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2. For an individual in a hospital

An approved FL-2/MR-2 is valid until the patient in the hospital is placed or until their condition changes.

a. If a patient must remain in the hospital inappropriate/swing bed because no appropriate bed can be located, a new FL-2 is required only if their condition changes.

b. A discharged patient must be placed within 30 days of discharge from the hospital or a new FL-2 is required.

3. For an individual in a LTC facility After placement, a physician, physician assistant, or nurse practitioner must certify that the patient continues to need approved services in a nursing facility. a. Skilled - At 30, 60, and 90 days after admission/readmission, and every 60 days thereafter.

b. ICF/MR - On admission and recertified annually.

G. Patient Approved For Adult Care Home Level of Care If the a/b is receiving nursing home care in the hospital or nursing facility but the FL-2 shows approved for adult care home level of care only, no facility charges for room and board can be applied to the deductible. Adult care home room and board is not a medical expense. Personal care services in the adult care home can be applied to the Medicaid deductible because personal care services are a medical expense. Use PLA budgeting procedures if the a/b applies for Medicaid only.

H. Reconsideration Review 1. If the level of Nursing Facility care which the attending physician recommends is denied initially or if the recommended level is changed at Utilization Review, the caseworker should advise the patient or representative that a reconsideration review may be requested by: a. The physician, who provides additional information on the patient's condition; or b. The patient or their representative who makes a written request by contacting the Department of Health and Human Services (DHHS) Hearing Officer at DHHS. DHHS Hearings and Appeals 2501 Mail Service Center Raleigh, NC, 27699-2501 (919) 855-3260

2. The patient whose level of nursing care changes is not required to move to another bed or to change nursing facilities during the reconsideration review process. Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493