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 of application. Section 304.14, Date of Application and Date When MA Begins.
Data enter any third party liability coverage and explain that MA is the payer of last resort.
The issuance of the PA ACCESS card is authorized when the CAO enters eligibility information into eCIS. 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, eCIS posts a renewal date which is 12 months from the authorization date. Modify the renewal date, if required. At renewal, all other categories of MA should again be evaluated prior to reauthorizing the Children with Special Needs category. 55 Pa. Code § 133.73
When the CAO receives documentation of disability from a physician, or licensed psychologist, 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 the Children with Special Needs category.
Updated April 12, 2018, Replacing February 14, 2012