Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.95-014 - Changes to the Long Term Care/AABD Section of the Medical Services Manual

Current through Register Vol. 49, No. 6, June, 2024
Summary
The entire policy section has been updated to include
				changes resulting from the recent Agency reorganization. Other policy changes
				are indicated below:
MS 3140 - For single veterans and surviving spouses of
				veterans who receive a VA Pension and who have no dependents, a $90 personal
				needs allowance will be given. The $90 PNA will not be given until VA has
				reduced the pension to $90.
MS 3170 - Exceptions to participation In the Medicaid
				Managed Care Program are residents of nursing and ICF/MR facilities, and AABD
				recipients with Medicare as their primary insurance.
MS 3310 #1 - The exception to the 30-day
				institutionalization requirement for individuals who die has been
				added.
MS 3310 #6 - Individuals who have established an Income
				trutt may be eligible for Long Term Care benefits.
MS 3320 - Reference is made to the begin date for
				services in cases Involving ICF/MRs and PASARRs.
MS 3322 - Parts of this section have been
				renumbered.
MS 3322.5 - Dual MRT and Social Security Disability
				applications will, in most cases, be processed the same as MRT/SSI
				applications. For cases involving dual MRT and SSI applications, approval of
				facility services may be made when SSI has been approved.
-
Medicaid cases will not be kept open
				pending an appeal of SSA disability denial. ANY OPEN MEDICAID CASES WHERE
				DISABILITY HAS BEEN APPROVED BY MRT, LATER DENIED BY SSA, AND PENDING A FINAL
				SSA DETERMINATION SHOULD BE CLOSED AFTER APPROPRIATE NOTICE.
MS 3323 - Parts of this section have been
				renumbered.
MS 3323.7 - The SGA section has been updated. SGA is
				$500.
MS 3324 - The address for the Memphis INS office has been
				changed.
MS 3331.3 #4 - A new section has been added Re.
				calculation of the value of dower/curtesy interests.
MS 3331.5 #1 - The requirement to document an LTC
				client's intent to return home has been changed from every six months to every
				12 months.
MS 3331.5 #2 - The entire section on nonhome Income
				producing property has been rewritten for clarification.
MS 3332.3 #5 - Applicants who separate burial from
				nonburial funds may be certified effective date of entry, if otherwise
				eligible.
-
Prepaid burial contracts that do not
				specify services and merchandise equal to the purchase price may result in a
				period of ineligibility for uncompensated transfer. Sections have been added
				Re. Out-of-State Burial Arrangements and Transfer of Assets
				Penalty.
MS 3334.4 - Transfers for love and consideration are
				considered transfers for uncompensated value. The life expectancy tables have
				been moved to 3336.17,
MS 3335.2 - Undue hardship provisions have been
				changed.
MS 3336.8 - The rules applicable to trusts prior to OBRA
				of 1993 have been reentered as historical policy.
MS 3336.9 #2 - The income limit for Income trusts from
				7/1/95 - 6/30/96 is $2198. Annual cost of living adjustments which cause Income
				to exceed the LTC maximum skilled care rate will not affect eligibility for
				cases previously certified under the income trust provisions. A paragraph has
				been added regarding assignment of income to an Income trust.
MS 3336.9 #6. - Effective for cases certified U/1/95, the
				ONLY fee which may be deducted from an income trust is the bank service charge
				for maintaining the trust.
MS 3336.10 - Parts of this section have been rewritten
				Re. overlapping penalty periods. New section has been added Re. transfer
				to
annuities.
MS 3337.1 - The "likely to remain" 30 days in an
				institution policy applies ONLY to individuals who have community
				spouses.
MS 3338 - A statement regarding income trusts has been
				added.
MS 3338.2 - A note has been added Re. rebuttal of pension
				and other retirement income.
MS. 3338.3#2c - VA A&A and CME/UME are not income to
				a CS.
MS 3338.3#4 - The noncovered medical expense section has
				been rewritten. Premiums for Medicare and for insurance which pays cash are not
				allowable medical expenses.
MS 3341 - No reapplication is required when regular or
				irregular lump sum income causes one month of ineligibility-
MS 3345 - Ctvil Service benefits has been added as a
				possible source of unearned income. VA CME/UME is excluded as
				income.
MS 3345 #2 - A note has been added
regarding
				consideration of taxes,
Insurance, maintenance,
etc. for individuals
				in nursing
facilities and ICF/MR
facilities, and for
				TEFRA/Waiver rEcipients.
MS 3346,2 - The address for the Railroad Retirement Board
				has been changed.
MS 3346.4 - Itne address for the Veterans Administration
				Regional Office has ben changed.
MS 3346.5 -
!k
section regarding Civil Service benefits has been
				added.
MS 3347.1 - Thie presumed values of in-kind support and
				maintenance have be«n updated.
MS 3348.1 - VA A&A benefits for periods 6/1/95 and
				later will not be applied to the NF vendor payment. Sections have been added
				Re. VA pensions reduced to $90 and VA CME/UME.
MS 3350.5 - Codes for hospice care have been added. Some
				changes have been made Re. level of care review date.
MS 3400 - This section has been rewritten. The
				consideration of VA pension benefits limited to $90 monthly has been added in
				the computation of the personal needs allowance.
Note the changes
				effective 11/1/95 In #2 and #6. With the exception of bank service charges,
				fees will no longer be allowed in Income trust cases. A $90 PNA- will not be
				given until VA has reduced the pension to $90. Individuals receiving a $90 PNA
				whose VA benefits have not been reduced to $90 will be given onlv a $30 PNA at
				next case change or reevaluation.
rayc »t
MS 3500 - Submit a DCO-730 to Medicaid Eligibility when
				an individual with an income trust is certified. A DCO-704 may be provided to
				the facility as notification of a denial.
MS 3500.1 - The maximum number of days in a facility that
				can be covered by Medicare has been changed from 150 to 100. Also, provisions
				for the authorization of Medicaid benefits (WASH only) on Medicare approved
				admissions have been added.
MS 3610 - It is not necessary to complete a full
				reevaluation of a facility case transferred to another county unless it is time
				to complete the annual reevaluation.
MS 3620 - Some changes have been made in this section Re.
				Level of Care Review Date.
MS 3634.1 - The procedure through which counties make
				case adjustments for LTC periods of ineligibility has been
				changed.
MS 3637.1 - Submit a DCO-730 to Medicaid Eligibility,
				Slot 1223. when a recipient with an income trust dies or is
				discharged.
MS 3650.1 - A DCO-704 may be sent to the facility to
				notify of case closure.
Inquiries to: Carol McKnight, 682-8259 Terri Wright,
				682-8258 Ann Dawson, 682-8254 Boyce Lovett, 682-1562
3000
Guidelines for the
			 Long Term Care Program and Other AABD
Categories
3100
General
			 Information
3110
Facilities Which
			 Provide Services
Facilities which provide medically necessary care and
				services 24 hours per day on a long term basis include private nursing
				facilities, Benton Services Center, Arkansas Human Development Centers, private
				intermediate care facilities for the mentally retarded (ICF/MR's), and ICF/MR
				facilities with both over and under 15 beds.
3120
Services Provided
			 Under Medicaid
In addition to facility vendor payments, all services
				listed in the pamphlet, "Your Guide to Medicaid Services in Arkansas", are
				available to individuals under the Long Term Care Program, with the following
				exception: Individuals in the State Human Development Centers are not eligible
				for the Prescription Drug Program.
3130
Licensing and
			 Classification of Facilities
To receive vendor payment under the Medicaid Program, a
				facility must be licensed and certified by the Office of Long Term Care (OLTC),
				and must execute a provider agreement with the Division of Medical
				Services.
The OLTC publishes a directory listing all participating
				facilities. Changes to the directory are issued periodically. The directory and
				updates are provided to each county office.
3135
Nursing
			 Facility
Section 1919 (a) of the Social Security Act defines a
				nursing facility as an institution which Is primarily engaged In
				providing:
Skilled nursing care and related services for residents
				who require medical or nursing care,
Rehabilitation services for the rehabilitation of
				Injured, disabled, or sick persons, or
Health-related care and services to individuals who
				because of their mental or physical condition require care and services (above
				the level of room and board) which can be made available to them only through
				Institutional facilities,
and is not primarily for the care and treatment of mental
				diseases.
3140
Personal Allowance for Facility
			 Residents
Each recipient in a facility is allowed to retain $30.00
				per month from their income for personal expenses. Upon written authorization
				of a resident, the facility must hold, safeguard and account for the personal
				funds of the resident deposited with the facility. If the resident's personal
				funds are in excess of $50.00, the facility must deposit the funds in excess of
				$50.00 in an interest bearing account (or accounts), separate from any of the
				facility's operating accounts, that credits all interest earned on the
				resident's account to his or her account. Resident personal funds may not be
				commingled with facility funds or with any person's funds other than another
				resident. The resident's individual financial record must be available on
				request to the resident or his legal representative.
In addition to the $30 personal needs allowance, ICF/MR
				clients who have income from employment are allowed to keep up to $100 of their
				earnings each month for personal needs.
A client with earnings and receiving intermediate care in
				a nursing facility may also keep up to $100 increased personal needs allowance
				if the client's physician has stated that a period of employment activity is
				necessary as a therapeutic or rehabilitative measure. If a client receiving
				skilled care in a nursing facility becomes employed, the Utilization Review
				Section of the OLTC should be contacted and requested to reevaluate medical
				necessity.
Certain SSI recipients whose stay in a nursing facility
				is not expected to exceed 3 months and who have a home to maintain will be
				allowed to retain full SSI benefits for personal expenses for three calendar
				months following the month of entry. The SSI payment, in these instances, will
				not be considered in eligibility or payment determination (Re. MS
				3401).
A $90 personal needs allowance will be given to a single
				veteran receiving a VA pension in a facility who has no spouse or dependent
				children. A $90 allowance will also be given to a surviving spouse of a veteran
				receiving a VA pension in a facility who has no dependents. The full $90
				allowance will be allowed only when VA has reduced the pension to $90. (Re. MS
				3348.1). Veterans receiving VA compensation do not qualify for the $90
				PNA.
3150
Special Charges to Recipients in
			 Facilities
The facility must inform the patient prior to or at the
				time of admission or application, and during his stay, of services available in
				the facility and of related charges, including charges for services not covered
				by Medicare or the per diem rate. Recipients may be charged only for optional
				services (services not necessary or consistent with the normal care of the
				patient). When such services are provided, documentation must be on file with
				the OLTC. The refusal of a recipient to accept optional services offered by a
				facility must not effect a decrease or alteration in the services required or
				necessitated by his condition or otherwise considered as normal care. Inquiries
				from recipients or family members concerning special charges will be referred
				to the OLTC.
3160
Nondiscrimination
The Division of County Operations complies with all
				provisions of the Civil Rights Act of 1964, Section 504 of the Rehabilitation
				Act of 1973, and the Americans With Disabilities Act of 1990. All facilities
				authorized to participate in the LTC program must also comply with these
				provisions. No person
win be prevented from participation, denied benefits, or
				otherwise subjected to discrimination based upon race, color, sex, national
				origin, or disabling condition.
The Division of County Operations has the responsibility
				of informing applicants and recipients that assistance is provided on a
				nondiscriminatory basis and of their right to file a complaint with the
				Division, the Department of Health and Human Services, the Department of
				Justice, or the United States Civil Rights Commission if they feel they have
				been discriminated against on the basis of race, color, sex, national origin,
				or disabling condition.
The OLTC is responsible for securing a statement of
				compliance from all hospitals and facilities authorized to participate in the
				Medicaid program, and for assuring that the Statement of Compliance is
				officially adopted and posted on the premises. The OLTC will also assure that
				copies of the policy are provided to all employers and staff, and to all
				referral agencies. The OLTC will conduct annual reviews of facilities to insure
				compliance with these provisions.
3170
Freedom of
			 Choice
Residents of nursing and ICF/MR facilities, and AABD
				recipients whose primary insurance is Medicare, are not required to participate
				in the Medicaid Primary Care Physician Managed Care Program.
These recipients will have freedom of choice in the
				selection of facilities, physicians, pharmacies, and other medical providers.
				The recipient should be informed that payment under the Medicaid program can be
				made only to medical providers authorized to participate In the Medicaid
				program. If the recipient wishes to utilize the services of a personal
				physician or other medical practitioner who does not participate in the
				Medicaid program, the recipient will be advised that payment cannot be made by
				the Agency for these services, and that the cost will be his
				responsibility.
3180
Placement
Relatives or friends of a facility applicant should help
				In making the selection of a Medicaid certified and licensed facility. Names
				and addresses of facilities that can provide the appropriate care and services
				will be given to the patient or his family.
If the applicant is unable to make this choice for
				himself and if he has no relatives or friends to assist In the decision, the
				county will assist with the placement. If placement cannot be made, a request
				for assistance should be made to the OLTC.
3200
Application
			 Process
3210
Initial Application for Facility
			 Payment
An application for facility services may be made by the
				applicant, his designated representative, next of kin, or person(s) acting
				responsibly for the individual. Applications should be made In the county where
				the facility chosen by the individual is located. If an application is made in
				the applicant's home county before facility entry, but the applicant enters a
				facility in another county, the application will be denied by input to WIMA,
				using denial Reason 53. A DCO-700 will then be completed, advising the client
				or his representative that his application has been sent to the appropriate
				county. All records will then be
transferred to the county where the facility is located.
				A new application will not be needed by the receiving county, and the original
				date of application will be entered in ACES when the application is
				reregistered.
NOTE: If a period of eligibility has been, or will be,
				established in a facility in the county of initial application, that county
				will certify the case for the eligible period before transferring the case to
				the second county.
Applications may be processed for deceased persons.
				Application may be made by any person with responsibility for the medical debts
				of the deceased person.
Application for facility services will be made on Form
				DCO-777. This form will be completed for all applications for facility vendor
				payment unless the individual is currently receiving assistance as.an AFDC,
				U-18, or Foster Care (Cat. 91 or 92) recipient. No new application is needed
				for these categories.
3220
Reapplication for Facility
			 Payment
Reapplication for facility services is made in the same
				manner as initial applications. Previous records will be reviewed. If the
				applicant comes from another county where his case was closed, the record will
				be secured from that county.
3230
Distinction Between
			 Application and Inquiry
Every person has the right to apply for Medicaid. No
				application or inquiry may be ignored.
The distinction between an application and an inquiry is
				as follows:
1.
An
			 application is the action by which an individual indicates in writing to the
			 Agency his desire to receive services.
2.
An inquiry is simply a request for
			 information about eligibility requirements for services. An inquiry may be
			 followed by an application.