Table of Contents
*Policies that do not correspond numerically are no longer applicable*
Administrative
Policy A-1 Policy Issuance
Policy A-2 Criteria Development & DocumentationEligibility
Policy B-1a Application Processing
Policy B-1b Incomplete Application
Policy B-1c Participant Information Change
Policy B-1d Processing Applications & Re-Evaluation
Policy B-2 Financial Eligibility
Policy B-4a Annual Re-Evaluation Processing
Policy B-4b Event Driven Re-Evaluation Processing
Policy B-5a Closure Due to Voluntary Withdrawal
Policy B-5b Closure When Location of Family Unknown
Policy B-5c Closure for Failure to Cooperate
Policy B-5d Closure for Financial Ineligibility
Policy B-5e Closure for Failure to Apply for Medicaid
Policy B-5f Closure for Death of Applicant/Participant
Policy B-5g Closure for Age 21 Participant
Policy B-5h Closure for Participant Becoming a Non-Resident
Policy B-5j Closure for Institutionalization that Provides Care
Policy B-5k Closure for Medically Ineligible
Policy B-5l Closure for Failure to Disclose Insurance Benefits
Policy B-5m Closure for Failure to Disclose Income
Policy B-5o Failure for Abuse of CSHCS Personnel
Policy B-5p Eligibility for Public Benefits to Illegal Aliens
Policy B-6a Grandfathered Adoption
Prior Authorization/EligibilityPolicy B-3a Medical Eligibility
Policy B-3a Medical Eligibility Determination Procedure
Policy B-3b Determination for Adding Medical Diagnoses
Policy C-1a Primary Medical Care
Policy C-1b Secondary Medical Care
Policy C-1c Provision of Basic Dental Care
Policy C-1d Vision Care
Policy C-2a Inpatient Services
Policy C-2b Emergency Services
Policy C-2c Durable Medical Equipment
Policy C-2c Authorized Equipment List
Policy C-2c Durable Medical Equipment Criteria
Policy C-2d X-Ray & Laboratory Services
Policy C-2e Surgery
Policy C-2f Dental Services
Policy C-2g Home Therapy
Policy C-2g Therapy
Policy C-2h Home Health Care -Nursing- Services Policy
Policy C-3a Linkage Policy
Policy C-3b Prior Authorization
Policy C-3c Alternate Provider
Policy C-3d Out of State Care
Policy C-4 Exclusions from Coverage
Policy C-5a Nutritional Supplements
Policy C-5b Cochlear Implant
Policy C-8 ABA
Claims1
Policy C-6 Travel Reimbursement
Policy D-1 Co-Payment Amount
Policy D-3 Medical Savings Accounts
Policy D-4 Claim Filing Limit Time Period
Policy D-5 Approved Claim Forms/Media
Policy D-6 Claim Processing Priority
Policy D-7 Claim Payment Amount
Provider Relations1
Policy E-1 Participating Provider
Policy E-1a Participating Provider – Old Agreement
Policy E-2 One Time Payment Provider
Policy E-3 Provider’s Authority – Linkage
Policy E-4 New Providers
Policy F-1 Medicaid Interface1 – The Claims and Provider Relations Section was formerly known as the Integrated Operational Systems (IOS) Section.