South carolina department of health and human services medicaid policy and procedures manual
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SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID POLICY AND PROCEDURES MANUAL CHAPTER 101 – Administrative Requirements Page 
101.01 Introduction (Eff. 10/01/05) 4 101.02 Definitions (Eff. 10/01/05) 4 101.02.01 Applicant (Eff. 10/01/05) 4 101.02.02 Authorized Representative/Responsible Party (Rev. 10/01/13) 4 101.02.03 Reserved for Future Use (Eff. 09/01/12) 5 101.02.04 Beneficiary (Eff. 10/01/05) 5 101.02.05 Incapacitated Individual (Eff. 10/01/05) 5 101.02.06 Incompetent Individual (Eff. 10/01/05) 5 101.02.07 Individual with Limited English Proficiency (LEP) (Eff. 10/01/05) 5 101.02.08 Sensory Impaired Individual (Eff. 10/01/05) 5
101.04.01 Choice of Category (Eff. 10/01/12) 7 101.04.02 Applying Without Delay (Rev. 10/01/13) 12 101.04.03 Processing Applications (Rev. 10/01/13) 13 101.04.04 Processing Applications of DHHS Employees And Family Members (Rev. 10/01/13) 16 101.04.05 DHHS Employees Conflict of Interest (Rev. 10/01/10) 19 101.04.06 Informing the Applicant (Rev. 07/01/10) 19 101.04.07 Request for Informal Medicaid Eligibility Opinion (Renum. 01/01/09; Eff. 01/01/07) 20 101.5Retroactive Applications (Rev. 10/01/13) 20 101.05.01 Appeal Rights (Eff. 06/01/13) 22 101.05.02 Claims for Retroactive Eligibility (Eff. 06/01/13) 22
101.07.01 Interpreters (Rev. 11/01/08) 23 101.07.02 Barriers (Eff. 10/01/05) 23 101.07.03 Reserved for Future Use (Eff. 10/01/13) 24 101.07.04 Electronic Application for Medicare Savings Programs (MSP) from the Social Security Administration (Eff. 11/01/10, Rev. 01/01/11) 24
101.08.01 FI-Related Applications (MAGI Eligibility Groups) (Rev. 10/01/13) 24 101.08.02 SSI-Related Applications (Non-MAGI Eligibility Groups) (Rev. 10/01/13) 25 101.08.03 Extension of Promptness MEDS Procedure (Rev. 07/01/09) 27 101.09 Disposition of Applications/Active Cases (Eff. 03/01/12) 28 101.09.01 Verification (Rev. 10/01/13) 28 101.09.02 Documentation (Rev. 10/01/10) 29 101.09.03 Application Actions (Rev. 04/01/07) 30 101.09.04 Effective Date of Eligibility/Accrual Rights (Eff. 10/01/05) 31 101.09.05 Case Actions (Eff. 10/01/05) 31 101.09.06 Exparte Determinations (Eff. 10/01/13) 31 101.09.07 Continuous Eligibility for Children Under Age 19 (Rev. 07/01/10) 34 101.09.08 SSI Recipients in E01 Payment Status (Eff. 10/01/05) 35 101.09.09 Case Record Retention Schedule (Eff. 10/01/05) 36 101.10 Written Notification (Eff. 10/01/05) 36 101.10.01 Applications (Eff. 10/01/05) 36 101.10.02 Active Cases (Rev. 04/01/11) 36 101.10.03 Advance Notice (Eff. 10/01/05) 37 101.11 Review (Eff. 11/01/13) 37 101.11.01 Processing Review Form (Eff. 06/01/13) 40 101.12 Case Transfers (Rev. 10/01/13) 42 101.12.01 Case File Requests (Rev. 10/01/13) 44 101.13 Rights of Applicants/Beneficiaries (Eff. 10/01/05) 46 101.13.01 Opportunity to Apply (Eff. 10/01/05) 46 101.13.02 Civil Rights and Non-Discrimination (Eff. 10/01/05) 46 101.13.03 Confidentiality of Information (Rev. 10/01/13) 47 101.13.04 Release of Eligibility Information (Eff. 10/01/13) 48 101.13.05 Release of Medical Information (Eff. 07/01/08) 49 101.13.06 South Carolina Health Information Exchange (SCHIEx) (Eff. 07/01/08) 49 101.13.07 Request for Information on Medicaid Beneficiaries from External Parties (Rev. 06/01/08) 50 101.13.08 Receipt of Subpoena to Request Release of Information to Courts (Eff. 10/01/05) 50 101.13.09 Confidentiality Release of Aggregate Data and Information for Audits (Rev. 06/01/08) 51 101.13.10 Right to Appeal and Fair Hearing (Rev. 11/01/12) 51
101.14.01 Applicants/Beneficiaries (Eff. 10/01/05) 57 101.14.02 Agency (Eff. 10/01/05) 58
101.15.01 Beneficiary Lock-In Program Selection Criteria (Eff. 11/01/08) 59 101.15.02 Beneficiary Lock-In Program Procedures (Eff. 11/01/08) 60
101.16.01 Fraud Penalties (Rev. 11/01/08) 62 101.16.02 Referral of Suspected Fraud Cases (Rev. 10/01/10) 62 101.16.03 Fraud Summary (Rev. 10/01/10) 62 101.17 Overpayments/Underpayments (Eff. 10/01/05) 63 101.17.01 Completing an Overpayment Summary (Rev. 07/01/09) 64 101.17.02 Repayment of Medicaid Benefits Resulting from an Overpayment (Eff. 10/01/05) 65 101.17.03 Repayment of Medicaid Benefits Resulting from Continued Benefits During an Appeal (Eff. 10/01/05) 66 101.18 Healthy Connections (Medicaid) Insurance Card (Eff. 03/01/08) 66 101.18.01 Instructions on the Use of the Medicaid Insurance Card (Eff. 03/01/08) 66 101.18.02 Procedures for Handling Returned Medicaid Insurance Card and Returned Mail (Eff. 03/01/08) 67 101.18.03 Requesting a Replacement Medicaid Insurance Card (Eff. 03/01/08) 68 101.19 Motor Voter Registration (Eff. 10/01/11) 68 101.20 Medicaid Eligibility Quality Assurance (MEQA) (Rev. 03/01/13) 71 101.20.01 Quality Measurements (Eff. 03/01/13) 71 101.20.01A Eligibility Quality Improvement Process (EQUIP) (Eff. 03/01/13) 71 101.20.01B Medicaid Eligibility Quality Assurance (MEQA) (Eff. 03/01/13) 72 101.20.01C Payment Error Rate Measurement (PERM) (Eff. 03/01/13) 72 101.20.02 Report of Eligibility Findings for EQUIP (Eff. 03/01/13) 72 101.20.02A USC will report EQUIP findings in the following ways (Eff. 03/01/13) 72 101.20.02B SC DHHS Response to EQUIP Findings (Eff. 03/01/13) 73 101.20.03 Report of Eligibility Findings for MEQA and PERM (Eff. 03/01/13) 74 101.20.03A USC will report MEQA and PERM findings in the following ways (Eff. 03/01/13) 74 101.20.03B SC DHHS Response to MEQA and PERM Error Findings (Eff. 03/01/13) 75 101.20.03C Corrective Action Plan for MEQA and PERM Quality Management (Eff. 03/01/13) 76 101.20.04 Beneficiary Error (Eff. 03/01/13) 78 101.20.05 Beneficiary Cooperation (Eff. 03/01/13) 78 |