403.04.01 Pre-Approval for Admission

(Rev. 10/01/23)

The DHHS eligibility worker from the OSS Specialty Unit is responsible for determining that an applicant meets all financial eligibility criteria before notifying the applicant they are cleared for admission to a facility.

Procedure for OSS Application/Referral Is the applicant known to the System of Record ? If yes: Is the person an SSI recipient (CAT 80)? If yes, Only the DHHS Form 1728 , SSI Recipient Request for Optional State Supplement – OSS is required Is DHHS Form 1728 completed/returned? If yes: Create a new tracking form for OSS Scan DHHS Form 1728 into OnBase (Refer to the Document Type Guide.pdf for additional scanning instructions) Proceed with Step 2 to determine OSS eligibility. If no, process is terminated. If not SSI, is the person eligible in another full or limited category? E ligible in a limited category, A DHHS Form 3400-A or DHHS Form 3400-B is required; If an addendum is required, has the addendum been returned? If not, terminate the process If yes, determine eligibility Eligible in a full category No updated application is required if eligible in a full coverage category . C reate an Application Tracking Form with the OSS claim type. Add comment indicating the request for OSS services. Determine OSS eligibility- See Step 2 Applicant is not known to System of Record or is not currently eligible in another PCAT The DHHS Form 3401 , Application for Nursing Home, Residential or In-Home Care or the DHHS Form 3400 and 3400-A or 3400-B are required Is an application returned with OSS requested on the application? If yes, Refer to the Document Type Guide.pdf for additional scanning instructions. If no, process is terminated. Determine Financial Eligibility If the applicant is eligible and already in an OSS approved facility: Call the CRCF listed as the applicant’s current residence to verify the admission date. Once the admission date is received, the worker can generate the CRCF-01 unless already provided by the facility If not already in the case file, complete the entire form If already provided by the facility, complete Sections II, IV and V Complete the DHHS Form CRCF-01 including the authorization date, countable income and personal needs amount. Sign Section III, scan into On-Base. Select “NO” as a trailing document. Submit the original DHHS Form CRCF-01 to the facility. If the applicant is financially eligible, and not already in the facility: Generate the CRCF Entry Ticket Notice in CGIS and send the form to the applicant. Cúram will automatically set a timer and take action if the applicant does not enter within 30 + 5 days. The applicant is given 30 days from the time they are notified to enter an OSS facility. C reate a Tracking Form, enter a comment, and set a follow-up for 35 days. The OSS facility will return the DHHS Form CRCF-01 to with the facility name and date of admission. CDM will scan the form back in to OnBase as a MEDS-Categorical Verification trailing document. If the DHHS Form CRCF-01 is returned from OSS for a financially eligible individual who entered an OSS facility, the Eligibility Specialist will finalize the eligibility determination: Complete the DHHS Form CRCF-01 including the authorization date, countable income, and personal needs amount. Sign Section III and scan into On-Base. Select “NO” as a trailing document. Submit the original DHHS Form CRCF-01 to the facility. If an applicant fails to enter a facility, OSS eligibility should be denied. The applicant should remain open in the previous category, or an ex parte determination should be made. Curam will automatically deny the request if the applicant does not enter. If the applicant enters a facility before the request is denied in the SOR, a new application is not required . If the applicant enters a facility after the request is denied in the SOR, a new application or request will be required. If the applicant is ineligible, deny the OSS application; and the process is terminated. NOTE For OSS participants currently living in a CRCF that have changes such as discharges, income changes, or individuals who have transferred to another facility, etc., the facility should send the DHHS Form CRCF-01 to SCDHHS-Central Mail. Centralized Document Management (CDM) should scan the DHHS Form CRCF-01 into On-Base. Once the changes have been made, the DHHS Form CRCF-01 should be updated as needed, signed, scanned into On-Base and returned to the facility. See MPPM 403.09