Sanctions

If the NH is under a Medicaid sanction resulting in a "ban on admissions", no Hospice Care Communicator (HCC) should be sent to DFCS until such time as the ban is lifted. Until the "ban on admissions" is lifted, no A/R should be approved for the IH COA if the A/R is admitted to IH on or after the effective date of the ban on admissions. A ban on admissions has no effect on A/Rs who are already Medicaid recipients in IH or who were admitted to IH prior to the imposition of the ban.

If an application is received on an A/R who was admitted during the time the "ban on admissions" is in place, hold the case until either the ban is lifted and the case can be approved under the IH COA or the standard of promptness (SOP) is reached. If the case cannot be approved under the IH COA by the SOP date, determine eligibility under another COA such as regular AMN. Do not determine eligibility under any LA-D COA. If the "ban on admissions" is subsequently lifted, historically close the other Medicaid case and approve under the IH COA back to the first month of eligibility.

The county DFCS will be copied on the facilities notification of "Denial of Payment" from DCH/Aging and Community Health Services. The county DFCS will also be copied when the Denial of Payment ban is lifted.