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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 67 The Rehabilitation facility may be a freestanding rehabilitation hospital or a rehabilitation unit in an Acute Care hospital. Medical Eligibility Requirements For In State Hospitalization and/or Rehabilitation Medical eligibility for Inpatient hospitalization/rehabilitation services received within the state is determined by the Division of Medicaid and Medical Assistance Pre-Admission Screening (PAS) units. The individual must have required the level of care provided by a hospital during the time of his/her hospitalization, as determined by the PAS units. Anyone 65 years of age or older, or statutorily blind would meet the medical eligibility criteria if they were in need of acute care services during the time of their hospitalization. Medical Eligibility Requirements For Out of State Rehabilitation Medical eligibility for Inpatient Rehabilitation services to be received out of state is determined by the Division of Medicaid and Medical Assistance Medical Director. The individual must require: ·close medical supervision by a rehabilitation physician; ·twenty-four (24) hour nursing supervision; ·an intensive level of physical, occupational or speech therapy; or ·psychological services; or ·prosthetic-orthotic services. The individual must be able to tolerate and participate in all required therapies or services. Medical eligibility must be reviewed on a bi-weekly basis. Prior authorization must be requested and approved before out of state placement is made. Financial Eligibility Requirements Financial eligibility is determined by the Division of Medicaid and Medical Assistance Financial units. An individual must meet income and resource guidelines. Income Guidelines The income limit is equal to 100% of the Federal SSI Standard. However, if the individual is going to a nursing home directly from a hospital or rehabilitation facility, the higher income limit of 250% of the Federal SSI standard will be applied. For out of state rehabilitation the income limit is 250% of the Federal SSI standard. Refer to DSSM sections 20200, 20210, and 20240 for additional guidelines regarding income. Resource Guidelines The resource limit is $2,000.00. Refer to DSSM sections 20300 – 20360, and 20400 for additional information on determining countable resources. Spousal If applicable, Spousal Impoverishment rules should be followed. (DSSM 20900) Financial Redetermination A redetermination of the individual’s financial eligibility should be completed at six month intervals. Post Eligibility Budgeting There is a patient pay requirement for these individuals. The patient pay amount is determined in accordance with DSSM section 20600 - (Post-Eligibility Definitions/Procedures). Notification of patient pay amount and approval must be sent to the appropriate hospital/rehabilitation social worker. Medicaid Eligibility Effective Date In no case shall the effective date of eligibility be earlier than the first day of hospitalization. 13 DE Reg. 263 (08/01/09) 20810 Treatment of Income and Resources of Couples This policy applies to all legally married couples when determining and redetermining Long Term Care Medicaid eligibility for both husband and wife. Treatment of Home and Community Based Services (HCBS) Couples The income and resource standards for a HCBS couple will be applicable if: Both are requesting HCBS AND reside at the same address; OR One is currently receiving HCBS and the spouse is requesting HCBS AND they reside at the same address. Treatment of Couples Residing in an Institution The income and resource standards for couples residing in an institution will be applicable if: ·Both are requesting institutional services AND they will be residing in the same facility; OR ·One is currently receiving institutional services and the spouse is requesting institutional services at the same facility. After a husband and wife have resided in the same facility for 6 months they have the option of being budgeted as a couple or as two individuals. This decision should be based on the couple's best interests in regard to the income and resource limits.