3632 Program Support Unit Initiated Denials/Terminations Revision 17-; Effective 1, 2017 The following sections contain policy citations that must be included on , Notification of Managed Care Program Services, when the denial or termination action is initiated by Texas Health and Human Services Commission (HHSC) staff. 3632.1 Denial/Termination Due to Death Revision 17-; Effective 1, 2017 Upon learning of the death of a member, Program Support Unit (PSU) must send to the managed care organization (MCO) within two business days of verification: , Managed Care Programs Communication; or , MEPD Referral Cover Sheet. Form H1746-A must be sent to the Medicaid for the Elderly and People with Disabilities (MEPD) , if appropriate. Do not send a notice to the member's address or family. The effective date is the date of death. If the member was receiving Supplemental Security Income (SSI) and the eligibility records reflect that SSI has been denied, PSU must use the same effective date of denial as the SSI denial date. If the eligibility records reflect SSI is still active, PSU must contact the Social Security Administration to notify it of the date of the member's death. If a member's Medicaid eligibility has been denied due to in the Texas Integrated Eligibility Redesign System (TIERS), the appropriate entries must be made to end enrollment in the Service Authorization System. Services must be denied/terminated once death of the member has been confirmed by PSU via: TIERS; obituaries in the local newspaper; contact with family or friends; notification from the MCO; or other reliable sources.
3632 Program Support Unit Initiated Denials/Terminations Revision 17-; Effective 1, 2017 The following sections contain policy citations that must be included on , Notification of Managed Care Program Services, when the denial or termination action is initiated by Texas Health and Human Services Commission (HHSC) staff. 3632.1 Denial/Termination Due to Death Revision 17-; Effective 1, 2017 Upon learning of the death of a member, Program Support Unit (PSU) must send to the managed care organization (MCO) within two business days of verification: , Managed Care Programs Communication; or , MEPD Referral Cover Sheet. Form H1746-A must be sent to the Medicaid for the Elderly and People with Disabilities (MEPD) , if appropriate. Do not send a notice to the member's address or family. The effective date is the date of death. If the member was receiving Supplemental Security Income (SSI) and the eligibility records reflect that SSI has been denied, PSU must use the same effective date of denial as the SSI denial date. If the eligibility records reflect SSI is still active, PSU must contact the Social Security Administration to notify it of the date of the member's death. If a member's Medicaid eligibility has been denied due to in the Texas Integrated Eligibility Redesign System (TIERS), the appropriate entries must be made to end enrollment in the Service Authorization System. Services must be denied/terminated once death of the member has been confirmed by PSU via: TIERS; obituaries in the local newspaper; contact with family or friends; notification from the MCO; or other reliable sources.
SPH_17-5_Section_3000.docx