Page 52

Chapter: 1400 Technical Requirements Program: MSSI, SFP 48 4. any time that placement in a special living arrangement or facility is not made within 45 days of a physician's signature on DOEA CARES Form 603 (Notification of Level of Care).

The eligibility specialist is not required to obtain an updated level of care determination at the time of the eligibility redetermination or when there is a change of placement for the individual between two Long-Term Care Medicaid Programs (ICP or HCBS). The DOEA CARES Form 603 or Certification of Enrollment Status for Home and Community Based Services Form (CF-ES 2515) is considered in effect until such time as the eligibility specialist is notified of a change.

There are circumstances when CARES will not need to complete another full determination. However, the eligibility specialist must request a determination in all of the above circumstances and will be notified if the current documentation is still valid. 1440.1302 Who Determines Need for Placement (MSSI) The agency or office responsible for determining the need for care depends on the applicant's age and what kind of facility or program is needed. After the eligibility specialist requests a determination, the specialist must receive DOEA CARES Form 603 (Notification of Level of Care) for nursing home placement or the Certification of Enrollment Status for Home and Community Based Services (HCBS) Form (CF-ES 2515) for HCBS waivers from the responsible office to document the specific need in the case record.

Note: The eligibility specialist does not request level of care decisions for HCBS waivers but must receive documentation of decisions from case managers, APD or CARES.

The determination will be obtained from one of the following offices:

CARES (Comprehensive Assessment and Review for Long Term Care Services), Department of Elder Affairs:

1. For ICP: determines Level of Care for applicant/recipients over age 21 in nursing facilities, swing beds or hospital based nursing facility beds. 2. For HCBS: determines if applicant/recipient meets waiver requirements for the specific HCBS waiver. 3. For PACE: determines if the applicant/recipient meets the Level of Care.

CMAT (Children’s Multidisciplinary Assessment Team), Children's Medical Services in the Department of Health:

1. For ICP: determines Level of Care for children under age 21, unless they are applicants for the Developmental Disabilities (DD) iBudget Florida Waiver. 2. For HCBS: determines if applicants meet waiver requirements for the Model Waiver.

APD (Agency for Persons with Disabilities):

1. For Intermediate Care Facility for Developmental Disabilities: Kepro determines Level of Care/Reimbursement for ICF/DD placement. 2. For HCBS: APD determines if applicant meets waiver requirements for iBudget Florida Waiver.

If the eligibility specialist is not sure who is handling this determination, or whether a determination has been requested, he should request assistance from his supervisor.