Page 373

NOTIFICATION REQUIREMENTS 2.18

All policies governing notifications apply to assistance units receiving LTC coverage. In addition, notify the assistance unit, any responsible party, and the LTC facility in writing of the effective date of the LTC coverage by sending the Notice of the Patient Pay Amount which must state:

 the monthly amounts of each source of countable income,  the applicable LTC Income Allowances (see Section 2.6: LTC Income Allowances in this Chapter),  the prorated PPA for the month of admission which should include the day of admission (see Section 2.14: Patient Pay Amount (PPA) in this Chapter), and  the ongoing PPA, including the PNA.

Complete a revised Notice of the Patient Pay Amount when changes occur in the individual's income, LTC Income Allowances, or other eligibility factors. If the individual is discharged from the facility, complete a revised Notice of the Patient Pay Amount showing the prorated PPA for the month of discharge. When prorating the PPA for the month of discharge, do not include the day of discharge or death.

COMMUNITY BASED LTC WAIVER 2.19

The District was awarded a waiver that allows the Medicaid program to pay for community-based care services in lieu of placing an individual in a LTC facility. This program is alternatively known as the “Elderly and Physically Disabled Home- and Community-Based Waiver.” Please see Section 3.4: Elderly and Physically Disabled Home- and Community-Based Waiver in Chapter 3 in this Part for more information.

Generally, to be eligible for these services, the individual:

 must have income below 300 percent of the SSI payment level,  have assets below the Medicaid categorically needy resource level;,  would be eligible for Medicaid if placed in an institution;,  must require a level of care provided in LTC facilities;, and  could be served in a more cost-effective manner with community-based services.

The waiver limits the number of individuals who can receive Medicaid-funded community-based services under this waiver. Customers may apply be calling (202) 535 2178 or (202) 442 5912.