8114.1 CARE Exceptions

Unless delayed or not required as per Section 2.1.4 of the KDADS Level I CARE Manual payment to the facility shall not be approved until the CARE is completed (or the PASRR requirements have been otherwise satisfied as per KDADS) and the individual has been found to meet LOC requirements.

A CARE assessment may be delayed if the individual is admitted under a special or emergency admission as defined by KDADS. Emergency admissions are made in specified situations, such as an APS placement, to allow the individual to obtain immediate care. Special admissions are made for a specified period of time, generally 7 to 30 days, as determined by KDADS. If the individual is otherwise eligible, payment shall be made during the special admission period. However, persons seeking reimbursement for services following the expiration of the special or emergency period must have a CARE completed and meet level of care. Payment to the facility shall terminate following the special or emergency period if the CARE is not completed but may be reinstated when the CARE is completed.

Example 1 : A 7-day emergency admission is made for an individual on 06-01-04. A CARE assessment is subsequently completed on 06-14-04 and the individual is found in need of care. Payment may be approved for the first 7 days of the stay through the emergency admittance policy. However, continued payments cannot resume until 06-14-04, when the required follow up CARE was completed. There is no Medicaid reimbursement for payment between 06-08-04 and 06-13-04.

Example 2 : Individual is admitted under a 30-day special admission on 07/01. On 07/20 the recipient is still at the facility, so a LOC score is requested. Verification of the CARE/LOC is received on 07/27 stating client meets the LOC. Payment now continues beyond day 30 because the CARE has been completed and LOC has been met.

For situations not exempt or delayed from CARE, no reimbursement for NF care will be made prior to the completion of the CARE and any necessary Level II screen. If a CARE is completed and the client meets the level of care, Medicaid payment may be approved beginning with the date the CARE assessment was completed. When NF reimbursement is denied for an individual who is otherwise eligible for reimbursement solely because of the delayed CARE, the individual is not responsible for any NF costs during the period of delay. These costs are assumed by the nursing facility.