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MEDICAL SERVICES POLICY MANUAL,SECTION F F 100 Non Financial Eligibility Requirements

• Has lastedor is expected to last for a continuous period of at least twelve (12) months; or • Is expected to result in death. (Refer to MS F-120.)

F-151 Functional Need MS Manual 01/01/22 Before nursing facility, waiver services or PACE can be authorized, it must be determined that the patient’s condition warrants facility care or waiver services. Functional need decisions are made based on the information submitted on the DHS-0703. The decision will be reported to the county office on the DHS-0704. Functional need decisions for: • Nursing facility applicants and recipients are made by the Division of Provider Services and Quality Assurance (DPSQA) Office of Long-Term Care (OLTC). • Living Choices, ARChoices Waivers, and PACE applicants and recipients are made by the Division of Aging, Adult and Behavioral Health Services (DAABHS). • DDS waiver applicants and recipients are made by the Division of Developmental Disabilities Services. • TEFRA applicants and recipients are made by the TEFRACommittee. • Autism applicants and recipients are made by the DPSQA Office of Long-Term Care, Utilization Review.

Applicants for nursing facility admission with indicators or diagnoses of mental retardation or mental illness must be evaluated under Pre-Admission Screening and Annual Resident Review (PASARR) requirements for determination of appropriate placement prior to entering a nursing facility. Persons requiring pre-admission evaluations for mental retardation or mental illness shall not be eligible for Health Care reimbursement of nursing facility services prior to the date that a determination is made (the PASARR effective date on the DHS-0704), unless emergency admission has been prior authorized by the DPSQA Office of Long-Term Care PASARR Coordinator or Utilization Control Committee. ICF/IID applicants are exempt from PASARR evaluation, but they are not eligible for services prior to the decision date on the DHS-0704.