Hospital-determined Presumptive Eligibility

(A) The MassHealth agency provides coverage for certain individuals for a limited period of time, in accordance with 130 CMR 502.003(H): Hospital-determined Presumptive Eligibility if, on the basis of attested information, a qualified hospital determines that the individual is presumptively eligible. Coverage for members with time-limited presumptive eligibility begins on the date on which a qualified hospital makes a determination regarding presumptive eligibility and continues until (1) the end of the month following the month in which the hospital-determined presumptive eligibility, if the individual has not submitted a complete application as described in 130 CMR 502.001: Application for Benefits by that date, or (2) an eligibility determination is made based upon the individual’s submission of a complete application as described in 130 CMR 502.001: Application for Benefits if the complete application was submitted prior to the end of the month following the month of the hospital presumptive eligibility determination. (B) A qualified hospital, for purposes of 130 CMR 450.110, is a hospital that satisfies the following requirements, as more fully described in provider bulletins and other guidance that may be issued by the MassHealth agency: (1) participates as a MassHealth provider; (2) notifies the MassHealth agency of its election to make presumptive eligibility determinations; (3) agrees to make presumptive eligibility determinations consistent with MassHealth policies and procedures; (4) has Certified Application Counselors on site and available to assist individuals with the application process, including submitting the full application and understanding any documentation requirements; and (5) has not been disqualified from making presumptive eligibility determinations. (130 CMR 450.111 Reserved) 1. Introduction (130 CMR 450.000)