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received from EDS and forward a copy to the facility. Distribute to the appropriate caseworker the stamped MR-2 received from the LME. A copy does not need to be forwarded to the facility. Retain a copy in the case record.

b. Request/submit a new FL-2 if eligibility is lost for more than 90 days.

2. Responsibilities of the Prior Approval Unit

a. Give telephone prior approval.

b. Decide if the patient meets criteria for recommended level of care.

c. Upon approval, a 13-digit service review number (SRN) is systematically generated and is entered in block 12. The number remains valid if the patient:

(1) Enters or remains in a nursing facility and receives that level of care; or

(2) Is admitted to a hospital and then returns to the NF and receives the same level of care.

3. Responsibilities of the Nursing Facility (NF)

a. Do not accept or transfer a patient if prior approval is in doubt.

b. Retain a copy of the FL-2/MR-2 and the DHB-5016(s) in the patient's file and make these available for state and federal review.

c. File claims for reimbursement from Medicaid.

d. Notify the local agency within 48 hours of plans to:

(1) Move the patient to a different facility or hospital.

(2) Discharge the patient to home.

(3) Readmit the patient from the hospital.

e. When the patient is transferred to a different facility, provide a copy of the current approved FL-2/MR-2 with the current service review number.

F. Validity of Approval and Expiration Dates The stamped approved FL-2/MR-2 is valid for the period of time listed below.

1. For an individual still in PLA

If the patient is at home when the FL-2 is completed, they must be placed within 30 days or a new FL-2 is required.

Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493