210 R.I. Code R. 210-RICR-50-00-4.9

Current through December 3, 2024
Section 210-RICR-50-00-4.9 - Information Tracking and Pre-Eligibility Screening and Review
A. Application Information Tracking. Once the application filing date is established, all information submitted to the agency is entered or scanned into the applicant's account in the IES and tracked going forward. LTSS eligibility specialists may provide information, upon request, of the status of any application materials the agency receives after the filing date.
B. Review of application completeness. Within thirty-five days (35) after the application filing date, a review is conducted of any pending application. The purpose of this process is to identify any outstanding information and/or additional supporting documentation or proof that is necessary to determine eligibility. Based on this screening and review:
1. Additional Documentation Request (ADR) - The IES generates a written notice informing the applicant of any outstanding/additional information necessary to complete the application.
2. ADR Response -Applicants must respond to the ADR within fifteen (15) days (ten days (10) from date of the notice plus five (5) days to cover mailing time). Information may be emailed, faxed, mailed, uploaded into the applicant's account or delivered in-person. At any time before the ADR response is due, an applicant may make contact the DHS office, at number indicated on the form, and request for a good cause extension. Such extensions are granted for an additional fifteen (15) days when the applicant provides proof that the inability to respond was due to returned mail, a debilitating health care condition or emergency situation, or the negligence or failure of a third-party.
3. Application Complete - If all requested information is received and the application is considered complete, the process for determining eligibility proceeds. While conducting the eligibility determination, an LTSS eligibility specialist may find that further information is required from the applicant and/or a current or prospective provider to establish a plan of care and/or authorize services. A supplemental ADR may be sent out at this juncture with an appropriate response time
4. Application Denial - If the information requested in an ADR is not received when due, the process for denying the application for non-cooperation is initiated. The applicant has the right to appeal the denial in accordance with the provisions of Part 10-05-2 of this Title.
5. Application reinstatement - An application denied on the basis of non-cooperation under this subpart may be reinstated if the information requested by the applicant is provided to the State within no more than thirty (30) days from the date the denial takes effect if there is time remaining in the ninety (90) day application review period. In such circumstances, a new application review period begins on the application reinstatement date and eligibility dates back to the original application filing date, providing all information subject to change has been updated. If the initial ninety (90) day application review period has expired, the reinstatement date is treated as a new application filing date and the start date of eligibility is determined accordingly.

210 R.I. Code R. 210-RICR-50-00-4.9