1. (FCRC) Enter admission date in Section A of Long Term Care Authorization Document (Form 2299). The date cannot be earlier than effective date of medical eligibility and date of the screening assessment, if required.

    NOTE: See PM 20-08-15 for 3 exceptions. 

  2. (FCRC) Only use the actual date of admission if the client is eligible for HFS to make payment to the facility starting on the date of admission (including admission for clients entitled to Medicare covered SNF services).

NOTE: Do not complete Form 2299 for a spenddown case.

Long Term Care Facility

  1. (FCRC) Enter the date of admission when the screening was done prior to admission.

    Example: A client enters a facility on 08/01. The screening requirement is met on 07/25. Medical eligibility is effective 07/01. Enter 08/01 in Section A and in Section D of Form 2299. 

  2. (FCRC) Enter the date of the screening if completed after the date of admission to an LTC facility and the person applies for or is eligible for benefits before admission.

    Example: A client applies for benefits on 08/07 and enters a facility on 08/10. The screening requirement is met on 08/15. Enter 08/15 in Section A and in Section D of Form 2299. 

  3. (FCRC) Enter the latter of the date of eligibility or the date of admission if the person applies for benefits after admission to an LTC facility.

    Example: A person enters a facility on 09/03 and applies for benefits on 09/05. Medical eligibility is effective 09/01. Enter 09/03 in Section A and in Section D of Form 2299.

    Since the person applied for benefits after admission, a screening is not required.

Supportive Living Facility

  1. (FCRC) Enter the date of admission to an SLF when the screening was done prior to admission.

    Example: A client enters a facility on 04/01. The screening requirement is met on 03/25. Medical eligibility is effective 03/01. Enter 04/01 in Section A and in Section D of Form 2299. 

  2. (FCRC) Enter the date of the screening if completed after the date of admission to an SLF.

    Example: A client enters a facility on 08/10. The screening requirement is met on 08/15. Enter 08/15 in Section A and in Section D of Form 2299. 

  3. (FCRC) Enter the beginning date of eligibility if the person converts from private pay to Medicaid after admission to an SLF.

    Example: A person enters a facility on 09/03 and pays the private rate through 10/31. Enter 11/01 in Section A and in Section D of Form 2299.

    Since the person converted from private pay to Medicaid, the date of the screening does not affect the date of payment authorization. However, do not authorize payment until the screening requirement is met.