5.17.8 REVIEWS AND RECERTIFICATIONS

Reviews/recertifications (2.2.2.1) are required every 12 months after the initial eligibility determination at the client’s Wisconsin Well Woman Medicaid enrollment date.  A review for Wisconsin Well Woman Medicaid only consists of receiving an updated HCF 10075 Wisconsin Well Woman Medicaid Determination (Refer to Example in 5.17.6 )

Each local agency must develop a manual method for scheduling and tracking reviews.  Notify the client 45 days before a review is due, and indicate what materials or information to send or bring with her.

Note: In order to eliminate  unnecessary reviews, a best practice is to check MMIS to be sure that the recipient has not become certified for another type of full benefit MA ( for example SSI MA), turned 65 years of age (or will turn 65 in the next twelve months), or become eligible for Medicare, Part(s) A, B or both, prior to notifying the recipient that a review is due.

Like other MA subprograms, the client has the option of responding to the review process by mail, phone, or in person.  
 

At review, the recipient must provide a newly completed WWWMA form HCF 10075 indicating she is still in need of treatment for breast or cervical cancer, as certified by a physician or nurse practioner.  The recipient does not need to provide a new DPH 4818 at recertification.

IM should ultimately get a copy of the HFC 10075 designated “IM” at the bottom.  Send a manual positive notice if all requirements are met.

Send a manual negative notice at least ten days prior to the case closing if the woman does not provide HCF 10075 or reports one of the changes listed in 5.17.7.

This page last updated in Release Number: 07-03

Release Date: 04/18/07

Effective Date: 04/18/07