7 AAC 100.905 - Special reviews

(a) In addition to the Medicaid eligibility review under 7 AAC 100.020, the department may conduct a special review of the eligibility of a recipient or recipient's household in the same manner that the department determines the eligibility of a new applicant if the department has reason to question the information on file or the eligibility of the recipient under (b) of this section. As part of a special review, the department may include requiring

(1) that a new application be completed and signed;

(2) an in-person interview;

(3) documentation of all eligibility factors, including those not subject to change; and

(4) a review of any other factor or matter relevant to the recipient's eligibility.

(b) If a recipient fails to comply with the applicable provisions of this section, the department may terminate Medicaid eligibility in accordance with this chapter and 7 AAC 49.

(c) The department may conduct a special review for any reason, including

(1) a recipient's failure, without good cause, to cooperate with an inquiry that the department conducts to verify information provided to the department under this chapter;

(2) the department's discovery of a change that the recipient did not report to the department;

(3) the department's receipt of a report of several contemporaneous changes that may affect a recipient's eligibility and that the department must verify;

(4) a change in federal or state law that may affect a recipient's Medicaid eligibility;

(5) a recipient's physical move to a new location in the state;

(6) reevaluation of whether a recipient continues to be disabled;

(7) reevaluation of a recipient's absence from the home or state residency;

(8) reevaluation of whether deprivation continues to exist under 7 AAC 100.106; and

(9) a recommendation for review from the office of the department handling matters of fraud.

Notes

7 AAC 100.905

Eff. 7/20/2007, Register 183

Authority:AS 47.05.010

AS 47.07.020

AS 47.07.040