Hospital Responsibility under Hospital Presumptive Eligibility (HPE) 510-03-60-50

(Revised 1/1/2023 ML #3696)

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Qualifying hospitals must be willing to abide by state policies and procedures to immediately enroll individuals who are likely eligible under a state’s Medicaid eligibility guidelines for a temporary period of time. Each qualifying hospital has the choice to make HPE determinations, and if they choose to, the qualifying hospital and their designee’s must:

1. Offer HPE to individuals without Medicaid or other health care coverage; and
2. Assure timely access to care while the HPE application and eligibility determination is made; and
3. Ensure all individuals designated to assist and complete HPE applications follow the regulations set forth for HPE; and
4. Provide the individual with the HPE determination notices; and
5. Inform individuals at the time of the HPE determination that in order to obtain Medicaid coverage beyond the HPE period they must file a full Medicaid Application.
6. Inform, recommend and assist individuals with completing and submitting a full application for Medicaid/Children’s Health Insurance Program (CHIP) or subsidized insurance through the Federally Facilitated Marketplace; and
7. Meet the Performance Standards as listed below; and
8. Ensure the individual responsible for managing the Hospital’s HPE and their designee’s (person’s assisting and completing HPE applications) attend all HPE Policy training provided by the Medicaid Eligibility Policy Unit of the North Dakota Department of Human Services and keep current with changes affecting HPE through various means of communication, including but not limited to the following:
   1. Participate in all in-person, telephone conference, webinar or computer-based HPE training sessions;
   2. Read all information provided regarding updates and changes to HPE.
9. Provide, upon request, verification that all members listed in #8 above have completed the training.

Effective September 1, 2016, all qualifying hospitals will be required to meet ongoing performance standards in order to remain a Qualified Hospital. These standards include:

• Ninety-five percent (95%) of individuals that have an HPE determination made were not enrolled in Medicaid at the time the HPE determination was made.
• Ninety percent (90%) of individuals determined presumptively eligible by the hospital submit a full application during the HPE period;
• Eighty-five percent (85%) of individuals approved for Hospital Presumptive Eligibility, who submitted a full application during the HPE period, are subsequently determined eligible for Medicaid based on the full application.

Qualifying hospitals who do not meet the standards listed above for three (3) consecutive months will be required to participate in additional training and/or other reasonable corrective action measures provided by the North Dakota Department of Human Services. If after participation in the additional training or other reasonable corrective action measures the hospital continues to fail to meet the standards for two additional (2) consecutive months, action will be taken to disqualify the hospital under this section.