405 IAC 2-9-7 - Medically improved disability
Authority: IC 12-15
Affected: IC 12-14-15-1; IC 12-15-2-6.5; IC 12-15-41
Sec. 7.
(a) In order
to qualify for the Medicaid for employees with disabilities program after
improvement of a medical condition, a member must meet the requirements in this
section.
(b) The person must be a
member of Medicaid under the Medicaid for employees with disabilities group
described in section 6 of this rule who no longer qualifies for coverage under
that category due to a medical improvement in his or her condition. The
improvement of the condition must be verifiable by acceptable clinical
standards; however, the disease, illness, or process must be of a type that,
due to the nature and course of the illness, will continue to be a disabling
impairment. A condition that has been resolved or a person who is completely
recovered does not medically qualify for this program.
(c) The determination of whether a member
meets the medical eligibility requirements for this category will be made
either:
(1) when the Social Security
Administration determines the member is no longer disabled according to
20 CFR
416.905 or 20 CFR 416.906; or
(2) at the time of the member's next medical
review as determined by the Medicaid medical review team (MMRT). Determination
of medical eligibility under this section is made by the MMRT.
Notes
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