PM 20-08-04

The screening verifies the need for care. Receipt of Interagency Certification of Screening Results (Form 2536), indicating the need for care, verifies that the screening is met.

  1. (Facility, Customer's Physician, or Other Interested Party) Notifies agents of DoA, DHS, or HFS that a Form 2536 needs to be completed and sent to the FCRC.
  2. (Agent of DoA, DHS, or HFS) Completes Form 2536.
  3. (Facility) May revised textuse the LTC EDI system (via MEDI or REV) to submit information provided on Form 2536 completed by a screening agency on behalf of a private pay customer applying for assistance.
  4. (DHS Facility) revised textEnters data in the MMIS LTC subsystem for persons in psychiatric hospitals. 
  • Optional: Complete Long Term Care Authorization (Form 2299) and Long Term Care Authorization Update Document (Form 2449) for persons in psychiatric hospitals.
  1. (FCRC) revised textEnters data and changes in the MMIS LTC subsystem for SLF, SNF, ICF, and ICF/MR services.
  • Optional: Form 2299 and Form 2449 may be completed for SLF, SNF, ICF, and ICF/MR services.
  1. (FCRC) revised textIf/when received, file copy of Form 2536 in case record.
  2. (FCRC) Send Notice of Denial of Payment for SLF, SNF, ICF or ICF/MR Services (Form 2537) when Form 2536 new text(or equivalent data submitted via MEDI or REV) shows that long term care is not needed:
    • to customer on the day Form 2536 new text(or equivalent data submitted via MEDI or REV) is received or on following workday; and
    • to facility, if customer is already living in the facility.