Maricopa Community Colleges  HSA148   19962-20086 
Official Course Description: MCCCD Approval: 07/22/08
HSA148 19962-20086 LEC 1 Credit(s) 1 Period(s)
Advanced Eligibility Issues
Examination of eligibility issues and case studies with regards to work study and medical spenddown. Also includes the legal basis and components of county liability and the appeals and hearings process.
Prerequisites: Permission of Department or Division.
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MCCCD Official Course Competencies:
 
HSA148   19962-20086 Advanced Eligibility Issues
1. Identify various types of work study. (I)
2. Compare and contrast work study programs to financial aid and educational income. (I)
3. Complete a case study. (I)
4. Calculate medical spenddown. (II)
5. Determine medical expenses eligible for spenddown. (II)
6. Identify the legal basis and components of county liability. (III)
7. Identify work practices that contribute to reduced county liability and appeals. (III, IV)
8. Examine the hearing process. (IV)
9. Identify guidelines for representation of the county at appeals hearings. (IV)
10. Process remanded applications. (IV)
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MCCCD Official Course Outline:
 
HSA148   19962-20086 Advanced Eligibility Issues
    I. Work Study
        A. Types
        B. Verifications
        C. Funding
        D. Eligibility Requirements
        E. Case Studies
      II. Medicare
          A. Expenses
            1. Types
            2. Eligibility
          B. Coverage
            1. Part A
            2. Part B
          C. Spenddown
            1. Definition
            2. Eligibility
          D. Calculations
        III. Liability
            A. Definitions
              1. County Liability
              2. Indigent
              3. In-Fact Eligible/Ineligible
              4. Factor
              5. Erroneous Certification
              6. Deficiency
            B. History and Statutes
              1. ARS 11-291
              2. ARS 11-297
              3. Emergency Medical Care
              4. "12 Hour Notice"
            C. Annual Costs
            D. Criteria
            E. Computations
            F. Quality Review Process
            G. Error Prevention
            H. Appeals Statistics and Liability
              1. Improper Determinations
              2. Untimely Determinations
          IV. Appeals
              A. Process
                1. Right to Appeal
                2. Accepting Requests for Hearing
                3. Untimely Appeals Determinations
                4. Extension of Eligibility
              B. Preparing for Hearings
                1. Appeals Coordinator Responsibilities
                2. Site Responsibilities
              C. Representing the County
              D. Appeal Decisions
                1. Proper
                2. Improper
                3. Default
                4. Voluntary Withdrawal
                5. Remand
              E. Statistics
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