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Table of Contents
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Overview
Definitions
Qualification and Requirements (
+
)
Requirements
Qualification Process
Notice of Intent
Medicaid Provider
Memorandum of Understanding
Training
Conflict of Interest
Steps to Complete PE Determinations
Due Dates
Eligibility Policy (
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)
Groups Eligible for PE
Citizenship and Immigration Status
Residence
Household Composition
Income
Periods of PE
Current Medicaid Recipients
Verification
Eligibility Dates
Systems Support
Case Example
Forms
Presumptive Eligibility Policies and Procedures Handbook
Requirements for Qualified Hospitals and Qualified Entities
Qualified Hospital
To make presumptive eligibility determinations as a qualified hospital, an organization must:
Be a hospital
Be a Medicaid provider
Submit a
Notice of Intent (NOI)
Agree to make presumptive eligibility determinations in accordance with HHSC policies and procedures
Sign a
Memorandum of Understanding (MOU)
Have staff complete required training
Qualified hospitals may designate any clinic owned by the hospital to participate in the presumptive eligibility process.
Qualified hospitals may make presumptive eligibility determinations for the following groups:
Children
Parents and caretaker relatives
Former foster care children
Pregnant women
Qualified Entity
Most qualified entities are Medicaid providers. Other types of organizations have the option to become qualified entities without becoming a Medicaid provider. The organizations that may participate as qualified entities are listed at Title 1, Texas Administrative Code (TAC), Part 15, Chapter 366, §366.251.
To be a qualified entity, an organization must fall into one of the categories above and must:
Submit a
Notice of Intent (NOI)
.
Agree to make presumptive eligibility determinations in accordance with HHSC policies and procedures.
Sign a
Memorandum of Understanding (MOU)
.
Have staff complete required training.