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

When an individual has met the institutional status requirement of thirty (30) consecutive days, eligibility for facility services will be effective the date of entry into the facility if all other eligibility requirements are met, unless the individual is in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) or was subject to PASARR. Refer to MS H-440. NOTE:The institutional status requirement does not apply to individuals who were certified for SSI or Foster Care in the month of facility entry.

Individuals who become ineligible for SSI or Foster Care following the month of nursing facility entry, will have their categorical eligibility determined according to SSI-related AABD facility eligibility criteria, with the exceptionof the institutionalstatus requirement. Refer to MS F-150. F-153 Appropriateness of Care MS Manual 07/01/20 For TEFRA and Autism, the necessary medical services must be available to provide care to the individual in the home and it must be appropriate to provide such care outside an institution.

F-154 Cost Effectiveness MS Manual 07/01/20 The average cost of services provided to individuals in the community must be less thanthe cost of services for those individuals if they were in an institution. For ARChoices, PACE, and Assisted Living, this determination will be made by the Division of Aging, Adult and Behavioral Health Services (DAABHS). If at any time DAABHSdetermines that costeffectiveness is not met, the eligibility worker will be notified by DHS-3330 and the case will be closed after the appropriate notice is sent to the individual. For DDS, the Division of DevelopmentalDisabilities Services is responsible for monitoring cost effectiveness. For Autism and TEFRA, theDivision of Medical Services is responsible for monitoring cost effectiveness.