Policy Library

Table of Contents

*Policies that do not correspond numerically are no longer applicable*

Administrative

Policy A-1              Policy Issuance
Policy A-2              Criteria Development & Documentation

Eligibility

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/Eligibility

Policy 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 Interface

1 – The Claims and Provider Relations Section was formerly known as the Integrated Operational Systems (IOS) Section.