B-6400, Processing Deadlines

Make and document an eligibility decision on an application as soon as all required verification is received.

Time frame for eligibility determination:

• Make an eligibility decision within 45 days on applications from applicants 65 years or older.
• Make a decision within 45 days on applications from applicants under age 65 who have had disability established based on the Social Security Administration criteria for RSDI Title II or SSI Title XVI disability.
• Make a decision within 90 days on applications from applicants who must have disability established by the HHSC Disability Determination Unit.

References:

• See Section B-4000, Date of Application, for clarification of date of application and complete application.
• See Section R-3100, Establish Processing Deadlines, for automation procedures to follow when applications cannot be completed within the normal 45/90-day limit and for requirements to request a delay in certification.
• See Section D-2100, When a Medical Determination Is Not Required, and Section D-2200, When a Medical Determination Is Required, for further information regarding a medical determination for applicants under age 65.

 

B-6410 Application Due Dates

Applications must be processed in a timely manner. For timeliness and processing purposes:

• The timeliness count begins the date the completed and signed application for assistance is received by HHSC.
• The file date of an application is day zero for application processing.

If a person applies for multiple programs and all requested information is provided for one program and not the other(s), make an eligibility determination for the program in which all the information has been received. Continue to allow for the opportunity to provide the remaining missing information for the other program(s) until the final due date.

Reminders:

• The date of application is established when HHSC receives the completed and signed application form.
• For applications submitted after the close of business for the day, or on days when HHSC is closed (including weekends and holidays), the date of application is the following business day.
• If an application is denied in error, the original date of application must be protected no matter how old the original date on the application for assistance. A new application processing date must be established.

Related Policy

Date of Application, B-4000
Previously Completed Application, B-5000

 

B-6420 Missing Information Due Dates

Applications

Use Form H1020, Request for Information or Action, to request missing information or verifications. The final due date for missing information for applications on Form H1020 is the:

• 39th day from the date of application, or
• 84th day from the date of application for a person who needs a disability determination.

Do not send a second request for missing information. Take appropriate case action based on the original request for missing information.

Delay in Certification

When there is an approved delay in certification, the 39th and 84th days are extended 90 days.

Always send notification to the applicant/authorized representative and nursing facility, using Form H1020 and Form H1247, Notice of Delay in Certification.

Use Form H1020 to indicate the needed information and the re-established due dates during the delay in certification. See Section B-6510, Failure to Furnish Missing Information.

Re-established due dates are based on the reason for the delay in certification and reasonable MEPD specialist judgment. For example, if the delay is due to the 30-day consecutive requirement not being met, the re-established due date would not automatically need to be the full 90-day extension. However, if the delay is due to the facility pending certification, the full 90-day extension may be necessary. When unsure of the re-established due dates based on the reason for the delay in certification, consult the supervisor to determine the re-established pending period. Do not send a second request for missing information during the re-established due dates based on the delay in certification. Take appropriate case action based on the Form H1247 and Form H1020 used to notify the applicant of the delay in certification and the needed verification.

Redeterminations

Use Form H1020 to request missing information or verifications. The due date for missing information or verifications for redeterminations should be 10 days from the date on Form H1020.