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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 85 Chapter 24 Long Term Care

24.12.2.C Date of PAS Examples Example 1: Mr. Rose enters a nursing facility as a private pay patient on October 18, 2016, and a PAS, which certifies his need for nursing care, is completed on that date. On February 1, 2017, he is still in the same nursing facility, and his family applies for Medicaid for his nursing facility care. Because the PAS completed at admission is more than 60 days old on February 1, 2017, a new PAS must be completed. If otherwise eligible, payment for services begins February 1, 2017. Example 2: Mr. Begonia enters a nursing facility on September 2, 2016, and a PAS which certifies his need for nursing facility care is completed on that date. On September 30, 2016, his family takes him home to care for him. On October 16, 2017, his family places him in another facility and applies for Medicaid for his nursing care. A new PAS is required because he left the nursing facility for which the PAS was originally completed, and the new facility must have an original approved PAS. Example 3: Mr. Calla enters a nursing facility on March 7, 2016, and a PAS, which certifies his need for nursing care, is completed on that date. On September 9, 2017, he is still in the same facility, and his family applies for Medicaid for his nursing care. They request payment for his care beginning June 1, 2017. Because the admission PAS, although approved, was completed more than 60 days prior to September 9, 2017, a new PAS must be completed. The approved PAS, completed March 7, 2016, is used to certify his need for nursing facility care from June 1, 2017, until the date of the newly approved PAS. 24.12.2.D Temporary Stays in Distinct Parts Distinct part, as used in the following, means the part of the acute facility which provides nursing facility services. When a nursing facility client is admitted to an acute care facility, moves to a distinct part of the facility, and then returns to the original nursing facility, special PAS requirements may apply. The special PAS procedures are as follows: • When the client moves from the acute care facility to a Medicare-only distinct part, no new PAS is required for the distinct part. However, a new PAS is required when the client returns to the original nursing facility.