DHS Clinical Team

The Executive Office of Health and Human Services (EOHHS) and DHS have together cared for our consumers on the State's Medicaid program. Specifically, EOHHS has been responsible for the Medicaid clinical eligibility determinations through its Office of Medical Review (OMR) while DHS determines the financial eligibility for those applicants.

To create a more efficient process, the State in the fall of 2021 moved all eligibility, both financial and clinical, to DHS. The Office of Medical Review, now called the DHS Clinical Team, is responsible for determination of LTSS clinical levels of care, Katie Beckett clinical eligibility, the Medical Assistance Review Team and Pediatric Private Duty Nursing (PDN) assessments, authorizations and oversight.

LTSS level of care determinations are necessary for the determination of LTSS eligibility. Katie Beckett (KB) is a Medicaid eligibility category for children under age 19, who are disabled and meet an institutional level of care and who are otherwise ineligible for Medicaid due to family income.

The Medical Assistance Review Team (MART) is responsible for adult disability determinations.  Medically-necessary Pediatric PDN is a covered benefit for children under age 21 who are considered severely disabled and/or technology dependent and would otherwise require inpatient care in a hospital or pediatric nursing facility. 

The PDN Policy Guidance Document details the current processes for the administration of PDN.