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(a continuous period of institutionalization).

b. Only adequate notice is required to budget LTC and assign PML to any beneficiary when the beneficiary begins to receive nursing home level of care:

(1) In a nursing home facility;

OR

(2) In a swing/inappropriate level bed in a hospital. Unlike acute hospital care, a nursing level of care is a new benefit which was not approved previously.

5. Special Changes in Situation Involving Hospitalization When a pla beneficiary is hospitalized for 30 days or more:

a. Do not budget as LTC when:

(1) The a/b has already been discharged back to PLA when you learn they were hospitalized, or

(2) They will be discharged back to pla before a pml can be effective following timely notice requirements.

b. Do re-budget the beneficiary as LTC when: (1) They are still hospitalized; or

(2) There are placement plans or their length of hospital stay is indefinite; or

(3) They begin to receive care in a nursing home or a swing/inappropriate level bed in the hospital.(XI.A)

B. Non-SSI Special Assistance Beneficiary Moves To Nursing Home Level Of Care (Refer to MA-1100, SSI Medicaid – County DSS Responsibility, for SSI Beneficiary Moves to LTC).

1. Do a special review using the last SA workbook and document reserve items and income on Supplement D to the DMA-5007/5008. 2. Do not re-verify information unless: a. Total countable resources exceed the MA reserve limit; or b. A change has occurred to income or resources; or

c. The new Medicaid c.p. extends beyond the SA payment review period; or

d. A transfer of resources has occurred (refer to MA-2240 Transfer of Assets) Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493