24.02 Long-term care residence period

In general. A patient share obligation is assessed in the month of admission to long-term care as long as the individual is expected to need long-term care services and supports for at least 30 consecutive days. If long- term care services and supports are expected to be needed for fewer than 30 consecutive days, no patient share is assessed. Instead, the individual’s services are covered through Medicaid, other than Medicaid coverage of long-term care services and supports, if the individual meets medical necessity criteria (see HCAR 4.101) and relevant financial, nonfinancial and categorical eligibility criteria. Duration of the long-term care residence period Beginning of long-term care residence (i) In a general hospital setting. A long-term care residence period in a general hospital setting begins with the first day that the utilization review committee finds acute hospital care is no longer medically necessary and skilled nursing care is medically necessary. (ii) In other long-term care settings. A long-term care residence period in a long-term care setting, other than a general hospital, begins with the first day that the utilization review committee finds medical need for long-term care or the date of admission, whichever is later. Ending of long-term care residence period. A long-term care residence period ends with the earliest of: (i) The individual’s date of death; (ii) The date of the individual’s discharge from a long-term care living arrangement (as defined in § 30.01); or (iii) The last day medical need for long-term care is established by the utilization review committee. Leave of absence or transfer. A long-term care residence period is not ended by a leave of absence from the current setting (see DVHA Rule 7604.1). A long-term care residence period also continues despite transfer from either: (i) One long-term care setting to another long-term care setting; (ii) A general hospital setting (where skilled nursing care has been continuously authorized while awaiting transfer) to another long-term care setting; or (iii) A long-term care setting to a general hospital setting followed by return to the long-term care setting without an intervening residence period in a community living arrangement (as defined in § 30.01). Percentage of month in long-term care. The percentage of the month an individual is in long-term care is determined using the appropriate table below. Special Rules for Medicaid Coverage of Long-Term Care Services and Supports – Eligibility and Post Eligibility Part 4 – Page 3 (Sec.24.00, Sub.24.02) Percentage of Month in Long-Term Care: All months except February Day of the month admitted to long-term care Percentage of the month in long- term care Day of the month admitted to long- term care Percentage of the month in long- term care Day of the month admitted to long- term care Percentage of the month in long- term care 1 100% 11 67% 21 33% 2 97% 12 63% 22 30% 3 93% 13 60% 23 27% 4 90% 14 57% 24 23% 5 87% 15 53% 25 20% 6 83% 16 50% 26 17% 7 80% 17 47% 27 13% 8 77% 18 43% 28 10% 9 73% 19 40% 29 7% 10 70% 20 37% 30-31 3% Percentage of Month in Long-Term Care: February Day of the month admitted to long-term care Percentage of the month in long- term care Day of the month admitted to long- term care Percentage of the month in long- term care Day of the month admitted to long- term care Percentage of the month in long- term care 1 100% 11 64% 21 29% 2 96% 12 61% 22 25% 3 93% 13 57% 23 21% 4 89% 14 54% 24 18% 5 86% 15 50% 25 14% 6 82% 16 46% 26 11% 7 79% 17 43% 27 7% 8 75% 18 39% 28 4% 9 71% 19 36% 29 0% 10 68% 20 32% Special Rules for Medicaid Coverage of Long-Term Care Services and Supports – Eligibility and Post Eligibility Part 4 – Page 4 (Sec.24.00, Sub.24.03)