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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 2 Chapter 24 Long Term Care

• Sections 24.41 – 24.44 provide information about the I/DD waiver. • Sections 24.45 – 24.48 provide information about the TBI waiver. • Sections 24.49 – 24.58 provide information about CDCSP. 24.1.1 INFORMATION PROVIDED TO THE CLIENT In determining eligibility for payment of LTC, the Worker must ensure that the client, or his authorized representative, is fully informed of the policies and procedures. This is necessary so that the client, his family, or his authorized representative is able to make informed decisions about the client's financial affairs. A face-to-face interview is not required, but there may be circumstances where the Worker may need to contact a client. When an applicant’s medical eligibility for, or enrollment in, LTC programs is pending due to a waitlist for services or another reason, he must still be allowed to apply and must be evaluated for any or all assistance programs. The Worker must not, under any circumstances, suggest or require that the client or authorized representative take any specific action in financial matters. The Worker must not act as a financial planner or make suggestions about the client's current or future financial actions, including those that could affect estate recovery. The Worker may respond to general estate recovery questions, but must refer the client or his authorized representative to the Bureau for Medical Services (BMS) or its contract agency for specific information. The Worker must not contact the BMS or their contract agency on behalf of the client, but must refer the client or authorized representative to the BMS contract agencies listed in Appendix E. 24.1.2 INQUIRIES FROM PROVIDERS AND STAFF The Worker must refer all inquiries about billing issues from the nursing or ICF/IID facility to the BMS contract agency listed in Appendix E. The Worker must not contact BMS on behalf of the provider. Questions from county staff about any aspect of LTC cases must be directed to BMS Medicaid Eligibility Policy Unit.

The applicant may designate an authorized representative to act on his behalf. Such a designation must be in writing and include the applicant’s signature. See Section 24.4.1.C.5 for more information about authorized representatives.