Long Term Care Overview

1. Long Term Care Overview What You Need to Know to Authorize Vendor Payments

2. What is Long Term Care? • Long Term Care provides a Medicaid Card and Vendor Payments to eligible individuals. • The only additional benefit for individuals who already receive a Medicaid card is the Vendor Payment, made directly to the LTC facility.

3. When to Make a Vendor Payment • The MAID card is received • Patient Status and Level of Care are established by DMS, PRO or Medicare • Income is below the Special Income Standard, or the individual has an approved QIT • The individual is in inpatient hospital NF, other NF, or PRTF • Eligible child is receiving EPSDT LTC services • Individual is in IMD, depending on age requirements

4. Eligibility Requirements • Technical Eligibility requirements of the AMA program must be met. • The individual must meet Patient Status and Level of Care. • Resources below the AMA limits: • $2000 for single and $4000 for a couple • Income below the Special Income Standard, or a QIT must be established, unless “Step II Processing” applies (more on this later)

5. Levels of Care Levels of Care are: • Nursing Facility (NF) • Intermediate Care Facility for the Mentally Retarded/ Developmentally Disabled (ICF/MR/DD) • Mental Hospital (MH) Patient Status and Level of Care needed are verified by the Confirmation Notice.

6. Confirmation Notices Confirmation Notices come in many forms: • Automated Certification on KAMES • RDS report titled: PRO Certifications Not Matched to KAMES • MAP-24 • MAP-374

7. Who is Eligible for LTC? • Aged, blind or disabled individuals in the A, B, or D category (SSIrecipients) • Aged, blind or disabled individuals in the J, K or M category (Non-SSI) • Specified Relative or Second Parent in a KTAP or Family Related MA case • Child in a KTAP or Family Related MA case, if parent exercises control over the child, or foster care status continues

8. LTC Facilities • Nursing Facility (NF) • Psychiatric Residential Treatment Facility (PRTF) • Intermediate Care Facility for the Mentally Retarded/ Developmentally Disabled (ICF/MR/DD) • Institution for Mental Diseases (IMD) • Mental Hospital (MH)

9. Vendor Payment Changes When increasing the Patient Liability: • Allow a 10-day adverse action period • If entered before cutoff, payments are effective the current month • If after cutoff, payments are effective the following month When decreasing the Patient Liability: • Effective date is the 1st day of the month in which the KAMES change is made

10. Wrap Up • LTC is for individuals in NF, PRTF, ICF/MR/DD, IMD, or MH. • LTC provides a Medicaid card and vendor payments made directly to the facility. • AMA Technical Eligibility must be met. • AMA Resource Limits apply. • Income must be below the Special Income Standard, or a QIT must be established, unless Step II Processing applies.