SSI-DCP: How Do I Code Phenylketonuria (PKU) Eligibility in FACS?

Eligibility

Pending inclusion in the SSI-DCP permanent rules, the following eligibility requirements must be met by the applicant.

Individual must:

  • Be under age 21
  • Be a resident of Oklahoma
  • Provide verification of a diagnosis of Phenylketonuria (PKU)
  • No income / resource limits for this program.

Certification

If the client is not eligible for Title XIX Medical Services through DHS or through Online Enrollment, but financial and medical eligibility has been determined for the PKU Program based on the Eligibility criteria above, certify the Medical Section only for PKU only. Use the following coding:

  • CATEGORICAL RELATIONSHIP INDICATOR (Medical General Tab in FACS) = Not Title XIX Eligible: Crippled Children’s Program or PKU Program – Child Diagnosed with Phenylketonuria and Has Medical Necessity for Food Supplements. Family Income and Resources Are Not Considered for PKU Children.

NOTE: “CCU” will appear in IMS Block F190, shown here.

  • MEDICAL APPLICATION REASON (Medical Financial Tab in FACS) = Short Term – Other Than Listed Above.

NOTE: “S” will show up in IMS Block D60, shown here.

  • BENEFIT (Household Tab in FACS) = Phenylketonuria Individual. ADD the individual to the benefit (PK/A).

NOTE: “PK” will show in IMS Block F24, shown here.

  • If the PKU individual is a minor, at least one parent will need to be added to the case as the Applicant (and the minor as an Applicant with Guardian) and that parent will be coded as “income and resources are not considered for benefit computation-individual not included” (PK/N in IMS blocks F24/25), shown here

Reviews

At the annual review, workers need to only verify if the individual is still under age 21 (per FACS/IMS) and residing in Oklahoma. There is no cure for PKU so the diagnosis is only verified with the initial application. A BRR form will be needed for Imaging to verify contact was made and to confirm the declared address as an Oklahoma residence.

NOTE: If additional information happens to be included on the review form (other than address and signature/date) which indicates that the person may now qualify for regular Medicaid the worker should contact the family to explore this with them to see if they are interested in applying.

Case Closure

The case is closed when:

  • The worker cannot verify if the individual still resides in Oklahoma
  • The first day of the month following the month the individual turns age 21. FOR EXAMPLE: The individual turns 21 on 10/28/19. The case should be closed with an effective date of 11/01/19.

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