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State of Maryland Medical Assistance Manual Revised April 2014

• Enter “NH” under the “INST Type” field. • Enter the date of entry under the “Entry Date” field. • Enter “S” under the “Level” field. • Enter the requested begin payment date under the “LTC Payment Auth Date” field. • Enter “A” under the “Medicare Cert” field. On the “DEM1” screen, under “Living Arrgmt,” enter “SN” for skilled or “CC” for chronic care. When the Medicare co-payment period has ended, no action is required by the LDSS. J. Transfer From One LTCF to Another An institutionalized person may transfer from one LTCF to another. The former LTCF should notify the LDSS by a 257 that the person has been discharged to another facility. The new LTCF must notify the LDSS of the admission date by a 257. The LDSS must enter the appropriate discharge date from the former facility to the new facility on the “INST” screen. If the discharging facility fails to issue a 257 prior to receipt of the 257 from the new facility, do not delay entry of the admission date if a valid 257 confirming the admission is received from the new facility. In the absence of the discharging 257, use the date of admission to the new facility as the date of discharge. Please Note: the process of transferring from one facility to another will take 2 days to complete. First, the CM must enter the date of discharge from the previous facility onto the “INST” screen. Secondly, the CM must send an Alert (745) for the next day to go back onto the “INST” screen and enter the new facility’s information on the line below the previous facility’s information. The second action must take place after over-night batch has run so that the leave date from the previous facility can be committed to CARES before the new information is received. The full available income, less the cost of care from the discharging facility, is the available income to be reported on the 206C to begin pay to the new facility. The 206C to begin pay must also change the income back to the full available income for the next month. K. Discharge to the Community When an institutionalized individual is discharged to the community, the month of discharge is an institutional month. The CM should initiate an unscheduled redetermination of eligibility. The portion of available income to be paid to the LTCF for the month of discharge needs to be recalculated. The individual’s Medical Assistance eligibility should then be evaluated using community MA rules (see the MA Manual Section 900) for the consideration period following the month of discharge. • If the individual is returning to a home with spouse or family, the individual is considered institutionalized for the entire month of discharge and remains an assistance unit of one. • When a child is discharged from the facility, the income and resources of the parent(s) are not counted until the first full month after institutionalization, provided an application is filed for continued MA. MA eligibility is extended for at least 90 days for a child discharged from an IMD, a RICA, or a RTC to allow time for a child’s redetermination of