WAG 20-08-15

When the screening shows that the customer needs long term care, approve payment for care. The date the screening is completed affects the beginning date for which payment is approved. Approve payment for care as follows:

Nursing Home

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  • If the screening requirement is met prior to admission, approve payment for care:
    • on the date of admission if eligibility is established prior to admission; or
    • with the date of eligibility if it occurs after admission.
  • For a person who applies for or is eligible for assistance before admission to a facility and the screening requirement is not met prior to admission, approve payment for care on the latter of:
    • the date the screening occurred; or
    • the beginning date of eligibility.

For a person who applies for assistance after admission to a facility, approve payment for care on the beginning date of eligibility.

Supportive Living Facility

  • If the screening requirement is met prior to admission, approve payment for care:
    • on the date of admission if eligibility is established prior to admission; or
    • with the date of eligibility if it occurs after admission.
  • If the screening requirement is not met prior to admission, approve payment for care on the latter of:
    • the date the screening occurred; or
    • the beginning date of eligibility.
  • A screening is required for a person converting from private pay to medical assistance after admission. However, the date of the screening does not affect the date of payment authorization. Approve payment for care on the beginning date of eligibility.

Nursing Home and Supportive Living Facility Exceptions

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There are 3 times when payment may be approved beginning with the date of admission when it is prior to the date of the screening:

  • The person was placed from out-of-state and directly entered an Illinois SLF or revised textNH;
  • The person has a preexisting condition that requires a caregiver and the caregiver is no longer able to provide care;
  • The person was admitted to the SLF or revised textNH directly from receiving hospital emergency room or outpatient services.

The person responsible for approving payment for care depends on the type of payment:

  • basic rate - Family Community Resource Center;
  • day programming rate - Bureau of Long Term Care;
  • exceptional care rate - Bureau of Long Term Care; or
  • bed reserve - Bureau of Long Term Care.

To determine the payment amount to approve, deduct any income or contribution available to the customer or received by the facility from any source. Credit contributions from responsible relatives for the amount paid when it is paid. Do not deduct the personal allowance amount. Credit income available for the calendar month against the cost of care for that month's billing period. When there are excess revised textresources, credit them against the cost of care.

The credit amount is the amount the customer or another source contributes to the cost of care. Apply nonexempt income and revised textresources of the customer toward the cost of care starting the first full month the customer is expected to be in the facility. See PM 20-08-04 and PM 20-08-05 for what to do when a customer enters an revised textNH or SLF directly from the community.

For a customer who transfers from a DHS facility to a facility in the community, apply nonexempt income received during the month of discharge and nonexempt excess revised textresources to charges at the DHS facility. There is not a credit amount for the facility in the community for the month of the transfer. Apply the credit amount to the community facility starting the month following the month of transfer.