DHHS finances the National Hospital Discharge Review Program as part of Medicaid. This program helps to ensure that only residents who are likely to need hospital treatment are sent to nursing homes or hospitals. To qualify, you must have a health reason that requires hospitals, nursing homes or other facilities to do certain things before referring you to an inpatient facility that meets the requirements of this program. A few examples include: living in nursing homes with a nursing disability that might cause you to require hospitalization; being a person living alone or with a parent with a disability; or having a physical or mental disability requiring hospital care. Once DHHS has determined that an entity meets both criteria, the facility will be designated an authorized treatment provider (ATP) and be eligible to receive Medicaid funding.
Who is eligible for an ATP?
Anyone who meets the requirements for the ATP can apply for a Medicaid or Medicare payment for one or more hospital stays. A qualifying patient must be referred to an ATP. The facility must first provide a physical or mental disability diagnosis from a physician or a nurse practitioner at least once during the previous 10 years. Any patient who meets the medical condition must be admitted to an ATP-designated facility as a qualifying patient, if a hospital stays is not required. As long as you have a medical condition that meets the physical or mental disability diagnosis criteria for a qualifying patient, DHHS will pay you the appropriate amount for hospital stays.
When does DHHS begin processing ATP payments?
DHHS begins processing ATP payments when they are received by DHHS or a federal agency. Payments may be due if they are received by another government agency within 60 days of your payment. Payments may be due as long as DHHS has received and considered your case within the 60-day period. You will need to submit all forms and documents required to complete your ATP application.
Can I get my payment directly from the hospital?
No. You must initiate payment directly from the hospital. Contact the hospital directly, so you have time to meet all payment requirements before your payment is received. Most states use an electronic system that will process payments for Medicaid and Medicare based upon the patient’s payment method and date of service, and the amount payable. If a hospital is using the same payment method from the state you live in for this program, you must contact them to ensure that payment will be made for both programs.
How do I apply for a Medicare Payment?
If you are requesting a payment directly from a
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