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2 TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE (a) Continue to meet the requirements for Medicaid eligibility that were in effect under the State's plan in December 1973 for institutionalized individuals; and (b) Remain institutionalized; and (c) Are determined by the State or a professional standards organization to continue to need institutional care. In accordance with this regulation, any nursing facility resident who has been continuously institutionalized since December, 1973, and who is ineligible by current SSI standards, must have his eligibility evaluated by 1973 standards. 29 DE Reg. 608 (01/01/26) 20101 Application Process - Long Term Care Services The application process is twofold. Applicants for Medicaid must be medically and financially eligible to receive coverage. Referrals for Medicaid may come from many sources: the applicant, the family of the applicant, persons in the community, hospital social workers, etc. The potential nursing facility or Home and Community Based Waiver patient may be in an adult foster care home, in his own home, in the hospital or in a nursing facility as a private pay patient. Rarely does the applicant himself initiate the referral. This means it is extremely important in the case of the mentally competent patient that the Division of Medicaid and Medical Assistance (DMMA) nurse determine initially if the patient is aware that a referral for nursing facility admission or Home and Community Based Waiver has been made. The person must be willing to enter a nursing facility or accept Waiver services, otherwise placement or referral cannot be made. The DMMA nurse and social worker may assist the family or others in helping the patient to accept the need for nursing facility or Waiver care, but the main responsibility belongs to the family or persons acting as family. If the patient is not competent, the family or someone acting responsibly as defined in 42 CFR 435.907(a) will act on behalf of the patient. It is not the responsibility of DMMA to find a nursing facility placement for a patient although they may give assistance when they have knowledge of available, Medicaid certified beds. 22 DE Reg. 66 (07/01/18) 20102 Medical Eligibility Determinations The first of two steps in the application process is to determine medical eligibility. This is usually determined by Pre- Admission Screening (PAS). Referrals to PAS may come from the family of the applicant as well as other sources. 20102.1 Four Levels of Nursing Facility Care There are four levels of nursing facility care for which Medicaid can make payment to qualified providers. 20102.1.1 Skilled Nursing Facility Level of Care 20102.1.2 Intermediate Nursing Facility Level of Care 20102.1.3 Intermediate Care - Facility for the Mentally Retarded 20102.1.4 Intermediate Care - Facility for Mental Disease 20102.1.1 Skilled Nursing Facility Level of Care Skilled Nursing Facility Level of Care - Skilled nursing facility (SNF) is an institutional setting which provides skilled nursing or rehabilitation services for mental or physical conditions. Such a setting includes availability of around the clock professional nursing observations, assessment or intervention. Super Skilled indicates a payment methodology to accommodate respirator and some other skilled level patients as recommended by the DSS Medical Operations Administrator. 20102.1.2 Intermediate Nursing Facility Level of Care Intermediate Nursing Facility Level of Care Intermediate care nursing facility (ICF) is an institutional setting in which nursing and allied health care and support services are provided on a daily basis. Such services are supervised by but not necessarily given by a licensed nurse. 20102.1.3 Intermediate Care Facility for the Mentally Retarded Level of Care Intermediate Care Facility for the Mentally Retarded (ICF/MR) An intermediate care facility for the mentally retarded (ICF/MR) is a residential setting which offers comprehensive habilitative and support services to persons with mental retardation or related conditions. To qualify for an ICF/MR level of care, individuals exhibit significant deficits in age-appropriate functioning in multiple domains. As a consequence, they require frequent assistance or supervision to competently or safely engage in activities of daily living (ADLs). 20102.1.4 Intermediate Care Facility for Mental Disease Level of Care