Family Healthcare (FAMIS) Manual

0910.050.15 EX-PARTE REVIEW

IM-54 June 2, 2005, IM-46  March 2, 2001

The system will alert staff to conduct an ex-parte review thirty (30) days in advance of TMA eligibility ending (6 or 12 month) by producing the following report:

FIM31419-01 TMA Cases to Close Effective (mm/dd/yy). This report will include TMA cases due to convert to MC+ for children at the end of twelve (12) months It will also include TMA cases that will convert to MC+ for Children because of failure to return the first quarterly report. All active persons on the case will be listed. Evaluate the children and the adults for another category or continued eligibility under MC+.

Reviews for on-going eligibility must be conducted without the involvement of the recipient, if possible. This is known as an ex-parte review. If the ex-parte review does not suggest eligibility, the recipient must be given the opportunity to provide any additional information needed to establish eligibility prior to termination. The system will generate a pre-closing review letter prior to the end of the twelve (12) month TMA period. The system will continue to close if other eligibility is not found during the ex-parte or pre-closing review.