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Effective: April 1, 2013 |
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12.15ar3 - TEFRA Referrals to the State Medical Review Team (SMRT) (Archive) |
Archived: June 1, 2015 |
The TEFRA option provides MA eligibility for some disabled children who live with their parents. One requirement for all TEFRA children is a State Medical Review Team (SMRT) disability and level of care determination. Only SMRT has the authority to evaluate disabilities for TEFRA certification.
TEFRA Documentation Requirements.
Length of TEFRA Certification.
TEFRA Documentation Requirements
Follow the SMRT Disability Determination process for TEFRA option referrals.
Include the information noted on the "SMRT - TEFRA Option" documentation form specific to the child's condition:
l Required Documentation - Physical Disability (DHS-3854).
l Required Documentation - Developmental Disability (DHS-3855).
l Required Documentation - Mental Health Disability (DHS-3856).
Current TEFRA enrollees must cooperate in submitting all medical documentation for renewal of MA eligibility and for TEFRA recertification. If an enrollee who would not qualify for MA without TEFRA certification:
l Fails to cooperate in submitting medical information by the due date, send a timely closing notice for failure to cooperate with the TEFRA certification process.
l Is cooperating but is unable to supply all medical documentation by the due date, leave the case open until the information is received and SMRT has made a decision.
l Parents of TEFRA-eligible children may be responsible to pay parental fees as partial reimbursement of the child's MA costs. Send a completed County Parental Fee Referral (DHS-2982) to DHS after approving eligiblity for the child under the TEFRA option.
SMRT may approve a TEFRA certification for up to a maximum of four years. SMRT's decision on the frequency of review of disability and level of care is a decision that may not be appealed.
For further information, see:
SMRT Disability Determinations.