9340 Agency Action on Timely Review - If the review form is timely filed and all review requirements have been met, the agency shall promptly process the review to ensure correct and timely coverage is provided.  Timely processing shall be defined as follows:

1.  A review form received before the 1st day of the last month of the review period shall be processed by the closure processing deadline in the last month of the review period.

2. A review form received on or after the 1st day of the last month of the review period shall be processed by the closure processing deadline in the month after the last month of the review period.  If unable to process by the closure date, the review must be processed within 30 days following receipt.  Whenever possible, the agency, though not required, shall still attempt to process the review by the closure processing deadline in the last month of the review period.

This process may result in an extended month of coverage.  Any extended month of coverage provided under this process is subject to adjustment as indicated in 9332(2) if understated eligibility has occurred.  However, in no instance shall a claim subject to recovery be created for the extended month [see 11122(2)]. 

3. Due to the nature of the program, all Medically Needy (MDN) reviews, regardless of when received, shall be processed by the closure processing deadline in the last month of the review period.  This will ensure that a new 6-months eligibility base period is properly established beginning with the month after the month the review period ends.  See also 1414.1(2).   

All households shall be notified of the appropriate reporting requirements upon review approval. See 9120.

9350 Household Failure to Act Timely - A household which untimely submits a review form or timely submits a review form but submits all verification in an untimely manner shall lose the right to a prompt review of eligibility (see 9340). The agency shall determine eligibility for these households within 30 calendar days after the date the untimely verification is provided. 

If the review form is not returned by the end of the current review period, the individual has a three month reconsideration period to return the review form. Individuals will have until the end of the third month after the end of the previous review period to return the form for processing. The reconsideration period also applies to information requested in order to process the review. An application received after that period is treated like a new application, including any request for prior medical assistance. If the requested information is provided after the reconsideration period expires, a new application may be required.

A review reconsideration period is not applicable to an individual who is approved at review or is denied at review for not meeting eligibility criteria.  Any application for review not submitted in a timely manner shall be treated as an initial application.  The timeliness provisions of 1413 apply. 

When eligibility has been discontinued for failure to provide required verification, and the verification is later provided within the review reconsideration period described above, eligibility shall not be reinstated pending completion of the review.  The discontinuance shall be rescinded, but no coverage past the end of the review period shall be provided, unless and until the review is fully processed. 

9360 Agency Failure to Act Timely  – If the agency fails to timely process a timely received review form, an administrative processing error may have occurred.  Eligibility will continue with coverage at the current level while the review is pending.  This may result in one or more months of coverage past the end of the review period before the review is processed [extended month(s)].  Once the review is processed, the extended months of coverage resulting from the delay shall be reevaluated as follows:

1.  If the new level of coverage determined by the untimely agency review is the same as the previous coverage, no adjustment to the extended month(s) is required.  No administrative error, other than delayed processing, has occurred. 

2.  If the new level of coverage determined by the untimely agency review is greater than the previous coverage, the extended month(s) must be adjusted accordingly.  Coverage for those extended month(s) shall be enhanced to match the newly determined coverage.  The agency shall promptly update the coverage and notify the household of the change. 

3. If the new level of coverage determined by the untimely agency review is less than the previous coverage, including discontinuance of coverage, an agency error overstated eligibility has occurred for the extended month(s).  Agency action must be taken to determine the amount of the overstated eligibility and establish a claim according to 11120 and subsections.