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II. LEVEL OF CARE (FL-2)
Eligibility for SAIH requires that the a/b needs licensed residential level of care
as documented on a valid FL-2 and signed by a licensed physician, physician
assistant, or nurse practitioner. Always thoroughly examine the FL-2 to
determine if it is valid. (See SA-3100 VII.A.3.)
It is also necessary to thoroughly examine the Diagnosis section of the FL-2 in
order to determine if there is a diagnosis of Alzheimer’s disease or dementia:
• SAIH beneficiaries without a diagnosis of Alzheimer’s disease or dementia are budgeted with the SA Basic rate.
• SAIH beneficiaries with a diagnosis of Alzheimer’s disease or dementia are budgeted with the SA Enhanced rate.
IMPORTANT NOTE: The term major neurocognitive disorder is
the updated terminology used in the DSM-5 to describe what was
previously known as dementia. Since these two terms are now
used interchangeably in both clinical and medical contexts, the
Special Assistance Program now also acknowledges major
neurocognitive disorder as interchangeable with dementia. As such, the use of major neurocognitive disorder shall be allowed and acknowledged to be the same as dementia when used on an FL-2. (Major neurocognitive disorder must NOT be confused with similarly named but unapproved diagnoses, such as “mild neurocognitive disorder”, “neurocognitive disorder”, or any variation of “neurocognitive impairment”. When in doubt about a diagnosis, contact the SA Listserv.)
A. The SAIH payment begins the date the application is made
(if all eligibility criteria are met) and is not tied to the date
the FL-2 is signed.
This is different from a SA beneficiary. The FL-2 must not be dated more
than 90 days prior to the date of SAIH application and must be received
during the application processing period.
B. The application cannot be approved until the valid, signed
FL-2 is received and the case management assessment
is completed.
The FL-2 is used to validate that the a/b meets the requirements for licensed residential level of care and the assessment is used to identify services that will help the a/b stay at home safely. SA-5200 II.