services from a medical assistance provider as soon as a
preliminary service plan is developed. As authorized under
Federal law, the department shall apply a final determination of
medical assistance eligibility beginning on the date that a
qualified entity determines that an individual is deemed
eligible for medical assistance under subsection (b)(4).
(2) If a qualified entity determines that an individual is
deemed eligible under subsection (b)(4), and the individual is
subsequently determined to be ineligible for home care services,
home health services and older adult daily living center
services by the department, the medical assistance provider
which provided home care services, home health services and
older adult daily living center services under clause (1) shall
not be reimbursed by the Commonwealth for the cost of the home
care services, home health services and older adult daily living
center services provided during the period of deemed
eligibility. If the individual provided fraudulent information
under this section, the medical assistance provider may seek
reimbursement from the individual for the cost of home care
services, home health services and older adult daily living
center services provided during the period of deemed
eligibility.
(3) Once the department makes a final determination of
eligibility, the department shall authorize medical assistance
payments for the first sixty days of home care services, home
health services and older adult daily living center services
provided during the period of deemed eligibility following the
date that the qualified entity established the preliminary
service plan.
(4) The department shall verify the information on the
application and make a final determination of medical assistance
eligibility. The department may request additional information
from an applicant for the purpose of completing the verification
process under this clause.
(d) Upon request, the department shall provide information
to a qualified entity about Commonwealth policies and procedures
on how to determine whether an individual may be deemed eligible
for medical assistance under subsection (b)(4).
(e) The department shall issue a medical assistance bulletin
which contains the Commonwealth policies and procedures
necessary to implement this section. The publication of the
medical assistance bulletin under this subsection shall not
delay the implementation of this section.
(f) Within seventy-five days of the effective date of this
subsection, the department shall apply for any necessary Federal
waiver or State plan amendment. Fifteen days prior to applying
for any necessary Federal waiver or State plan amendment, the
department shall submit the proposed application to the Health
and Human Services Committee of the Senate, the Health Committee
of the House of Representatives and the Human Services Committee
of the House of Representatives. The department shall maximize
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