10 Colo. Code Regs. § 2505-3-140
Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-3-140 - REDETERMINATION140.1 "Redetermination of eligibility" means a case review and necessary verification to determine whether the member continues to be eligible to receive Medical Assistance. "Reconsideration period" means the 90-day period following termination of eligibility. Eligibility shall be redetermined at least every twelve (12) months since the last eligibility determination. An Eligibility site may redetermine eligibility through telephone, mail, or online electronically. A. Ex Parte Review: A redetermination form will not be sent to the member if all current eligibility requirements can be verified by reviewing information from another assistance program or if this information can be verified through an electronic data source - this process is referenced as Ex Parte Review. The use of telephonic or electronic redeterminations shall be noted in the case record. When applicable, the eligibility site shall redetermine eligibility based solely on information already available. If verification or information is available for any of the six months prior to the redetermination month, and all other eligibility requirements are met, then an approval notice will be sent for all eligible members of the household who are requesting assistance. This approval notice shall include directions on how to view the information used to determine eligibility.B. If all required information is not available and/or the information received does not support a finding of eligibility, a redetermination form will be issued to the household at least 30 days prior to the end of the eligibility period. The redetermination form shall be prepopulated with the current information on file and sent to the household at least 30 days prior to the redetermination period ending. As part of the ex parte review, the member will be informed of any verification needed to determine eligibility. The redetermination form shall direct members to verify that the information provided is accurate or to report any changes to the information. Members must complete and return the redetermination form with necessary verifications and the signature form. If a member fails to sign the signature form or comply with any failure to complete the redetermination process.
C. Members who return properly completed redetermination forms and requested information during the reconsideration period shall not be required to submit a new application of eligibility. If redetermination forms and requested information are not returned within 90 days after the termination, the member must submit a new application to obtain enrollment in the program. For individuals who are determined to be eligible for Medical Assistance within the reconsideration period, the effective date of coverage will be the first day of the month in which the redetermination form was returned. If the member has a gap in coverage due to submitting the redetermination within the reconsideration period, the member can request up to three months in retro coverage.D. Due to the Coronavirus COVID-19 Public Health Emergency, required through the Federal CARES Act for the Maintenance of Effort (MOE), the Department will continue eligibility for all Medical Assistance categories regardless of changes made for a redetermination or additional documentation for current CHP+ enrollee and allow them to continue eligibility through the emergency declaration. Once the emergency declaration has concluded, the Department will process the redetermination and /or changes for all members whose eligibility was maintained during the emergency declaration. Effective May 11, 2023 the coronavirus COVID-19 pandemic federal emergency has been declared to end. To ensure the Department Maintains access to State and Federal funding provided by the Federal 'Families First Coronavirus Response Act" Pub.L. 116-127, and the Federal "Consolidated Appropriations Act, 2023", the Department will process eligibility redeterminations and take appropriate action for all members whose eligibility was maintained during the emergency declaration. By May 2024 all members whose eligibility has been maintained due to the Public Health Emergency will have completed the renewal process. A member's eligibility may no longer be maintained after May 31, 2023 if they have completed the renewal process and/or a change is reported, and they are found ineligible. Members whose eligibility has been maintained during the Public Health Emergency and whose renewal is not due yet will remain in their current category until their renewal due month, regardless if there is a change reported that makes them ineligible.38 CR 11, June 10, 2015, effective 7/1/201540 CR 03, February 10, 2017, effective 3/2/201740 CR 17, September 10, 2017, effective 9/30/201740 CR 19, October 10, 2017, effective 10/30/201741 CR 19, October 10, 2018, effective 10/30/201842 CR 18, October 10, 2019, effective 10/1/201942 CR 23, December 10, 2019, effective 12/30/201943 CR 11, June 10, 2020, effective 5/8/202043 CR 17, September 10, 2020, effective 9/4/202044 CR 01, January 10, 2021, effective 12/11/202044 CR 17, September 10, 2021, effective 8/9/202144 CR 23, December 10, 2021, effective 11/12/202145 CR 03, February 10, 2022, effective 3/10/202245 CR 07, April 10, 2022, effective 3/11/202245 CR 11, June 10, 2022, effective 6/30/202245 CR 15, August 10, 2022, effective 7/8/202245 CR 22, November 25, 2022, effective 10/14/202245 CR 19, October 10, 2022, effective 10/30/202246 CR 02, January 25, 2022, effective 1/13/202346 CR 06, March 25, 2023, effective 2/10/202346 CR 07, April 10, 2023, effective 4/30/202346 CR 11, June 10, 2023, effective 5/12/202346 CR 19, October 10, 2023, effective 10/30/2023