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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 103 Chapter 24 Long Term Care

24.24 ESTABLISHING MEDICAL NECESSITY Medical necessity for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) care is determined by the Bureau for Medical Services (BMS) contracted agency based on information provided by the ICF/IID facility on BMS forms DD-1 through DD-5. The ICF/IID must submit the medical eligibility certification to the BMS contracted agency within 90 days of the date of placement in the ICF/IID. The case management agency, in conjunction with the admission committee of the certified ICF/IID facility, may determine that applicants meet medical necessity requirements for placement in an ICF/IID facility on a presumptive basis not to exceed 30 days. The first half of the presumptive application form, DFA-ICF/MR-1, is the medical certification that the ICF/IID placement is the least restrictive and best placement for the applicant, and must be signed by a licensed psychologist or other Qualified Intellectual Disabilities Professional (QIDP) on the day the applicant is admitted to the ICF/IID facility. For applicants presumptively approved, the facility sends one copy of the DFA-ICF/MR-1 to the attention of the Community Services Manager (CSM) in the county where the ICF/IID facility is located, and one copy, along with the psychological/medical/social treatment plan that is compiled on forms DD-1 through DD-5, to the BMS contacted agency. At the time of the client's presumptive approval, the psychological/medical/social treatment plan is submitted to the BMS contracted agency to document that the client meets medical necessity criteria. When the BMS contracted agency makes a determination, the CSM is notified. The effective date of a finding of medical necessity is indicated in the memorandum.