Certification Eligibility Coordination of Services

The review of certification, eligibility and coordination of services involves the process of determining and documenting participant eligibility (income eligibility as well as nutritional risk determination, standards and criteria), and the coordination of certification activities with other health services.

  1. Eligibility Determination and Documentation - 246.4(a)(6); (10); (11)(i) and (19): describe the policies and procedures for determining and documenting eligibility including the application process, residency requirements, identity requirements, documented physical presence or valid exception; proof of categorical eligibility, income limits, income eligibility documentation, determination of special populations and a definition of and policy toward the economic unit.
  2. Nutrition Risk Determination, Documentation, and Priority Assignment - 246.4(a)(11)(i): describe the policies and procedures for determining and documenting nutritional risk and priority assignments. Include a copy of the nutritional risk criteria the State agency plans to use with the appropriate documentation.
  3. Health Care Agreements, Referrals, and Coordination - 246.4(a)(6); (7); (8) and (19): describe the procedures for coordinating agreements and services with other health care providers at the State and local agency level including procedures to ensure that benefits are provided to persons with special needs.
  4. Processing Standards - 246.4(a)(11)(i): describe the State agency's processing procedures to ensure that the required standards and timelines are met.
  5. Certification Periods - 246.4(a)(11)(i): describe the policies and procedures used to establish certification periods for participants and the autonomy (if applicable) granted to local agencies in determining eligibility time periods.
  6. Transfer of Certification - 246.4(a)(6) and (11)(i): describe the State agency's procedures for the transfer of certification and VOC cards ensuring that vital participant and program information is included.
  7. Dual Participation, Participant Rights and Responsibilities, Fair Hearing Procedures, and Sanction System - 246.4(a)(11)(i)); (15); (16) and (17): describe the procedures used to detect and prevent dual participation at the State and local level, the procedures for ensuring participants are notified of their rights and responsibilities, and the procedures regarding participant fair hearings and sanction system.