Provider Notice Issued 12/19/2017

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Date:  December 19, 2017                                         

To:     Long Term Care Facilities (Nursing Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities and Specialized Mental Health Rehabilitation Facilities) and Supportive Living Providers

Re:     Reporting an Admission to Long Term Care Facilities and Supportive Living Program Participants with Current Medicaid Eligibility in the Community

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This Notice informs providers that, effective January 1, 2018, the admission procedures for individuals currently Medicaid-eligible in the community and entering a Long Term Care facility or the Supportive Living Program for the first time may have an abbreviated review to expedite the approval process.

To be eligible for this new process an individual must have lived in the community and been eligible for full Medicaid coverage for a minimum of six consecutive months immediately prior to the date of admission.  This new process does not include those currently living in a Long Term Care facility or Supportive Living setting who are applying for Medicaid coverage.

The new process for this targeted population allows an admission to be submitted via Medicaid Electronic Data Interchange (MEDI) or one of the Electronic Data Interchange vendors without completion of Form HFS 3654, Additional Financial Information for Long Term Care Applicants, and submittal of twelve months of banks statements in certain circumstances.  If the applicant or their community spouse, if applicable, has not transferred resources (assets) during the past 60 months or consulted with a financial/ estate planner or other professional regarding financial matters, the supporting financial documentation listed above is not required.     

When completing the MEDI “Admission Screen” for an applicant described above indicate

“Community” in the “From” field dropdown box.  Department of Human Services (DHS) staff will confirm that the applicant meets the six-month Medicaid eligibility requirement detailed above prior to processing the admission.  

Form HFS 3654 has been revised to inform applicants they are not required to complete it under the circumstances described above.  Additional language revisions have been included to clarify questions regarding resources and to provide contact information for the three DHS Long Term Care offices.

Questions regarding this Notice may be directed to the Bureau of Long Term Care at 217-782-0545 or 844-528-8444 toll-free.

Felicia F. Norwood, Director

Healthcare and Family Services