New textNOTE: Completion of Form 2299, as described below, is OPTIONAL.  All of the following actions may be done by entering new data and revising existing data in the MMIS LTC subsystem.

Use Form 2299 to start payment to a Revised textnursing home (NH) or a supportive living facility (SLF). For private facilities, use the form for each customer admitted for whom the facility requests reimbursement. For DHS facilities, use the form to report a customer's admission. This starts payment using a computer tape match between HFS and DHS. Complete Form 2299 only when:

  • a customer is admitted into a facility;
  • a customer moves into a different facility;
  • a person was a private pay resident, but has become eligible for aid as an Revised textNH or SLF credit or zero credit case;
  • a customer changes status from spenddown to regular Revised textmedical assistance (no cash) and income is not enough to meet Revised textNH or SLF costs; or
  • a customer returns to the facility after being discharged.

Do not complete Form 2299 for spenddown cases, additions, corrections, or discharges.