Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 332 - MAINECARE ELIGIBILITY MANUAL
Part 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS
Section 144-332-18-8 - PERFORMANCE STANDARDS FOR QUALIFIED HOSPITALS
Universal Citation: 10 ME Code Rules ยง 144-332-18-8
Current through 2024-38, September 18, 2024
1. Performance Standards
OFI will use the following standards to determine the accuracy and legitimacy of presumptive eligibility determinations made by each qualified hospital:
A. Was the
MaineCare Presumptive Eligibility Card (HPE-Card) received by OFI within 5
working days from the determination date?
B. Was a full MaineCare application received
by OFI before the expiration of the presumptive eligibility period?
C. If a full application was received, was
the individual found to be eligible for full MaineCare coverage?
2. Corrective Action
A. The first time a qualified hospital fails
to meet any of the standards established in Section 8-1 of this Part for any
presumptive eligibility determination that the hospital made, OFI will notify
the hospital in writing within 5 days from when the standard was not met. The
written notice will include:
(1) A description
of the standard that was not met and an explanation of why it was not met;
and
(2) Confirmation that a second
finding will require that all applicable hospital staff participate in
mandatory training on hospital presumptive eligibility rules and regulations to
be conducted by OFI.
B.
The second time a qualified hospital fails to meet any of the standards
established in Section 8-1 of this Part for any presumptive eligibility
determination that the hospital made, OFI will notify the hospital in writing
within 5 days from when the standard was not met. The written notice will
include:
(1) A description of the standard
that was not met and an explanation of why it was not met;
(2) Confirmation that all applicable hospital
staff will be required to participate in a mandatory training on hospital
presumptive eligibility rules and regulations to be conducted by OFI (the date,
time and location of the training will be determined by OFI); and
(3) Confirmation that if in the future the
hospital fails to meet any of the standards established in Section 8-1 of this
Part, the hospital will no longer be qualified to make presumptive eligibility
determinations.
C. The
third time a qualified hospital fails to meet any of the standards established
in Section 8-1 of this Part for any presumptive eligibility determination that
the hospital made, OFI will notify the hospital in writing within 5 days from
when the standard was not met. The written notice will include:
(1) A description of the standard that was
not met and an explanation of why it was not met;
(2) Confirmation that because this was the
third occurrence of failure to meet the required standards, effective
immediately the hospital will no longer be qualified to make presumptive
eligibility determinations of any kind.
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