7 AAC 100.020 - Review application requirements

Current through December 2, 2021

(a) Except as provided in (h) of this section, at least once every 12 months, the department will require a recipient who is eligible for Medicaid to submit a review application on a form provided by the department and furnish the documentation requested by the department to support continued eligibility.

(b) Repealed 10/1/2009.

(c) Repealed 4/1/2009.

(d) The department will notify a recipient or a known person acting on the recipient's behalf that a review of the recipient's eligibility is required and the date on or before which the recipient must submit the recipient's review application. In the notice, the department will state that failure to submit a review application on or before the date stated in the notice will result in the recipient's loss of eligibility under (e) of this section.

(e) Except as provided in 7 AAC 100.070 and (f) of this section, if a recipient fails to submit a review application on or before the date indicated in the notice under (d) of this section, the recipient will lose Medicaid eligibility.

(f) If a recipient is receiving SSI, the department will continue that recipient's Medicaid eligibility until the department receives verification that the recipient has ceased getting SSI or has moved out of the state, even if the recipient fails to submit the recipient's review application.

(g) The department may set a recipient's review period of less than the duration set in (a) of this section to establish a review date that coincides with a level of care review date, home and community-based waiver services review date, or other significant date related to that recipient's continued eligibility for Medicaid or other programs administered by the department.

(h) Notwithstanding the review periods established in (a) - (g) of this section, upon receipt of information from any source that indicates that a change in circumstances affecting a recipient's continued eligibility may have occurred, the department will investigate and may require that a review application be completed.

(i) If additional verification or documentation is necessary to support continued eligibility under this section, the department will act in accordance with 7 AAC 100.016.

(j) In this section,

(1) "review date" means the date marking the end of a review period and the end of a recipient's Medicaid eligibility for or authorization for services if the department does not redetermine the recipient's eligibility under this chapter;

(2) "review period" means the period of time a recipient is eligible for Medicaid without the department redetermining the recipient's Medicaid eligibility.

Notes

7 AAC 100.020

Eff. 7/20/2007, Register 183; am 4/1/2009, Register 189; am 10/1/2009, Register 191

Authority:AS 47.05.010

AS 47.07.040