Article 8 Section 03 Recertification
Table of Contents
TITLE PG CITE
General 080301A
NonChronics 080301B
Chronics 080301C
Exceptions 080301D
080301 Recertification
080301A Recertification is a determination that a beneficiary continues to meet
General the CMS eligibility criteria and has not had a break in aid of more than one month Recertification information shall be recorded in case comments
CMS has two standards for recertification standard and chronic
080301B Nonchronic beneficiaries may be recertified for up to six months NonChronics
MPG LTR 713 1110
080301C Chronics are those beneficiaries who have been identified by the ASO
Chronics as having a chronic medical condition by entering a CHRONIC indicator on the IDX Eligibility Enrollment Summary Screen Before recertifying the worker must look for the CHRONIC indicator
CMS beneficiaries with the CHRONIC indicator who recertify or reapply may be certified for up to 12 months if they continue meet all eligibility requirements and there are no foreseeable changes in circumstances that affect eligibility during the certification period as described in 080301D below
If the beneficiary has been identified as chronic before their certification period ends the case may be eligible for an automatic extension Refer to 0801
CMSPG LTR 08 0112
080301D Exceptions Chronic and nonchronic CMS beneficiaries are to be recertified for up to the allowable period with the following exceptions
When a beneficiary has a foreseeable change in circumstances that affects eligibility during the recertification period the recertification period may be less than the allowable period When the recertification period is less than the allowable the worker must state the reason in the comment section of the CMS IT automated NOA that certifies CMS
and in case comments
Example Recertification Allowable Period
Scenario 1 A CMS beneficiary with the CHRONIC indicator on IDX will turn 65 years old in 9 months The worker will recertify for 8 months and note Turns 65 monthyear in case comments
Scenario 2 A CMS nonchronic beneficiary will turn 65 years in 9 months the worker will recertify for six months and note Turns 65 monthyear in case comments
MPG LTR 720 0511