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Elizabeth M. Whitehorn, Director

Provider Notice issued 06/05/14

Submitting Admissions for All Dual-Eligible (Medicare/Medicaid) Residents

To:​ LTC Providers (Nursing Facilities Only)​
​Date: ​June 5, 2014
​Re: Submitting Admissions for All Dual-Eligible (Medicare/Medicaid) Residents​

This notice serves to remind Nursing Facilities that all admissions of dual-eligible (eligible for both Medicare and Medicaid) residents must be reported electronically to the Department of Human Services caseworker even if the admission period is entirely covered by Medicare.

Not submitting the Medicare-covered admission can impact later Medicaid coverage for LTC services due to the Pre-Admission Screen only being valid for 90 days from the date it was completed.

The Medicare admission should be reported as;

Category of Service (COS) 65 – Full Medicare, first 20 days (1-20)

COS 72 – Medicare Copayment, remaining 80 day Medicare coverage period (21-100).

Once Medicare coverage is exhausted the resident should be reported as:

COS 70 – Medicaid Skilled, or

COS 71 – Medicaid Intermediate Care, whichever is appropriate.

If you have questions regarding this informational notice, please contact the Bureau of Long Term Care at 217-524-0545.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs