Upon receipt of the quarterly report suspended TMA individuals must be reinstated.
If “good cause” is allowed (Section 0910.025.10) reinstate back to the date of the suspension. If “good cause” is NOT allowed reinstate effective the first of the month following the receipt of the report.
To do this, make the following entries:
- Field 5
- Case Action 35
- Field 38a
- Enter the appropriate quarterly report code
- Field 33, 34, 35
- 100% budget required if a “4” is entered in field 38a
For suspended individuals, make the following entries:
- Field 13e
- Enter appropriate date
- Field 13g
- Enter level of care “T”
- Field 13g2
- Enter “T” for no sanction
This reinstated should be done as quickly as possible to prevent any disruption in health coverage or managed care enrollments. If TMA eligibility is restored from suspended status, send a quarterly report if the third quarterly report is needed.