If a participant who is 65 year of age or older leaves the vendor situation and enters the State Hospital:
- Record the information at the Eligibility Unit Member Role/EUMEMROL/FM3Z screen in FAMIS.
- Contact the resource investigator at the facility to establish:
- whether the participant has been admitted to the General Medical and Surgical Unit or the Psychiatric Unit of this hospital.
- anticipated length of stay and/or possible date of release
- plans for placement and/or living arrangements upon release.
- If plans have been made for the participant’s release:
- set a priority to follow up on the participant’s planned date of release
- take necessary action, based on the participant’s living arrangements at the time of release from the State Hospital.
- If no plans have been made for the participant’s release, set a priority to follow up in 21 days.
- If, after 21 days, no plans have been made for the participant’s release and s/he is residing in the General Medical and Surgical Section of the State Hospital:
- record the information at the Eligibility Unit Member Role/EUMEMROL/FM3Z screen in FAMIS.
- Complete an MA spenddown/non-spenddown determination as if the claimant were in his/her own home.
- If, after 21 days, no plans have been made for the participant’s release and s/he is residing in the Psychiatric Section of the State Hospital, determine claimant’s eligibility for MHC level of care by obtaining the medical certification on the DA-124. (See Section 0815.030.00.)
If a participant, 65 years of age or older, leaves the NF or IMR for the State Mental Hospital and is certified by COMRU for MHC Level of Care:
- Record the change in the case record
- Enter the new level of care in the system
- Send the participant, legal guardian, relative and new facility a notification letter (IM-62).
If the participant who is 65 years of age or older is not medically certified by COMRU for MHC level of care but continues to meet all other Medical Assistance eligibility:
- Record information at the Eligibility Unit Member Role/EUMEMROL/FM3Z screen in FAMIS.
- Complete a MA spenddown/non-spenddown determination as if the participant were in his/her own home.