Establish Institutional Care - PPS

1. Access the case through Person Search or enter the Case Number in the quick search field from Task Navigation and click Go. The Case Summary page displays.  

2. Click the View Details button in the Medical Programs block.

3. Click the Edit button to make the page editable.

   • If the child is in a Foster Care placement, proceed to STEP 4.

   • If the child is in an Adoptive placement, proceed to STEP 15.

4. Click the Edit button in the Administrative Role section next to the Administrative Role that needs to be End Dated. The Administrative Role Detail page displays.

5. Enter the date prior to the facility admission date in the End Date field using the <mm/dd/yyyy> format or the calendar icon.

6. Click the Save and Return button. The Medical Program Detail page displays.

7. Click the Add button in the Administrative Roles section. The Administrative Role Detail page displays.

8. Select Placement Provider from the Administrative Role drop-down menu. The Resource label displays.

9. Click the Select button under Resource. The Select Resource page displays.

10. Enter the name of the PRTF in the Name field and select Active in the Status drop-down menu. Click the Search button. The Select Resource page displays with a list of resources.

11. Click the radio button next to the correct resource.

12. Click the Select button. The Administrative Role Detail page displays. Verify the correct resource has been chosen.

13. Enter the date of PRTF admittance in the Begin Date field using the <mm/dd/yyyy> format or the calendar icon.

14. Click the Save and Return button. The Medical Detail page displays.

15. Review the Requested Medical Type section:

    • If the child has a Requested Medical Type of PPS, proceed to STEP 16.

    • If the child has a Requested Medical Type of LTC, proceed to STEP 22.

16. Click the Edit button in the Program Persons section. The Medical Person Detail page displays.

17. Click the Add button in the Requested Medical Type section. The Requested Medical Type Detail page displays.

18. Select LTC from the Requested Medical Type drop-down menu.

19. Enter the Begin Month using the <mm/yyyy> format or calendar icon.

20. Click the Save and Return button. The Medical Person Detail page displays.

21. Click the Save and Return button. The Medical Detail page displays.

22. Click the Save and Return button. The Case Summary page displays.

23. Select Eligibility from Global Navigation and Customer Information from Local Navigation. The Contact Summary page displays.

24. Select LTC Data from Task Navigation. The LTC Data List page displays.

    • If the child has HCBS, proceed to STEP 25.

    • If the child does not have HCBS, proceed to STEP 35.

25. Click the Edit button on the HCBS record that is ending. The LTC Data Detail page displays.

26. Enter the Admission Date to the facility in the Nursing Facility Admission Date field using the <mm/dd/yyyy> format or the calendar icon.

    • If the Anticipated Length of Stay is less than 30 days, proceed to STEP 27.

    • If the Anticipated Length of Stay is 30 days or more, proceed to STEP 29.

27. Select Less than 30 days from the Anticipated Length of Stay drop-down menu.

28. Click the Add button in the Temporary Care Dates section. The Temporary Care Details page displays.

29. Enter the Temporary Care Admission Date using the <mm/dd/yyyy> format or the calendar icon.

    • Enter the Temporary Care Discharge Date, if known, using the <mm/dd/yyyy> format or the calendar icon.

    • Click the Save and Return button. The LTC Data Detail page displays.

30. Click the Save and Return button. The LTC Data List page displays.

    • If the child is in a foster home, proceed to STEP 36.

    • If the child is in an adoptive home, proceed to STEP 49.

31. Select 30 days or more from the Anticipated Length of Stay drop-down menu.

32. Select Yes from the HCBS Terminated drop-down menu.

33. Enter the exact day the consumer was admitted to Institutional Care in the Termination Effective Date field using the <mm/dd/yyyy> format or the calendar icon.

34. Click the Save and Continue button. The LTC Data List page displays.

35. Click the Add button to complete the Institutional Care record. The LTC Data Detail page displays.

    • Select the consumers Name from the drop-down menu.

    • Select Institutional Care from the LTC Type drop-down menu. Additional fields display.

    • Enter the current date in the Recorded Date field using the <mm/dd/yyyy> format or calendar icon.

    • Click the Select button under Facility Name/Location. The Select Provider Resource page displays.

    • • Enter the name of the facility and click the Search button. The Select Provider Resource page displays with results.

      • Click the radio button for the desired resource.

      • Click the Select button. The LTC Data Detail page displays with the facility information populated.

    • Select Yes from the Admission Information drop-down menu in the Facility Placement/Discharge section. Additional fields display.

    • Enter the Admission Date using the <mm/dd/yyyy> format or the calendar icon.

    • Select the Anticipated Length of Stay from the drop-down menu.

    • Select Psychiatric Residential Treatment Facility from the Current Level of Care in Your Facility drop-down menu.

    • Enter 9000.00 in the Cost of Care.

    • Select Yes from the Care Screening Met drop-down menu in the Care Screening section.

    • Enter the Screening Date as recorded on the MS-2126 or the admission date in the Date Screening Completed field using the <mm/dd/yyyy> format or the calendar icon.

    • Select Yes from the Discharge Information drop-down menu if the discharge information is known. Additional fields display.

    • Select the appropriate value from the Discharged To drop-down menu and enter the Discharge Date as shown on the MS-2126 using the <mm/dd/yyyy> format or the calendar icon.

    • Click the Save and Return button. The LTC Data List page displays.

    • • If the child is in a foster home, proceed to STEP 36.

      • If the child is in an adoptive home, proceed to STEP 48.

36. Click the + to expand the Foster Care pages from Task Navigation. Select Child Placement from Task Navigation. The Child Placement List page displays.

37. Click the Add button. The Child Placement Detail page displays.

38. Click the Search button associated with the Placement Resource. The Resource Search page displays.

39. Enter as much information about the PRTF as possible. Click the Search button. The Resource Search page displays with a list of resources.

40. Click the radio button next to the appropriate resource and click the Accept button. The Child Placement Detail page displays with the resource populated.

41. Select Child Welfare Agency from the Payee drop-down menu. The Search button dynamically displays.

42. Click the Search button. The Resource Search page displays.

43. Enter as much information as possible for the Case Management Agency. Click the Search button. The Resource Search page displays with a list of resources.

44. Click the radio button for the appropriate resource and click the Accept button. The Child Placement Detail page displays with the Case Management Agency populated in the Payee field.

45. Enter the date of admission in the Begin Date field using the <mm/dd/yyyy> format or the calendar icon.

46. Click the Save and Continue button. The Effective Dating Confirmation List page displays with the Begin Date for the current placement and the Begin Date and End Date for the previous placement.

47. Click the Save button. The Child Placement List page displays with a record showing the child placement as the facility.

48. Select Run EDBC from Task Navigation. The EDBC List page displays.

49. Select the month Institutional Care begins from the Benefit Month drop-down menu and click the Select button.

50. Select the check box(es) for Foster Care and Medical, then click the Run EDBC button. The EDBC List page displays.

    NOTE: Users should only run EDBC for Medical when the child is in an adoptive home.

51. Select Yes from the Timely Notice Exception drop-down menu.

52. Select LTC Late Change from the Reason drop-down menu.

53. Click the Foster Care hyperlink with a Run Status of Not Accepted. The Foster Care EDBC page displays.

54. Verify the information on the Foster Care EDBC page is correct.

    • If the information is correct, click the Accept button. The EDBC List page displays with a Run Status of Accepted-Not Saved. Proceed to STEP 55.

    • If the information is incorrect, click the Cancel button and return to the data collection pages to make corrections.

55. Click the Medical hyperlink with a Run Status of Not Accepted. The Medical EDBC Summary page displays.

56. Review the information, see Read the Medical EDBC Summary Page – PPS.

    NOTE: If there is an amount in the Premium/LTC Liability/Spenddown, the user should click the Cancel button and follow the steps to Modify Existing Income - PPS.

57. Click the Medical hyperlink in the Eligible Budget section. The Requested Medicaid EDBC – (Program) Medical page displays. Review the LTC Details section to verify the information is correct.

58. Click the Close button. The Medical EDBC Summary page displays.

    • If the information is correct, click the Accept button. The EDBC List page displays with a Run Status of Accepted-Not Saved. Proceed to STEP 59.

    • If the information is incorrect, click the Cancel button and return to the data collection pages to make corrections.

59. Click the Save and Continue button. The Distributed Documents page displays with the Notice of Action (NOA) generated for the Medical program.

60. Click the NOA hyperlink. A new window opens with the NOA.

61. Review the NOA for accuracy.

62. Click the X in the upper right hand corner of the window. The window closes.

63. Click the check box for the NOA. Click the Delete button.

64. Run EDBC on the Medical program for each month through the come-up month. Delete any NOA generated.

65. Set a task for 30 days from the admission date if no discharge information has been received. See Adding a Task.

66. Update the ES-3161 and forward to the MCO if the child was receiving HCBS.

67. Image the updated ES-3161 to the case. See Imaging PPS Documents.

68. Select Journal from Utility Navigation. Record all actions taken on the case. See Journal for additional information about journaling functionality.