Tips for Completing TEFRA Application

Once financial eligibility for TEFRA has been established, the TEFRA application will be reviewed to evaluate whether the criteria for disability, institutional level of care, cost effectiveness, and safety and appropriateness have been met.

To avoid unnecessary delays in processing your application, please make sure that both you and your child’s physician have completed all sections of the TEFRA-1 assessment form.

In addition, we will need supplemental documentation to support information provided on the TEFRA-1 document, as follows:

  1. Disability – Include a current (within the past 12 months) physician’s history and physical examination, as well as any hospital discharge summaries, psychological evaluations, or other information that will help us verify the disability. Even if SSA has established disability, we will also need this information to help us establish eligibility for institutional level of care.
  2. Institutional Level of Care (ICF/MR, Nursing Facility, acute medical Hospital) – general overview of eligibility and document requirements.
  3. Cost Effectiveness – Before submitting your TEFRA application, please make sure you fully document all cost information requested as follows:
    • If your child has private insurance coverage that you intend to maintain in addition to any TEFRA eligibility, please document only your actual costs per month for the services listed. If the service is not covered by the insurance provider, or you will not have third party insurance coverage, indicate the full cost of each service provided.
    • The TEFRA-1 application asks you to list the child’s current medications, however, space was not provided on the form to indicate prescription costs. Please itemize the child’s prescription drug costs on a separate page and attach to the application.