AGING AND DISABILITY SERVICES ADMINISTRATION

2005 NH "Dear Administrator" Letters

July 1, 2005

ADSA: NH #2005-016
CHANGE IN NOTIFICATION REQUIREMENTS FOR NEW ADMISSIONS

Dear Nursing Facility/Home Administrator:

This letter contains important information for nursing facility administrators and staff responsible for submitting intake referrals and Notice of Action (NOA) forms (DSHS 15-031) to Home and Community Service (HCS) offices. There will be a change in policy for the Medicaid payment start date for residents converting from Medicare, private pay, or long-term care insurance.

Medicare/Private-pay Conversions

Our current policy for the Medicaid payment begin date for residents converting from private pay or Medicare was issued in a “Dear Nursing Home Administrator” letter dated April 15 th, 1996. It states:

For Medicare/Private-pay nursing home residents converting to Medicaid; Medicaid payment will begin on the date of financial application for nursing facility care, or the date of the request for an assessment, whichever is earlier. However, payment back to the request date is limited to no more than 3 months prior to the date of financial application.

The relationship between the payment begin date and the date of a request for assessment has created occasional problems for nursing facilities when coverage by another funding source such as Medicare, private funds or long-term care insurance, is assumed and later found to be lacking. In those situations, Medicaid payment has been denied by the Aging and Disability Services Administration (ADSA) unless a request for assessment was made. Nursing facilities have often dealt with this risk by submitting an intake referral or NOA for every person who is admitted, even when there is no reason to suspect that Medicaid coverage will be needed.

Effective August 1 st, 2005, ADSA’s policy for the Medicaid payment begin date for residents converting to Medicaid from another payment source will be as follows:

For residents converting to Medicaid from another funding source, ADSA will consider the financial application for Medicaid as the request for assessment. Payment back to the request date is limited to no more than 3 months prior to the first day of the month in which the application is received.

Beginning in August, the NOA should only be sent for residents who are already eligible for Medicaid. Do not send the NOA or an intake referral to an HCS office for residents converting to Medicaid.

Medicaid Recipients

The department must be notified by means of the NOA or an intake referral when a Medicaid recipient is admitted. Payment will begin the date of admission or date of request for an assessment, whichever is later. This is not a change in policy.

If you plan to admit a Medicaid recipient from the community, please continue to request an assessment from HCS prior to admission if a request has not already been made by the client, client’s representative, AAA case manager or other residential provider. A Medicaid client must be assessed by HCS prior to nursing facility admission unless the recipient is admitted from a hospital.

Please continue to notify the department of a change in circumstances for Medicaid-eligible recipients such as transfers, discharges, deaths, and payment status by sending the NOA.

If you have any questions about this letter, please contact: David Armes, Financial Program Manager, at (360) 725-2561 or ArmesJD@dshs.wa.gov .

Sincerely,

Joyce Pashley Stockwell, Director
Residential Care Services