Page 90

MEDICAL SERVICES POLICY MANUAL,SECTION C C-200 Alternative Application Processes

C-255 Approval/Denial for New ALF Applicants (Non-Nursing Facility) MS Manual 07/01/20 After all eligibility criteria have been established, the effective date of ALF Waiver eligibility is established by the DHS RN based on the latter of the date of application, date of admission to the assisted living facility, or the date the person-centered Service Plan is signed by the DHS RN and the applicant. The DHS RN will provide the Waiver eligibility date to the County Office. lf financial or non-financial criteria are not met, the application will be denied. If the application is denied, the client has the right to appeal by filing for a Fair Hearing. Refer to the MS L-100 section.

C-256 ALF Approvals for Medicaid Recipients Who Leave a Nursing Facility or ARChoices Waiver MS Manual 07/01/20 The ALF Waiver case can be approved once verification of an Intermediate Level of Care and the ALF waiver begin date from the DHS RN is received.

C-260 Program of All Inclusive Care for the Elderly (PACE) Application Process MS Manual 07/01/20 Prospective PACE recipients can apply for PACE services through their local DHS County Offices. Applicants may apply by referral from the PACE provider, by referral from the DHS RN, or without a referral from any source. Regardless of the origin of the inquiry, the prospective recipient must meet the medical and financial eligibility criteria outlined in MS E-400 and F-155 and reside in a PACE service area. Refer to Appendix K for PACE providers and the zip codes they serve. Applicants residing in a PACE service area will be referred to the DHS RN for coordination of the medical assessment. The eligibility worker will approve or deny the application based on financial and non-financial eligibility requirements. The final determination of eligibility will be communicated to the PACE provider by the DHS RN. C 255 Approval/Denial for New ALF Applicants (Non Nursing Facility)