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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 84 Chapter 24 Long Term Care

When the PAS indicates the client is not in need of nursing facility care, the application for Medicaid, unless withdrawn, is processed for any other coverage group for which the person qualifies, and all client notification procedures apply. When the client no longer has medical necessity for long term care services, the nursing facility must notify the Worker. There is no requirement that the name of the facility in which the client resides appear on the PAS. 24.12.2.B When the PAS Must Be Completed For Medicaid to pay for nursing facility services, the PAS must be completed when: • The client enters a Medicaid-certified nursing facility. • The client transfers from one facility to another, even when the client moves from one facility to another governed by the same corporation, and even when 60 days has not passed since the completion of the PAS for the first facility. • The client is admitted to an acute care facility and returns to the same nursing facility after 60 days. • The client’s condition changes to the extent that he no longer requires nursing facility services. • Nursing facility care is approved for a limited time, a new PAS must be submitted by the facility before the end of the approved period. • A private-pay patient applies for Medicaid, unless an approved PAS was completed within 60 days prior to the application. This applies even if a PAS certifying medical need was completed at the time of admission to an approved facility. This also applies if a PAS was completed any other time before 60 days prior to the application. The new PAS certifies current need for nursing facility services. A previously approved PAS may be used for backdated eligibility and payment for nursing facility services, so long as the client has remained in the same facility since completion of the previously approved form.