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Revision 26-3; Effective Sept. 1, 2026
Designated staff complete Application Registration when accepting an application. Applications are tracked using TIERS and DataMart reports.
When the application is for a person under 65 who has never had a disability determination, pend for Disability on the Disability – Details page and run Eligibility Determination and Benefit Calculation (EDBC). This overrides the application due date default of 45 days. The application due date is 90 days from the file date. If the application is not pended appropriately, the application is delinquent in 45 days.
If an application cannot be disposed before the applicable due date:
- Complete Form H1215, Report of Delay in Certification.
- Submit the form to management for approval.
Once approved, send Form H1247, Notice of Delay in Certification, to the applicant and the facility administrator. Enter appropriate information in TIERS to initiate the delay in certification.
Do not send Form H1247 if certification is delayed because Home and Community-Based Services waiver services are pending. No notification is required for those cases because services have not yet begun.
Note: Refer to B-6300, Institutional Living Arrangement, for applications pending the 30-day institutional stay requirement. Do not deny applications for failing to meet the requirement if the 30 days has not passed, and the applicant remains in the facility.
Applications appropriately placed on delay are excluded from the delinquent count in timeliness reports for the applicable period.
- Applications for people 65 or older are excluded for 135 days (45 days + 90-day extension). However, if the application is still pending on the 136th day, it is counted as delinquent.
- Applications for people under 65 who have never had a disability determination are excluded for 180 days (90 days + 90-day extension). However, if the application is still pending on the 181st day, it is counted as delinquent.
Applications that cannot be certified within the normal 45/90-day limit plus the 90-day extension must be denied. A new application is necessary to reconsider eligibility.
Eligibility System Delay Reasons
- Certification of facility is pending
- Disability determination is pending
- Institutional 30-consecutive day requirement is not met
- Legal review of documents
- Level of care decision is pending
- Medical necessity
- Mental health medical necessity is pending
- Miscellaneous reason
- New income/resource information is received after 30th day
- Resource spend down
- Waiver ISP is pending
- Waivers start date of services is pending