The Skinny on Implementing Presumptive Eligibility

Previously, we discussed Presumptive Eligibility. Here’s the Skinny on becoming a Hospital Presumptive Eligibility Qualified Entity (“HPEQE”) and implementing Presumptive Eligibility in your facility:

  1. Obtain HPEQE Status.
    1. CEO/CFO submits Form 4-HPE and Form 2-HPE listing all representatives to;
    2. Each Representative submits Form 3-HPE to; and
    3. Submit a Request for training of intended HPEQE representatives.
      1. After DHH has solidified the contractual agreement, training for representatives will commence. After training, DHH keeps a copy of the passing training records and gives the facility a copy.
    4. After receiving the training records from DHH, submit a copy of the training certificates to Medicaid.
    5. Once all required documents are received and the application approved, DHH will issue the facility an Authorization to Participate.
  1. Implement Presumptive Eligibility.
    1. Conduct face-to-face interviews with individuals;
    2. Record individual’s answers on Form 1-HPE, which is used to determine eligibility;
      1. Educate all HPE enrollees regarding their need to complete Form 1A-BHSF for full Medicaid benefits..
    3. Make a determination of presumptive eligibility; and
    4. Submit the completed Form 1-HPE to Louisiana Medicaid via fax to (225) 389-2741 or (877) 747-0985 within 5 days of determination.

For more information, visit DHH’s website.

Written by: Danielle L. Borel

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