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Effective: December 1, 2006 |
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23.10 - Continuous LTC/EW Period |
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A continuous LTC/EW period must be established to determine:
l When LTC Income Calculations should begin. See Beginning or Ending LTC Income Calculation for more information.
l Whether an asset assessment is required at MA application.
This term is referred to as the "Continuous Period of Institutionalization" by the federal Medicaid program.
Determining 30 Consecutive Days.
Confirming Expected Length of Stay.
A 30-consecutive-day period beginning on or after October, 1989, in which a person meets either of the following conditions:
l Resides in a long-term care facility.
l Receives a nursing facility level of care provided by home and community-based services that meets all of the following conditions:
n Was determined to be necessary by a long-term care consultation completed within the past 60 days.
n Is paid by or would qualify for payment by the EW program or the AC program if the person were otherwise eligible for either program.
n Is delivered by a licensed provider qualified to provide home and community-based services.
The term used by the federal Medicaid program is Continuous Period of Institutionalization.
Determining 30 Consecutive Days
Use these rules to determine if a client has had or anticipates having a 30 consecutive day stay in a medical or LTC facility or receipt of EW:
l Begin counting the 30 consecutive days on the date of entry into a medical or LTC facility, or the date the qualifying home and community-based services begin.
Note: When determining the 30 consecutive days for an asset assessment include as the begin date the receipt of services that EW would pay if the client was receiving EW.
l End the count on the date of discharge.
Example:
Jillian is admitted to General Hospital on July 20 and is discharged home on August 10. She begins receiving EW the same day as her discharge and is anticipated to continue those services until September 30.
Action:
Jillian has established her Continuous LTC/EW Period.
n Begin counting on July 20, the date she is admitted to the hospital.
n End the count on September 30, the date the services are anticipated to end.
Start the count over with the next admission or approval of services for clients who are:
l Discharged or discontinue receiving services before reaching 30 consecutive days.
l Discharged or discontinued receiving services for at least 30 consecutive days.
Example:
Lou begins receiving EW services on March 10 while recovering from a fall for which he has not been hospitalized or admitted to a facility. He is only expected to need these services for two weeks.
Action:
Lou does not meet a Continuous LTC/EW Period.
n Begin counting on March 10.
n End the count for the anticipated end of services, which is March 24.
Lou continues his spell of bad luck and falls again. He is admitted to the hospital on April 20 and is discharged to an LTCF to recuperate on April 30. Because he is in a body cast, he is not expected to be discharged home until June 2.
Action:
Lou has now established his Continuous LTC/EW Period.
n Begin counting on April 20, the day he was admitted to the hospital.
n End the count on June 2, the anticipated date of discharge.
DHS pays claims for the date of entry but does not pay claims for the day of discharge.
Confirming Expected Length of Stay
The Physician Certification Form (DHS-1503) indicates the anticipated length of stay for clients in a LTCF.
Contact the client's social or public health worker to determine the anticipated length of EW services.