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

 

For instructions when a Working Healthy/WORK recipient enters a nursing facility for a Permanent Stay, please see Working Healthy (with or without WORK) to Institutional Care – Permanent 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 a spouse, or any other 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 k.

  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.

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

  1. Select Yes next to the Admission Information field.

  2. Using 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 Less than 30 days from the Anticipated Length of Stay drop-down menu.

NOTE: Admitted From Hospital requests the Previous Admission Date. The Previous Admission Date is used to determine the Community Spouse Resource Allowance start date.

  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 situation:

  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 the 300% rule on the LTC-NF cases, use the Nursing facility daily rate (from MMIS or KDADS) x 31 days if the stay is more than 30 days.

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

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

  2. 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 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 MMIS correctly. See Deny or Discontinue a Program or Person for more information.

  1. Run EDBC for the appropriate program block the month Institutional Care begins. See Running EDBC for detailed steps.

    1. If necessary, select Yes for a Timely Notice Exception and a Reason of LTC Late Change. In most instances, a timely notice exception is not required for this 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 aid code with IC/TC/SN LOC details displays.

  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 checkmark next to the 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 match the Working Healthy premium determined for the month the Institutional Care begins. Click the Save and Return button.

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 ran, using the <mm/dd/yyyy> format or the calendar icon

    6. End Date:  Last day of the month EDBC is being ran, 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.

  1. The Medical EDBC Override Detail List page displays.

    1. Select Administrative Decision for EDBC Override Decision.

    2. Click in the box to display a checkmark 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 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.