Section 1200.40 Applications for Care Coordination Services and Financial Assistance

Section 1200.40

Applications for Care Coordination Services and Financial Assistance

a)         Applications

for care coordination services

1)         Applications for care coordination

services shall include, at a minimum:

A)        The name, age, address and

telephone number of the applicant child;

B)        The name, address and

telephone number of the LRA;

C)        The LRA's signature; and

D)        Information necessary to determine

medical eligibility or provide or arrange for diagnostic services as described

in Sections 1200.90 and 1200.110.

2)         Completed Applications for

Care Coordination Services

Applications for care coordination services shall be

considered completed on the business day the requirements of subsections (a)(1)

and (d) are met.

b)         Applications

for Financial Assistance

1)         Applications for financial

assistance shall include, at a minimum:

A)        The name, age, address and

telephone number of the applicant child;

B)        The name, address and

telephone number of the LRA;

C)        The LRA's signature;

D)        Information necessary to

determine medical eligibility or provide or arrange for diagnostic services as

further described in Sections 1200.90 and 1200.110; and

E)        Information necessary to determine

financial eligibility as further described in Section 1200.80.

2)         Completed Application for

Financial Assistance

Applications for financial assistance shall be

considered completed on the business date the requirements of subsections (b)(1)

and (d) are met.

c)         Diagnostic

Services

No separate application is required for diagnostic services.

Diagnostic services may be provided as part of the eligibility process for care

coordination services or financial assistance

cation for

Financial Assistance

Applications for financial assistance shall be

considered completed on the business date the requirements of subsections (b)(1)

and (d) are met.

c)         Diagnostic

Services

No separate application is required for diagnostic services.

Diagnostic services may be provided as part of the eligibility process for care

coordination services or financial assistance.

d)         Supplemental

Information

1)         After an application

meeting the requirements of subsection (a)(1) or (b)(1) is received by DSCC,

supplemental information, including interviews and Reimbursement Agreements

(for financial assistance applications), may be requested by DSCC to establish

eligibility.

2)         The LRA shall submit the

supplemental information no later than 45 days after the dated DSCC written

notice or the date specified in that written notice, whichever is later.

3)         Failure to submit the

supplemental information within the required time frame shall cause the

application to be deemed incomplete under subsection (e).

e)         Incomplete

Applications

1)         Applications that do not

meet the requirements of subsections (a), (b) and (d) shall be considered incomplete

and will not be accepted or processed.

2)         Notice

A)        If DSCC does not accept or

process an application for any reason set forth in this Section, DSCC shall use

reasonable efforts to identify the LRA who initiated the application and inform

the LRA of:

i)          The reason that DSCC did

not process or did not accept the application; and

ii)         The action or actions

required to accept or process the application.

B)        Notices sent pursuant to

this subsection (e)(2) will not be required to comply with Section 1200.180.

3)         The LRA does not have any

appeal rights for notices sent under this subsection (e).

f)         Good

Cause Shown

DSCC may waive the requirements of

this Section for good cause shown.