Provider Notice issued 12/12/14

Timeframes for the Submission of Admission Information by LTC Facilities

This notice provides guidance to all LTC providers regarding the submission of admission information to the Department of Human Services (DHS).

Effective December 15, 2014, LTC providers are required to electronically submit admission information through the MEDI (Medicaid Electronic Data Interchange) system or one of the EDI vendors (formerly referred to as REV). Admission information includes information found on forms: Long Term Care Facility Notification (HFS 1156), Report on Resident of Private Long Term Care Facility (HFS 26) and Interagency Certification of Screening Results (HFS 2536).

• DHS will no longer accept “admit packets” containing hard copies of HFS 1156, HFS 26 and HFS 2536.

• The facility is still required to send income and health insurance verifications to the DHS caseworker.

• The facility is required to retain the Interagency Certification of Screening Results (HFS 2536) for each resident, electronic or hard copy, to be available for review upon request.

• The facility must record the Transaction Audit Number (TAN) for each admission submission.

• Any one of the three “Required” fields (RIN, Case Number, or Social Security Number) on the “Admission” screen is sufficient for completion.

Effective December 15, 2014, LTC providers are required to electronically submit the admission information within 15 business days of:

Receipt of screening assessment, Interagency Certification of Screening Results (HFS 2536) WHEN:

• The person is already enrolled in Medicaid;

• The person is enrolled in Medicaid and admits to the facility under Medicare coverage;

• The facility helps the person apply for Medicaid; or

• The person transfers from another facility and the receiving facility has to obtain a copy of the screening assessment from the screening entity.

Effective December 15, 2014, LTC providers are required to electronically submit the admission information within 15 business days of:

Date of admission WHEN:

• The person transfers from another facility and a copy of the most recent screening assessment accompanies transferring resident.

• The screening assessment was received by the facility prior to the person moving into the facility.

Date on the notice of Medicaid approval (Form HFS 458LTC, Notice of Decision on Application for Medical Assistance) WHEN:

• The person has been paying privately and is converting to Medicaid;

• The person has been under Medicare coverage but not already enrolled in Medicaid and is converting to Medicaid; or

• The application has been made by someone other than the facility and the facility is unaware that the person is applying for assistance.

When admission information is submitted AFTER the required timeframe, the DHS caseworker will use the date the information is received as the date of admission.

Prior to December 15, 2014: If the admission date was adjusted to a later date due to timeframes not being met, the facility may electronically resubmit the admission information and DHS caseworker will revise the admission date. This adjustment applies only to admissions submitted prior to December 15, 2014.

Completion of form HFS 3654 is required to determine eligibility for Long Term Supports and Services. LTC facilities are encouraged to assist the person applying for Medicaid assistance by ensuring that form HFS 3654 is completed and submitted with the application. Failure to submit this form with the application, or with the requested verifications, may delay the processing of the application. Form HFS 3654 Additional Financial Information for Long Term Care Applicants (pdf) has been improved and revised. A link to the form has been provided and the new version is available for immediate use.

Note: The Department periodically completes form revisions due to changes in statute, rulemaking or policy. Providers should frequently check the HFS/DHS websites to ensure that they are using the most current version of the form.

If the screening assessment does not accompany a person from the hospital, the facility should first contact the hospital to request it. If the hospital does not provide the screening assessment, the facility should contact their local Care Coordination Unit (CCU) to verify completion of the screen and transmit the screening assessment to the facility. If the screen was not completed, the CCU must complete for the facility. If after this process there is still no resolution, the facility should contact the Department on Aging (DoA) Benefits, Eligibility, Assistance, and Monitoring (BEAM) Unit by phone 1-855-228-6516 or email Aging.Advisor@illinois.gov for assistance. DoA will check their system to verify screening completion and will send the necessary information to the facility or will contact the CCU to complete the screen.

If you have any questions concerning this notice, contact the Bureau of Long Term Care at 217-782-0545.

James M. Parker, Acting Administrator

Division of Medical Programs