Whether continuing disability review supports cessation from disability CDR

Situation

The desk packet is disability CDR medical-evidence pack after an issuance file that is 1,104 issuances over control. Child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches has to name Pay or continue or Recoup for this Public Benefits Trafficking and Eligibility Fraud file.

Decision

Child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches must choose Pay or continue / Recoup / Deny / Hold using disability CDR medical-evidence pack after an issuance file that is 1,104 issuances over control.

Hypotheses to test

• Authorize Pay or continue now; disability CDR medical-evidence pack already has the discriminator after an issuance file that is 1,104 issuances over control.
• Keep Recoup in force until disability CDR medical-evidence pack is completed after an issuance file that is 1,104 issuances over control for child-care provider integrity lead.
• Treat disability CDR medical-evidence pack as Deny because both readings appear after an issuance file that is 1,104 issuances over control.
• Refuse a Public Benefits close: child-care provider integrity lead does not have the page continuing disability review supports turns on in disability CDR medical-evidence pack.

Analysis required

• Trace the notice and appeal path child-care provider integrity lead must preserve.
• Test eligibility, recoupment, and improper-payment facts in disability CDR medical-evidence pack after an issuance file that is 1,104 issuances over control.
• Quantify overpayment if continuing disability review supports is wrong.
• For this Public Benefits Trafficking and Eligibility Fraud file, read disability CDR medical-evidence pack against an issuance file that is 1,104 issuances over control and write the one fact that would move continuing disability review supports for child-care provider integrity lead.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Trafficking and Eligibility Fraud packet (disability CDR medical-evidence pack after an issuance file that is 1,104 issuances over control). The follow-on Trafficking and Eligibility Fraud action is what child-care provider integrity lead does next: implement the option, assign an owner, and log the missing fact.