SUBJECT:
ACTIVE MEDICAID RECIPIENTS WHO ENTER A MEDICAID CERTIFIED FACILITY; MANUAL REVISION #44: SECTIONS 0630.000.00, 0630.005.00, 0630.010.00, 0630.015.15, 0840.005.00 & 1060.005.25
DISCUSSION:
This memorandum clarifies the policy that a reinvestigation is not required to change the level of care for an active Medical Assistance (MA)/Supplemental Nursing Care (SNC) recipient who enters a Medicaid certified facility or moves from one facility to another. Staff must change MA/SNC cases to vendor levels of care, N, K, or D as soon as:
- the claimant is medically certified for nursing facility (NF), institution for the mentally retarded (IMR) or state mental hospital (MHC); AND
- pre-admission screening requirements are met (NF cases); AND
- the claimant meets the age requirements if in a MHC; AND
- the county can determine the surplus and when necessary the allotment; AND
- the county determines the transfer of property penalty period no longer applies to those cases with a transfer of property code (Y) in field 13L of IMU5.
Note: Reinvestigations are still to be completed in a timely manner. When a reinvestigation is needed in these situations, complete it as a separate action from the change to vendor care.
NECESSARY ACTION:
- Review this memorandum with all appropriate staff.
- Change active MA/SNC claimants to a vendor level of care as an action separate from a reinvestigation.
- Continue to follow current instructions on when to reinvestigate MA cases.