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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 100 Non Financial Eligibility Requirements

For Home and Community-Based Waivers, Autism, DDS and PACE, the individual must meet the medical necessity, appropriateness of care, and cost effectiveness requirements. Refer to MS F- 151, MS F-152, MS F-153, and MS F-154. For TEFRA, the individual must meet the medical necessity and appropriateness ofcare requirements. Refer to MS F-151 and MS F-153.

F-150 Establishing Categorical Eligibility for Long Term Services and Supports (LTSS) MS Manual 01/01/22 Current recipients of SSI and Foster Care, for whom the Agency has legal responsibility, automatically meet the categorical eligibility requirement. However, if any question regarding the categorical eligibility of these individuals should arise, the question will be resolved with either Agency or SSA personnel before proceeding further with the application. If the eligibility of an SSI recipient is questionable, a statement will be obtained from SSA (preferably written) to document its awareness and treatment of the eligibility factor. Categorical eligibility for individuals other than SSI or Foster Care will be determined according to SSI-related AABD facility eligibility criteria as follows: 1. Institutional Status (Nursing Facility Only) - It must be verified that the individual has been institutionalized for thirty (30) consecutive calendar days (an exception to the thirty (30) days is made when death occurs prior to thirty (30) days). Refer to MS F-152. The period of thirty (30) days is defined as being from 12:01 a.m. of the day of admission to 12:00 midnight of the thirtieth (30th) day following admission. Hospitalization will count toward meeting the institutional status requirement if the individual enters a facility on the date of discharge from the hospital. This includes hospitalization at Arkansas State Hospital in Little Rock. It also applies to individuals who enter an Arkansas institution directly from an out-of-state institution. EXAMPLE: An individual enters a facility anytime on July 18. The thirty-day count begins at 12:01 a.m. of the morning of July 18 and ends at midnight of August 16. 2. Categorical Relatedness - To meet the requirement of categorical relatedness, the individual must meet one (1) of the following: Aged – Sixty-five (65) years of age orolder (MS F-110); Blind - Central visual acuity of 20/200 or less in the better eye (with correction) or a limited visual field of twenty degrees 2 ) or less in the better eye (MS F-120); or Disabled - Physical ormental impairment that preventsthe individual from doing any substantial gainful work (for a child under eighteen (18) years of age, an impairment of comparableseverity), and that meets the following criteria: