Working Healthy (with or without WORK) to Institutional Care - Permanent Stay

 

 

For instructions when a Working Healthy/WORK recipient enters a nursing facility for a Temporary Stay, please see Working Healthy (with or without WORK) to Institutional Care - Temporary Stay.

 

Complete the Following Steps:

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

    1. If the consumer is on a program block with an active spouse, or any other active household member, the consumer will need to be moved to their own medical block. See Add New Program or Reapply Program.

    2. If the consumer is on a medical program block with no other persons:

      1. Add/Update Requested Medical Type to LTC with a Begin Date the month Institutional Care begins.

      2. Add/Update Administrative Role if there is a community spouse or additional correspondent who needs to receive notices. If there is a medical representative, they can be added at this point using the Resource Databank.

  2. Select Eligibility from Global Navigation. Select Customer Information from Local Navigation. Select LTC Data from Task Navigation.

  3. Click the Add button on the LTC Data List page. The LTC Data Detail page displays.

    1. Select the consumer’s name from the Name drop-down menu.

    2. Select Institutional Care from the LTC Type drop-down menu.

    3. Enter the date the information is being recorded in the Recorded Date field using the <mm/dd/yyyy> format or the calendar icon.

  4. Complete the Facility Information block.

    1. Click the Select button in the Facility Information block.  The Select Provider Resource page in the Resource Databank displays. To search for and select the correct Facility Name/Location:

      1. Enter the Provider ID using the Active Nursing Facility (NF) List.

      2. Select Active under Status.

      3. Click the Search button.

    2. Click the radio button for the desired Facility Name/Location.

    3. Click the Select button. The provider selected populates on the LTC Data Detail page.

  5. NOTE: If the Agency or provider is not found or needs to be updated, see Requesting an Addition or Change to the Resource Databank.

  6. Using the MS-2126 Notification of Facility Admission/Discharge received from the facility, complete the required fields.

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

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

NOTE: If the Admitted From is a facility (including a hospital) the page will ask for the Previous Admission Date; however, this field is not required. The Previous Admission Date is used to determine the Community Spouse Resource Allowance (CSRA) start date, if applicable.

  1. Select the Current Level of Care in Your Facility using the drop-down menu.

  2. Enter the Cost of Care.

NOTE: The amount used for the Cost of Care depends on the consumer’s income:

  1. If income does not meet the 300% rule on LTC-NF cases, use $9,999 as the Cost of Care.

  2. When the Cost of Care meets or exceeds 300% of the FPL for LTC-NF cases, use the Nursing facility daily rate (from KMMS or KDADS) x 31 days.

  3. IFor PRTF Cost of Care use $9,999.

  1. Complete the CARE Screening information using the provided information from KDADS. Under Care Screening, select Yes if the consumer meets the CARE Screening requirements, if they do not meet the CARE Screening requirement select No. Enter the Date Screening Completed using the <mm/dd/yyyy> format or the calendar icon.

NOTE: In some situations, the consumer may be exempt from a CARE Screening. In this scenario the user should enter Yes for CARE Screening Met and the date the consumer became exempt from the screening requirement.

  1. If allocating income, complete the Dependents of LTC/Applicant/Member or Dependents of Spouse block. See Income Allocation for more information.

  2. Click the Save and Return button when all necessary information is recorded.

NOTE: If the consumer was previously open on a program block with another active household member and is now being approved on their own LTC program block, the consumer will need to be closed on the old program block in the come-up month. This will need to be done prior to running EDBC on the new program block for coding to send to KMMS correctly. See Deny or Discontinue a Program or Person for more information.

 

NOTE: Check KMMS to confirm if any WH months have already been billed through premium billing. If appropriate, seeAdding an Expense in KEES (ks.gov) to add the expense.

  1. Run EDBC for the appropriate program block the month Institutional Care begins. See Running EDBC - Medical (ks.gov) or Running EDBC (ks.gov) for detailed steps.

    1. If necessary, select Yes for a Timely Notice Exception and a Reason of LTC Late Change.

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

    1. In the Eligible Budgets section, a 300/DS or 300/OA aid code with IC/NF level of care details displays. (Note: The SOBRA/Inmate and facility LOC identifiers were intentionally left out from this example.)

  3. Click the Override Medical Summary button. The Medical EDBC Override List page displays.

    1. Select Administrative Decision for EDBC Override Decision.

    2. Click in the box to display a check-mark next to Medically Needy under Test.

    3. Click the Override button. The Medical EDBC Override Detail page displays.

      1. In the LTC Details section, click the Edit button. The Medical EDBC LTC Override Detail page displays. In the Override Detail section, update the Liability $ field value to $0. Click the Save and Return button.

NOTE: When processing a Permanent Stay for a Working Healthy/WORK recipient and admission occurs on any date that is NOT the 1st day of the month, you must enter the WORK LOC details for the dates prior to the date of entrance to the nursing facility (NF). This will only need to be done for the month of entrance. This ensures the consumer will retain the WORK LOC for the days in the month until the date of permanent admission to the NF.

 

Example:  WORK recipient enters the NF for a permanent stay on 3/21. Add the WORK LOC details for 3/1-3/20 as shown below:

  

 

NOTE:  This will need to be done prior to editing any other fields in this screen.

  1. The Medical EDBC Override Detail page displays. In the User Override section, select the following:

    1. Test:  LTC

    2. Test Result:  Pass

    3. FPL %:  0

    4. Premium:  The WKH premium determined in the month Institutional Care begins

    5. Start Date:  First day of the month EDBC is being run, using the <mm/dd/yyyy> format or the calendar icon

    6. End Date:  Last day of the month EDBC is being run, using the <mm/dd/yyyy> format or the calendar icon

    7. Aid Code:  Select the correct Working Healthy aid code (Disabled, Blind, Medically Improved, or Medically Improved Blind)

    8. Click the Save and Continue button.

  2. The Medical EDBC Override Detail List page displays.

    1. Select Administrative Decision for EDBC Override Decision.

    2. Click in the box to display a check-mark next to the LTC under Test.

    3. Click the Save and Return button.

  1. The Medical EDBC Summary page displays.

    1. Review the aid code, LOC details, and premium that are now displayed in the Eligible Budgets section with an LTC test.

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

  3. Click the Save and Continue and button.

  4. Send Notices. See Manual NOA Generation and Generating a Form for an Institutional Care Facility for detailed steps on sending the notifications.

  5. Create a Journal entry documenting the changes.