Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.11-002 - Revisions to MS Policy 27000, Appendix P, and PUB-405 - TEFRA Waiver

Current through Register Vol. 49, No. 6, June, 2024
Notice of Rule Making
Pursuant to Arkansas Code
				20-76-201, and Section 1916A of
				the Social Security Act, the Director, Division of County Operations issues
				proposed revisions to MS Policy 27000, Appendix P, and PUB-405, TEFRA Waiver,
				to not assess a premium to a family whose annual income after allowable
				deductions is at or below 150% of the Federal Poverty Level. Copies of the
				proposed change may be obtained by writing the Division of County Operations,
				P.O. Box 1437, Slot S-332, Little Rock, AR 72203, Attention: Office of Program
				Planning & Development. All comments must be submitted in writing to the
				address indicated above no later than _____
If yoy need this material in a different format, such as large
				print, contact our Americans with Disabilities Act Coordinator at 682-8920
				(voice) or 682-8933 fTDD).
The Arkansas Department of Human Services is in compliance with
				Titles VI and VII of the Civil Rights Act and is operated, managed and delivers
				services without regard to religion, disability, political affiliation, veteran
				status, age, race, color or national origin.
Summary of Changes
Determining TEFRA Premium Amount
MS Policy }7000, Appendix P and PUB-405 have been revised to
				incorporate the change for determining TEFRA Premium amounts. A premium will
				not be assessed if the family's annual income after allowable deductions is at
				or below 150% of the Federal Poverty Level.
MS - TEFRA WAIVER/HOME CARE FOR CHILDREN
TEFRA WAIVER
27000
TEFRA Waiver/Home
			 Care for Children
TEFRA Waiver is a Section 1115(a) demonstration waiver which
				imposes cost sharing requirements on children age 18 and under who are
				otherwise eligible for Medicaid under Section 134 of the Tax Equity and Fiscal
				Responsibility Act of 1982 (TEFRA).
TEFRA, as amended by OBRA of 1987, provides for coverage of
				certain disabled children in the home if they would qualify for Medicaid as
				residents of a Title XIX Institution, such as a nursing home or ICF/MR
				Facility.
TEFRA Waiver is a Medicaid category that enables children to
				have care in their homes rather than in an institution. Children who live in
				institutions or receive extended care in institutions are not eligible in the
				TEFRA category. Recipients of TEFRA Waiver receive the full range of Medicaid
				benefits and services. There is no cap on the number of children covered by the
				program.
Cost sharing measures are based on household size and total
				annual income of the custodial parent(s) as reflected on the most recently
				filed IRS Federal Tax Return. A family's total annual out-of-pocket cost
				sharing cannot exceed five percent of the family's gross income. There are no
				co-payments charged for services to TEFRA Children.
Families of children eligible for TEFRA Waiver who are covered
				by insurance should not drop their existing coverage as it will cause the child
				to be ineligible for TEFRA Waiver benefits for a period of six (6) months from
				the date the insurance is dropped.
27005
Eligibility
			 Requirements
07-01-11
The following eligibility requirements must be met for a child
				to be eligible for TEFRA Waiver:
1.
Age
: The child must be 18 years of age or younger.
			 Eligibility will end on the child's 1ST birthday.
2.
Disability
: The
			 child must be disabled according to the SSI definition of disability. If
			 disability has not been established by SSA, it must be determined by MRT ([MS
33221
).
3.
Citizenship or Alien Status
: The child must be a U.S.
			 citizen or a qualified alien (
[MS 3310 #31
and
[MS 3324]
).
4.
Residency:
The
			 child must be an Arkansas resident (
MS
			 22001
).
5.
Social Security Enumeration
: The child must meet the
			 Social Security Enumeration requirements shown at
MS
13901
.
6.
Income:
The
			 child's gross countable income must be less than the current Long Term Care
			 (LTC) income limit, (Re: SSI Chart at [A
ppendix SI
).
			 In-Kind Support and Maintenance is not considered income in TEFRA cases. SSI
			 exclusions are not allowed. Parental income is not considered in the
			 eligibility determination, but is considered for the purpose of calculating the
			 monthly premium (Re:
l"MS 270101
).
7.
Resources:
The
			 child's countable resources cannot exceed $2,000.00. The parents' resources are
			 not considered. No period of ineligibility will be imposed for transfers made
			 without compensation.
8.
MedJcal Necessity
: The child must either meet the
			 medical necessity requirement for institutional placement in an acute care
			 facility, a skilled nursing facility, an ICF/MR facility or Alternative Home
			 placement, or be at risk for future institutional placement. The determination
			 of medical necessity will also be based on services that improve, maintain or
			 prevent regression of the child's health status and will be based on the
			 child's medical, health and family situation.
9.
Appropriateness of
			 Care
: Medical services must be available to provide care to the
			 child in the home, and it must be appropriate to provide such care outside an
			 institution.
10.
Cost
			 Effectiveness
: The estimated cost of care for the child in the
			 home cannot exceed the estimated cost of care for the child in an institution.
11 .
Child Support
			 Enforcement Referral
: A TEFRA child is eligible for free services
			 through OCSE. If the child's custodial parent receives Medicaid in a category
			 other than Pregnant Women or Family Planning, cooperation with OCSE is
			 mandatory. If the custodial parent does not receive Medicaid, referral to and
			 cooperation with OCSE is strictly voluntary.
12.
Payment of
			 Premiums
: Some TEFRA Waiver households will be required to pay a
			 sliding scale monthly premium based on the income of the custodial parent(s)
			 beginning with families estimated to be earning in excess of $25,000 annually
			 and whose income exceeds 150 percent of the Federal poverty level (FPL). The
			 monthly premium will only be assessed if the family income is in excess of 150
			 percent of the FPL (Re.
[MS 270201
).
13.
Dropped Health Insurance
			 Coverage
: A child can receive TEFRA Waiver services and retain
			 health insurance coverage. For applicants, if primary comprehensive health
			 insurance is voluntarily dropped for the Waiver child in the six months prior
			 to application, the child will be ineligible for TEFRA benefits for a period of
			 six (6) months from the date the insurance is dropped. Primary comprehensive
			 health insurance is insurance that covers both physician and hospital charges.
			 For recipients, if it is found at the yearly reevaluation that health insurance
			 coverage was voluntarily dropped after the case was approved, the case will be
			 closed for six (6) months beginning with the month following the month of
			 discovery.
The six-month period of ineligibility will apply unless one of
				the following conditions is met:
[GREATER THAN] The health insurance is a non-group or
				non-employer sponsored plan.
[GREATER THAN] The health insurance was lost through
				termination of employment for any reason, including voluntarily
				quitting.
[GREATER THAN] The health insurance was lost through no fault
				of the custodial parent(s), guardian or custodian. For example, the employer
				ceases to provide employer sponsored health insurance, the insurance was
				carried by the non-custodial parent, and the non-custodial parent dropped it,
				the maximum benefit limit for the child has been reached, etc.