Article 8 Section 03 Recertification

 

Table of Contents

Title

PG Cite

General

08.03.01A

Non-Chronics

08.03.01B

Chronics

08.03.01C

Exceptions

08.03.01D

 

 

08.03.01 Recertification

 

08.03.01A
General

Recertification is a determination that a beneficiary continues to meet 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. 

 

08.03.01B
Non-Chronics

Non-chronic beneficiaries may be recertified for up to six months.

 

MPG LTR 713 (11/10)

 

08.03.01C
Chronics

Chronics are those beneficiaries who have been identified by the ASO 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 08.03.01D 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 08.01).

 

CMSPG LTR 08 (01/12)

 

08.03.01D
Exceptions

Chronic and non-chronic 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 month/year” in case comments. 

Scenario 2

A CMS non-chronic beneficiary will turn 65 years in 9 months, the worker will recertify for six months and note “Turns 65 month/year” in case comments.

 

MPG LTR 720 (05/11)