Adult Medicaid Manual MA-2305 EVALUATING COUNTY/DDS PERFORMANCE

III. DEFINITIONS

A. Average Processing Time (APT)

APT is a measurement of the average number of days taken to disposition all applications in a report card month. This includes approvals, denials, and withdrawals. Refer to IV.A.

B. Percent Processed Timely (PPT)

PPT is the percentage of applications in a specific category that are dispositioned timely each month. The percentage is based on county size. Refer to IV.B.

C. Improper Dispositions

1. Denials

A denial is considered improper when:

a. The applicant was never interviewed and any of the procedures in MA-2304, Processing the Application, were not followed.

b. The application was denied due to the county’s inability to locate and the record does not document that the procedures in MA-2304, Processing the Application, were followed.

(III.C.1.)

c. The application was denied prior to the 45th/90th day and ineligibility was not verified. For example, there is no documentation to support inability to meet the Medicaid deductible.

d. The application was denied prior to the 45th/90th day for missing information. The application must pend until the 45th/90th day for missing information even if there have been two requests for information with at least 12 calendar days between requests.

e. The application was denied on or after the 45th/90th day for missing information and the information was not requested following the procedures in MA-2303, Verification Requirements For Applications.

Do not deny the application on the 45^th/90^th day if two requests for information with at least 12 calendar days between requests have not been sent. The application may have to pend beyond the application due date to meet this requirement.

f. Failure to provide the applicant with an automated or manual DSS-8109, Your Application For Benefits Is Being Denied or Withdrawn. The date of the notice and the date of disposition in EIS must be the same.

2. Withdrawals

Applications withdrawn due to the following actions are considered improper:

a. Suggesting or encouraging that an applicant withdraw an application; or

b. Encouraging withdrawal through improper verification practices such as requiring the applicant to provide information that is:

(1) Not necessary to determine eligibility, or

(2) Not necessary when the a/r’s statement as primary verification is allowed by policy. Refer to MA-2303, Verification Requirements For Applications, or

(3) Ultimately the responsibility of the county, or

(4) Not requested by the county dss in an easily understandable manner, or

(III.C.2.)

c. Failure to give accurate and complete eligibility information at the time of withdrawal.

d. Failure to clearly document the reason for the withdrawal and explain all alternatives.

e. Failure to provide the applicant with a DSS-8109, Your Application For Benefits Is Being Denied or Withdrawn. The date of the notice and the disposition date in EIS must be the same.

3. Inquiries

An inquiry is considered improper when it does not contain the following:

a. A DMA-5094/DMA-5094S, Notice of Right to Apply

and

b. A completed DMA-5095/DMA-5095S, Notice of Inquiry. Refer to MA-2301, Conducting a Face-to-Face Intake Interview, for procedures on completing the notice.

D. Incorrect Denials, Withdrawals, Inquiries

Anytime the county misapplies policy outside of MA-2300, Initial Contact, MA-2301, Conducting a Face-to-Face Intake Interview, MA-2303, Verification Requirements For Applications, and MA-2304, Processing the Application, the action is considered incorrect.