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Chapter: 1400 Technical Requirements Program: MSSI, SFP 49 1440.1303 Appropriate Placement for Institutional Care (MSSI) The Institutional Care Program (ICP) includes coverage for individuals in nursing homes, Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), certain state mental hospitals for those aged 65 and over, and certain rural hospitals on a temporary basis (swing beds).

Placement is appropriate when the individual is placed in a Medicaid facility certified to provide the level of care the individual requires. The individual must be in a bed certified to provide the same level of care determined necessary by CARES.

Individuals must require one of the following levels of care:

1. Skilled, Intermediate I, or Intermediate II in a nursing home or hospital swing bed; 2. one of three types of care/reimbursements Level 1, 2 or 3 (LOR 1, LOR 2, or LOR 3) 3. appropriate care in a mental hospital for individuals age 65 and over.

The individual must be in a bed certified to provide the same level of care as determined necessary by CARES, CMAT, or APD.

Certified rural hospital swing bed providers or hospital based nursing facility bed providers can provide skilled or intermediate levels of care to individuals for a 30-day period. Prior authorization for stays beyond 30 days must be approved by CARES.

Note: For swing bed providers, 30-day extensions may be granted. For hospital based nursing facility bed providers, only one 15-day extension may be granted. 1440.1304 Appropriate Placement for Hospice Services (MSSI) An individual must meet the following requirements for appropriate placement for Hospice services.

Medical Programs - The individual must have a medical prognosis as terminally ill with a life expectancy of six months or less, if the illness runs its normal course. The written certification must be signed by the Hospice director or the physician member of the Hospice interdisciplinary group, and the individual's attending physician, if the individual has one. This certification satisfies the level of care and the disability determination requirements. No determination is made by CARES.

Election of Hospice Care - An individual must elect Hospice care services in order to receive that care, by signing and filing with the Hospice an Election Statement. An individual's representative may also make the election. The individual or his representative must designate the effective date of his election of Hospice care. The effective date is the first date of Hospice care. An effective date may not be a date that is earlier than the date the election is made. 1440.1305 Appropriate Placement for HCBS (MSSI) Individuals seeking alternatives to nursing home placement are considered for placement in the HCBS Program. The following criteria must be met for an individual to be considered appropriately placed for HCBS:

1. be determined to meet a need for waiver services as evidenced by receipt of DOEA CARE Form 603 in case record (as determined by CARES, CMAT or DS), and 2. be enrolled in a Medicaid waiver with an appropriate case manager as evidenced by a CF-ES 2515.