Article 8 Section 09 Changes and Information Reported During The Certification Period
Table of
Contents
TITLE PG CITE
General 080901A
Information Received 080901B
Fraud Referral 080901C
080901 Changes and Information Reported During The Certification Period
080901A General
CMS eligibility continues until the end of the certification period unless the beneficiary has been determined no longer eligible for CMS prior to the certification end date Refer to CMSPG 150101A for discontinuance reasons
Exception Erroneous certifications Refer to CMSPG 0802 for additional information
CMSPG LTR 14 0713 CMSPG LTR 14 0713
080901B When the worker receives information or becomes aware of a change
Information that may affect CMS eligibility the worker shall
Received
Step Action
1 Review the case and determine whether clarifying information is needed
2 Send informing letter HHSA CMS34 to the beneficiary if additional information is required The CMS34 1 Explains how the information may affect CMS eligibility and the beneficiary may need to make other payment arrangements with health care providers before the certification period ends 2 Informs the beneficiary of any additional verification that must be provided and the specific due date for the requested verification
3 Upon receipt of verifications update the CMS case with the new information If beneficiary Then remains eligible CMS case remains active is found to be ineligible discontinue CMS case according to CMSPG 1501
080901C If information is received after a case is granted that would have made Fraud the applicant ineligible to CMS at the initial application the worker Referral
shall follow the instructions for fraud referrals in CMSPG 1101 and discontinues the CMS case as appropriate Refer to CMSPG 1501
CMSPG LTR 14 0713