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State of Maryland Medical Assistance Manual Revised April 2014

MCO-Enrolled Recipients Admitted to Nursing Homes, Rehab Facilities, or Chronic Facilities LDSS CMs are not required to track the 30 days for which the MCO is responsible. This is handled through procedures arranged with the MCO and DHMH. LDSS CMs may continue to determine eligibility based on the dates submitted on the DHMH 257. MMIS-II includes edits which will not allow MCO enrollment dates and long-term care spans to overlap, and ensure that the recipient in long-term care is disenrolled from the MCO on the appropriate date. The LDSS must complete an unscheduled redetermination when a recipient is considered institutionalized to allow the long-term care facility to bill the Medical Assistance Program on a fee-for-service basis after the 30-day period for which the MCO is responsible. A long-term care application and DHMH 257 are required. Upon receipt of the DHMH 257, with an approved level of care determination by the UCA, the CM must take the following action to effect a change from community MA to long-term care MA: • If the recipient is the Head of Household (HOH), select “L” (Add-A-Program). If the recipient is not the HOH, select “J” to rescreen the case, making the recipient the HOH (“SE”). Go in through “O” Interview and enter the appropriate valid value code, i.e. “IC”, “CC”, etc. under “Living Arrangement” on the “DEM1” screen for the new AU. Update the “ADDR” screen to reflect that the individual is residing in a long-term care facility and include information on the authorized representative on the “AREP” screen. Evaluate countable assets to ascertain whether a disposal has taken place within the applicable look- back period. • Complete the “INST” screen, including: o Institution Type; o CARES Vendor ID (Prov ID); o Date of Admission (Entry Date); o Level of Care (Level Auth); and o The requested begin pay date (LTC Payment Auth Date).

• After completing the Interview, go to “DONE”. This will simultaneously close out the community AU and allow you to process the new long-term care AU. Then Process (“P”) and Finalize (“Q”) the case. The long-term care facility must bill the MCO for the first 30 days and then bill the Medical Assistance Program on a fee-for-service basis for the subsequent days. When the case is processed in CARES, a long-term care span will be created on the MMIS-II system through the interface process. Recipients Admitted to Institution for Mental Disease (IMDs) An Institution for Mental Disease (IMD) means a hospital, nursing facility, or other medical institution of more than 16 beds that is primarily engaged in providing diagnosis, treatments, or care of individuals with mental diseases or substance abuse problems. IMDs include such long-term care facilities as psychiatric hospitals, residential treatment centers (RTCs), Regional Institutes for Children and Adolescents (RICAs), intermediate care facilities-alcoholic (ICF-As), and residential drug-free treatment programs.