If eligible, authorize eligibility for the child with special needs in category “PH,” program status code “95.” Generate a notice of eligibility per Chapter 377, Notices.
Authorize eligibility for MA effective the date the signed application is date stamped by the CAO, submitted on COMPASS or the date it was signed if submitted by a provider. Chapter 368, Determining Eligibility For NMP, Section 368.31, Continuing Period Of Eligibility.
Data enter any third party liability coverage and explain MA is the payer of last resort.
The issuance of the PA ACCESS card is authorized when the CAO enters eligibility information into the Client Information System (CIS). The CAO will ensure that the authorization and data entry process is completed timely to meet the medical needs of the eligible child. Chapter 380, Issuing The ACCESS Card.
For continuing eligibility, CIS posts a renewal date which is 12 months from the authorization date. Modify the renewal date, if required. At renewal, other categories of MA should again be evaluated prior to reauthorizing Children With Special Needs category. 55 Pa. Code § 133.73
When the CAO receives documentation from a physician, or licensed psychologist of disability, and the child has not been determined disabled by SSA or MRT, the child should be authorized presumptively and a DAP referral should be completed for MRT review. Section 305.26, Presumptive Eligibility – PH/PJ/TJ.
Eligibility may be authorized for the retroactive period when medical documentation (either by SSA or MRT determination) confirms the disability existed in the retroactive period.
There is no presumptive eligibility to qualify for MA in the retroactive period for Children with Special Needs category.
The CAO is to use the PH 95 data base to report the parental income (earned and unearned) and household information that is required under Act 7A of 2002 in order for the department to submit an annual report to the General Assembly.
For all applications and renewals, the caseworker must complete the Data Collection Interface Data Entry Slip. Clerical staff enters the information in the Data Collection Interface Data Inquiry Screen: http://PH95LH
Updated February 14, 2012, Replacing April 14, 2011