursement to Recipients
0304 TECHNICAL ELIGIBILITY REQUIREMENTS
0304.05 REQUIREMENTS OF CITIZENSHIP/ALIENAGE
0304.05.10 Eligibility as a United States
Citizen
0304.05.10.05 Verification of Citizen Status
0304.05.15 Elig as a Qualified Non-Citizen
0304.05.20 Eligibility as an Amerasian
0304.05.20.05 Verification of Amerasian Status
0304.05.21 Elig as a Lawful Permanent Resident
(LPR)
0304.05.21.05 Verification of LPR Status
0304.05.25 Elig as an Amer Indian Born Outside
the US
0304.05.25.05 Ver of Stat as Amer Ind Born Outside
the US
0304.05.30 Eligibility as a Conditional Entrant
0304.05.30.05 Verification of Conditional Entry
0304.05.35 Eligibility as a Battered
Non-Citizen
0304.05.35.05 Verification - Battered Immigrant
0304.05.45 State-Funded Coverage Group Defined
0304.05.45.05 Eligibility as a State Funded
Non-Citizen
0304.05.45.10 Verification of Lawfully Residing
Status
0304.05.45.15 Documentation of RI Residency Before
7/1/97
0304.05.50 Eligibility as a Refugee
0304.05.50.05 Verification of Refugee Status
0304.05.55 Eligibility as an Asylee
0304.05.55.05 Verification of Asylee Status
0304.05.60 Eligibility as Deportation Withheld
0304.05.60.05 Verification of Deportation Withheld
0304.05.65 Eligibility as a Cuban/Haitian
Entrant
0304.05.65.05 Verification of Cuban/Haitian Status
0304.05.70 Elig as a Member of US Armed
Forces/Veteran
0304.05.70.05 Verification of Veteran/US Armed Forces
0304.05.75 Eligibility as a Parolee
0304.05.75.05 Verification of Parolee Status
0304.05.80 Eligibility as an SSI Recipient
0304.05.85 Eligibility as a Victim of
Trafficking
0304.05.85.05 Verification of Victim of Trafficking
Status
0304.10.05 MA Residency Requirements
0304.10.05.15 MA Individual Over 21
0304.10.05.20 MA Individual Under 21
0304.10.05.25 Institutionalized MA Individual
0304.15 REQUIREMENT FOR SOCIAL SECURITY NUMBER
0306 CHARACTERISTIC REQUIREMENTS
0306.05 CHARACTERISTIC REQS FOR INDS & COUPLES
0306.05.05 SSI-Related Age Requirement
0306.05.10 Eligibility Based on Blindness
0306.05.15 Eligibility Based on Disability
0306.10 CHARACT REQS FOR FAMILIES (AFDC-RELATED)
0306.10.10 Relationship Requirement
0306.10.15 Deprivation of Parental Support
0306.10.20 Exceptions to the Req of an AFDC
Charact
0308.05 APPLICANT REQUIRED TO COOPERATE
0308.10.05 Coop in Est Paternity &
Obtaining Support
0308.10.10 Coop in Identifying & Providing
TPL Info
0308.15 REQUIREMENT TO UTILIZE RESOURCES
0308.15.05 Dist Office Procedures When
Unavailable
0308.20 APPLICANT'S PURSUIT OF OTHER BENEFITS
0308.20.05 Availability of Other Program
Benefits
0308.20.10 Requirement to Pursue Other Benefits
0308.20.15 Good Cause for Not Pursuing Other
Benefits
0310.05 RETROACTIVE COVERAGE DEFINED
0310.10 ELIGIBILITY REQUIREMENTS
0310.15 PROCEDURES FOR DETERMINING RETRO ELIGIBILITY
0310.20 AUTHORIZATION OF RETROACTIVE ELIGIBILITY
0312 LIENS & RECOVERY OF MA PAYMENTS
0312.10 APPLICATION OF THE LIEN
0312.15 EXCEPTIONS TO THE LIEN
0312.15.05 REDUCTIONS OF THE LIEN UNDER QLTCIP
Program
0312.35.05 Request for Discharge Due to
Inapplicability
0312.40 UNDUE HARDSHIP CONSIDERATION
0312.40.05 Application for Undue Hardship
Consideration
0312.40.10 Undue Hardship Granted
0312.40.15 Transfer/Sale of Property
0314 MA PAYMENT FOR OUT OF STATE CARE
0314.05 REQUIREMENT OF PRIOR AUTHORIZATION
0314.05.05 Exceptions to the Requirement of
Prior Auth
0314.05.10 Services Rendered to Temp Absent
Recipients
0314.05.15 Follow-up Procedures
0316 MEDICAL ASSISTANCE FOR ALIENS
0316.05 IMPACT OF ALIEN STATUS ON SCOPE OF SERVICES
0316.05.10 Refugee Medical Assistance
0316.10 INELIG ALIENS
RECEIVING RESTRICTED SERVICES
0316.10.05 Restricted Services Eligibility
Requirements
0316.10.05.05 Restricted Services Eligibility
Requirement
0316.10.05.10 Exception to SAVE Requirement
0316.10.05.15 Exception to Enumeration Requirement
0318 MEDICAL ASSISTANCE REDETERMINATION
0318.05 REDETERMINATION
OF MA ELIGIBILITY
0318.10 REDETERMINATION PROCESS
0318.15 REDETERMINATION IN SHORT TERM FLEX TEST CASE
0318.20 Redetermination of Disability Determination
0320 REFERRAL TO OTHER RESOURCES FOR MED CARE
0320.05 AVAILABILITY OF OTHER RESOURCES
0320.10 REHABILITATION (ORS) SERVICES
0320.10.05 VR Responsibilities
0320.10.10 MA Responsibilities
0320.10.15 Prior Authorization Required
0320.10.20 Referral of MA Ineligible Indiv
w/Disability
0320.15.15.10 Medical Benefits
0320.15.15.15 Cost of Living Increases
0320.15.20 How to Receive VA Benefits
0320.20 RI PHARMACEUTICAL ASSIST FOR ELDERLY (RIPAE)
0320.20.05 Eligibility for Coverage
0320.20.10 Covered Medications
0320.20.15 Application Process
0322 EARLY INTERVENTION PROGRAM
0322 Early Intervention Program
0322.05 Purpose the the Early Intervention Program
0322.20 Interagency Coordinating Council (ICC)
0322.25 Certification Requirements
0322.35 Central Directory of Services
0322.40 Comprehensive Child Find System
0322.45 Evaluation and Assessment Procedures
0322.50 Individualized Family Service Plan (IFSP)
0322.55 Development, Review and Evaluation of IFSP
0322.60 Transition of Children to Preschool Programs
0322.65 Comprehensive System of Personnel Dev
0322.70 Procedural Safeguards and Confidentiality 19
0322.75 Mediation and Impartial Hearing Process
0326.10 ELIGIBILITY REQUIREMENTS FOR FAMILIES
0326.10.05 Family Categories - Eligibility
Tests
0328 CHARACTERISTIC REQUIREMENTS
0328.05.05 Verification of Age
0328.10 RELATIONSHIP REQUIREMENT
0328.10.05 Verification of Relationship
0328.10.05.05 Verif Relationship Unwed Father
0328.10.10 Establishment of Home/Temporary
Absence
0328.15 DEPRIVATION OF PARENT SUPPORT
0328.15.05 Deprivation, Continued Absence
0328.15.05.05 Evidence of Parental Absence
0328.15.05.10 Referral to Child Support
0328.15.10 Deprivation by Death
0328.15.15 Deprivation, Phy/Mental Incap
0328.15.15.05 Evidence of Parental Incapacity
0328.15.15.10 Continuing Elig, Parental Incap
0328.15.20 Deprivation by Parent Unemployment
0328.15.20.05 Definition of Unemployment
0328.20 EXCEPTIONS TO CHARACTERISTICS
0328.20.15 Section 1931 and MA Waiver Families
0330.05 INCOME STANDARDS - FAMILIES
0330.15 DOCUMENTATION OF INCOME
0330.25.05 Earned Income From Wages
0330.25.10 Earned Income From Self-Employment
0330.25.10.05 Payment for Providing Child Care
Services
0330.25.15 Earned Income From Roomer/Boarder
0330.25.20 Earned Income From Real Property
0330.30 EARNED INCOME DISREGARDS
0330.35 OTHER SOURCES OF INCOME
0330.35.05 Fed/State Insurance, UCB, TDI
0330.35.05.05 Unemployment Compensation Benefits
(UCB)
0330.35.05.10 Temporary Disability Insurance
0330.35.10 Workforce Investment Act
0330.35.15.05 Retirement Benefits
0330.35.15.10 Survivorship Benefits
0330.35.15.15 Lump Sum Death Benefits
0330.35.15.20 Disability Benefits
0330.35.15.25 Requesting Info from Social Sec
0330.35.20 Employment Pensions
0330.35.25 Veterans Administration Benefits
0330.35.30 Workers' Compensation
0330.35.35 Insurance Settlement
0330.35.40 Money/Goods From Other Agencies
0330.35.45 Relative Contribution
0330.35.50 Child Support Income
0330.35.55 Inc for Ind Pursuing an Educ
0330.35.55.05 Treatment of VA Educ Assis
0330.35.55.10 Fed or Non-Fed Supported Source
0332.05 DEFINITION OF A BUDGET PERIOD
0332.10 MEDICALLY NEEDY BUDGET PERIODS
0334 DETERMINING INCOME ELIGIBILITY
0334.15 GROUP SIZE AND COUNTABLE INCOME
0334.20 STANDARD OF ELIGIBILITY
0336.05.05 When Eligibility Begins
0336.05.10 Whose Expenses Are Used
0336.10 DEDUCT LOANS TO PAY BILLS
0336.15 DEDUCTING RECOGNIZED MEDICAL EXPENSES
0336.15.05 Deducting Recognized
Medical/Remedial Care
0336.15.05.15 Home Health Aide/Homemaker Services
0336.25 CERT OF FLEXIBLE TEST CASES
0336.25.05 Controlling Flexible Test Cases
0338.10 DEFINITION OF RESOURCE
0338.10.05 Countable/Excluded Resources
0338.15 DOCUMENTATION OF RESOURCES
0338.20 TIMING OF RESOURCE EVALUATION
0338.25.10 Real Property Other Than Home
0338.25.15 Income-Producing Property
0338.25.20.05 Special Use Vehicles
0338.25.35 Resources Excluded by Law
0338.30.05 Date of Eligibility