42 CFR § 435.1110 - Presumptive eligibility determined by hospitals.
(a) Basic rule. The agency must provide Medicaid during a presumptive eligibility period to individuals who are determined by a qualified hospital, on the basis of preliminary information, to be presumptively eligible subject to the same requirements as apply to the State options under §§ 435.1102 and 435.1103, but regardless of whether the agency provides Medicaid during a presumptive eligibility period under such sections.
(1) Participates as a provider under the State plan or a demonstration under section 1115 of the Act, notifies the agency of its election to make presumptive eligibility determinations under this section, and agrees to make presumptive eligibility determinations consistent with State policies and procedures;
(2) At State option, assists individuals in completing and submitting the full application and understanding any documentation requirements; and
(c) State options for bases of presumptive eligibility. The agency may -
(1) Limit the determinations of presumptive eligibility which hospitals may elect to make under this section to determinations based on income for all of the populations described in §§ 435.1102 and 435.1103; or
(d) Disqualification of hospitals.
(i) Making, or is not capable of making, presumptive eligibility determinations in accordance with applicable state policies and procedures; or
(3) The agency may disqualify a hospital as a qualified hospital under this paragraph only after it has provided the hospital with additional training or taken other reasonable corrective action measures to address the issue.
The following state regulations pages link to this page.
- IL Admin. Code 89.120.68 - Section 120.68 - Hospital Presumptive Eligibility (HPE) under the Affordable Care Act
- Miss. Admin. Code. 23-101-1.12 - Rule 1.12 - Mandatory Presumptive Eligibility Determined by Qualified Hospitals
- Miss. Admin. Code. 23-101-4.9 - Rule 4.9 - Medicaid Applications Filed Through Another Agency or Entity
- 210-RICR-30-00-1 - Part 1 - Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways (210-RICR-30-00-1)
- 210-RICR-30-00-4 - Part 4 - Presumptive Eligibility for Medicaid as Determined by Rhode Island Hospitals (210-RICR-30-00-4)
- 210-RICR-50-05-1 - Part 1 - Medicaid Long-Term Services and Supports: Institutionally Based LTSS (210-RICR-50-05-1)