PACE to Institutional Care – Permanent Stay In-Network

 

NOTE: Change the consumer’s mailing and physical address to the facility’s address. See Contact Summary for information on updating an address.

 

  1. Select Eligibility from Global Navigation. Select Customer Information from Local Navigation. Select LTC Data on the Task Navigation menu. The LTC Data List page displays.

  2. Click the Edit button for the current PACE record.

  3. Click the Edit button on the LTC Data Detail page in the Complete for Current PACE Enrollees block.

  4. Complete the Current PACE Enrollees section:

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

  2. Select Run EDBC from Task Navigation to run EDBC for the appropriate month- If the admittance to the in-network facility was on the first of the month, use the month of admittance. If the admittance was after the first day of the month, use the month after admittance. The Run EDBC page displays. See Running EDBC for detailed steps.

  3. Select the Benefit Month the permanent stay begins from the drop-down menu then click the Select button.

  4. Select the program using the check box. If the month the permanent stay begins is not the come-up month, select Yes for a Timely Notice Exception and a Reason of LTC Late Change then click the Run EDBC button.

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

  6. Click the Eligible Budgets hyperlink to check that the LTC Details have accurate start and end dates. If the information is incorrect the user needs to correct the LTC Data Detail page(s).

  7. Click the Close button to close the window. The Medical EDBC Summary page displays.

  8. Click the Accept button if the EDBC Result is correct. The EDBC List page displays.

  9. Click the Save and Continue button.

  10. Run EDBC through the come-up month to high date the new eligibility. See Running EDBC for detailed steps. For months prior to the come-up month, select Yes for a Timely Notice Exception and a Reason of LTC Late Change.

  11. Send Notices as appropriate. See Manual NOA Generation, Generating a Form for an Institutional Care Facility, and ES-3166 Notification of Pace Information for detailed steps on sending notifications.

  12. Select Journal from Utility Navigation.  Record a Journal entry of the actions taken on the case.  See Journal for more information about journaling functionality.