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5. Maintain a copy of the DHB-5053 with the case. No further action is required at this time.

D. Determination of “Permanent or Indefinite Basis” for Beneficiaries Under age 55 (Group 1 Above)

Living in a medical facility on a permanent or indefinite basis means the individual under the age of 55 cannot reasonably be expected to be discharged to return home. This determination is based on documentary evidence. This does not mean an individual would never be able to return home. The local agency is responsible for making the determination that the a/b cannot reasonably be expected to be discharged home. There are several ways to establish this.

1. Initial Determination

a. Review the FL-2, DHB-2039, PHP Notification of Nursing Facility Level of Care Form, or other documentary evidence.

(1) Other documentary evidence may include the nursing facility’s plan of care, level of care documentation, hospital discharge summary/planner’s report, or a physician’s statement.

(2) Verify whether it contains a specific discharge plan/date or period of time that care in an institution is needed.

Example: The FL2 may indicate placement required for five months to provide care and physical therapy for an individual who is recovering from a broken hip. This indicates a plan for discharge in five months and is therefore not considered permanent or indefinite.

b. When the documents do not indicate a specific discharge plan/date, the placement is considered permanent or indefinite and cannot be reasonably expected to be discharged home.

c. When the documents do indicate a specific discharge date or reasonable plans for discharge:

(1) Take no further action at this time.

(2) Create a task in NC FAST for review at the projected date of discharge or at the next recertification, whichever is first. DocuSign Envelope ID: FDC5A36F-C20D-40ED-8E94-3167F2A747A6 DocuSign Envelope ID: 9CB30F35-4CFE-41A3-8663-00DA59A946C6