What is Hospital Presumptive Eligibility (PE)?
The Affordable Care Act (ACA) gives qualified hospitals the opportunity to determine presumptive eligibility (PE) for certain Medicaid eligible populations. PE enables hospitals to temporarily enroll individuals in the Medicaid program. The temporary enrollment provides individuals immediate access to medical care and a pathway to longer-term Medicaid coverage. This enrollment ensures provider compensation for all covered services, including hospital-based services, while a final eligibility determination is made.
Who is eligible to determine PE?
Only acute care hospitals (provider types 11 and 75) are eligible to enroll as a PE qualified provider. To be eligible to make PE determinations, a qualified hospital must:
- Participate in the Medicaid program as an active provider.
- Complete the Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum.
- Attend mandatory training.
- Agree to make PE determinations consistent with state policies and procedures.
- Agree to be listed on the Division of Welfare and Supportive Services (DWSS) website as an authorized site for application assistance.
- Provide application assistance for anyone requesting coverage under PE, not just those in need of hospital services.
- Meet performance standards established by the state.
Want to sign up?
Acute care hospitals interested in enrolling as a PE provider may do so by submitting a completed Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum and training sign-up sheet to the Division of Health Care Financing and Policy (DHCFP) for consideration. The PE Provider Addendum and the associated training sign-up sheet can be found at: Nevada Medicaid Website Portal - Provider Enrollment