8115 Resident Status Review - Eligible individuals in Medicaid approved nursing facilities will be reassessed for the need for NF level care on a recurring basis through the MDS assessment. Individuals identified as high functioning and for whom placement in a less intensive HCBS care setting is being sought will be placed in resident status review. The individual must cooperate in this process and accept appropriate care and services that are available in a less intensive setting. Failure to do so will lead to termination of nursing facility payment. The designated case manager will notify EES staff when the need to terminate payment is required and action to do so must be based on timely and adequate notice. Eligibility would also be adjusted accordingly.

 

8120 Assistance Planning - As with independent living, assistance planning refers to the concept of defining who assistance is being requested for and determining eligibility based on that request. For long term care arrangements, all individuals shall have a separate assistance plan except in the following situations.

 

  1. Persons who are temporarily admitted to a general hospital per 8112.3(3) for a period not to exceed the month of entrance and the following two months as indicated in 8113.
     

  2. Persons whose income is being considered available to an eligible spouse. (See 8143 (2).)
     

  3. Persons whose spouse is in the same institution and one spouse's income falls below the $62 personal needs allowance. This provision permits the couple to be budgeted together thus providing a total $124 needs allowance of which up to $62 can be provided to the spouse with insufficient income.

  4. Persons who fail the 300% special income test described in 7430(4) and whose patient liability (8172.2(2)), client obligation (8270.2(2)) or participant obligation (8320.1) exceeds the cost of care shall be subject to independent living standard, budgeting methodology and base period.

 

8130 Establishing Base Period - The basic principles regarding base periods as referenced in 7330 for independent living also apply to institutional care. That is the base period is the length of time used in determining financial eligibility and can vary from one to six months depending on the circumstances. In addition, the date of receipt of a signed application is the application date for determining eligibility and the month of application also establishes the first month of the current base. Prior eligibility can also be determined for a person in institutional care as indicated below. For further information, see 7330.