PM 20-08-07.

If the client transfers between facilities in the same county:

  1. Complete Long Term Care Update Authorization Document (Form 2449) (see WAG 26-04-08) to discharge the client from the first facility.
  2. Complete Long Term Care Authorization (Form 2299) (see WAG 26-04-07) to admit the client to the new facility.
  3. Attach completed Form 2449 to completed Form 2299.
  4. Send both forms to the Financial Unit.

If the client transfers between facilities in different counties:

  1. (Old FCRC) Complete Form 2449 for the discharge.
  2. (Old FCRC) Send a copy of Form 2449 to the new FCRC.
  3. (New FCRC) Contact the old FCRC to ask:
    • for the case record, and
    • if HFS 2449 has been submitted for the discharge.
    1. If HFS 2449 has not been submitted, ask the old FCRC to do so within 2 workdays and send a copy to the new FCRC.
  4. (New FCRC) Complete HFS 2299 when the copy of HFS 2449 is received from the old FCRC. Show the client's name and number exactly as shown on the HFS 552 from the old FCRC.
  5. (New FCRC) Send completed HFS 2299 to the Financial Unit.

NOTE: Send the completed HFS 2299 to the Financial Unit even if the case record has not been sent from the old FCRC.

Transfer Because of Change in Facility Status

  1. (BLTC) Provides instruction to Family Community Resource Center when client needs to be moved because facility has lost its license or stopped being in Medicaid or Medicare programs.
  2. (FCRC) Send HFS 2221, Notice of Move, to client or guardian when client must leave facility because facility:
    • lost its license, or
    • has been disqualified from participation in Medicaid or Medicare, or
    • has terminated participation in Medicaid or Medicare.

      NOTE: BLTC notifies the Family Community Resource Center when HFS 2221 is needed. 

  3. (FCRC) Send HFS 2221NM, Notice of Nonpayment of Care Due to a Change in Level of Care, to client who must leave a facility to get:
    • a different level of care, or
    • shelter care, or
    • a level of care less than sheltered care.
    1. Send copy of HFS 2221NM to facility the client is leaving.