New Procedure Active Community Case to LTC NH/SLP/DoA Case

Illinois Department of Healthcare and Family Services

Illinois Department of Human Services

12/26/17

Policy Memo

Summary:

The new process for Active Community Case Requesting LTSS is effective 01/01/18. To expedite the approval of Long Term Services and Supports (LTSS) for persons who are already active on community medical for at least 6 months prior to requesting Nursing Home (NH), Supportive Living Program (SLP) services or Department on Aging (DoA) Home and Community Based Services (HCBS), the procedures are revised.

The revised procedures apply to persons who move to an NH or SLP and request LTSS and the person:

  • Lived in the community and had an active ACA or AABD community case;
  • had been active ACA or AABD for a period of 6 consecutive months immediately prior to moving to a nursing home or supportive living program facility;
  • has not transferred resources (including spouse) during the 60 months prior to requesting LTSS; and
  • has not consulted with a financial, estate planner or other professional regarding financial matters.

The revised procedures also apply to persons who live in the community and have an active ACA or AABD case for a period of 6 consecutive months immediately prior to requesting DoA HCBS.

6 Months Consecutive Means:

  • No break in active status for a period of 6 months;
  • months during which a person is in active status with an income or resource spenddown count towards the 6 months.

The New Procedure Does Not Apply to:

  • Persons applying for medical assistance and requesting LTSS;
  • persons requesting LTSS that have had an active medical case for less than 6 months;
  • persons requesting LTSS who have an active community case and live in an NH or SLP under private pay status;
  • cases where the person or their spouse report resource transfers in the past 60 months; and
  • cases where the person reports consulting with a financial, estate planner or other professional about financial matters.
  1. Change in Requirements
  2. Form HFS 3654 Revised
  3. NH/SLP Admission Transactions
    1. Admission Transactions Rejected Prior to 01/01/18
    2. When Request Has Already Been Sent
    3. Admission Transactions Submitted On or After 01/01/18
    4. Add Remark to VCL
  4. NEW PROCEDURE
    1. When Form HFS 3654 Is Not Returned
    2. When Form HFS 3654 Is Returned
  5. Referral to Long Term Care-Asset Discovery Investigation (LTC-ADI)
  6. Data Collection to Establish LTC NH/SLP EDG in IES
    1. Add Medical Expenses to Facility Details Page
    2. Income and Resources
  7. Forms referenced

Change in Requirements

Completion of form HFS 3654 and the requirement to provide a minimum 12 months of financial documents no longer applies when a person has had an active community case for 6 months or longer immediately prior to requesting LTSS, UNLESS:

  • The person or their spouse have transferred resources in the past 60 months; or
  • the person has consulted with a financial, estate planner or other professional regarding financial matters.

Form HFS 3654 Revised

Form HFS 3654, Additional Financial Information for Long Term Care Applicants (pdf)is revised as follows:

  • Instructions added to help the person determine if they are required to complete and return the form;
  • resource transfer questions are updated to improve clarity and provide guidance regarding acceptable documentation; and
  • contact information updated to include all three LTC Hubs.

Note: Accept the old form HFS 3654 when it is sent in place of the new revised form.

NH/SLP Admission Transactions

Apply the revised procedures to NH and SLP admission transactions received:

  • On or after 01/01/18; and
  • admission transactions received prior to 01/01/18 that have not been processed.

Admission Transactions Rejected Prior to 01/01/18

An admission transaction remains rejected when the transaction was:

  • Rejected prior to 01/01/18; and
  • the reason for rejection was failure to provide HFS 3654 and/or resource verifications.

When Request Has Already Been Sent

When a request to provide completed form HFS 3654 and/or resource verifications has already been sent and form HFS 3654 has not been returned, including requests that are overdue:

  • Check MMIS (PF8) to determine if the person has an active medical case; and
  • if the person's medical case has been active for 6 consecutive months or longer immediately prior to date of admission to the facility;
  • send a new VCL and attach revised form HFS 3654;
  • do not request resource verifications.

When a request to provide completed form HFS 3654 and/or resource verifications has already been sent and form HFS 3654 is returned follow instructions below, When Form HFS 3654 Is Returned.

Admission Transactions Submitted On or After 01/01/18

When "Community" is checked on the MEDI admission transaction:

  • Check MMIS (PF8) to determine if the person has an active medical case;
  • if the person's medical case has been active for 6 consecutive months or longer immediately prior to date of admission to the facility;
  • send VCL and attach revised form HFS 3654.

Add Remark to VCL

Enter the following statement in the remark section of the VCL:

"Follow the instructions on the attached form to determine if you are required to complete and return the form by the due date."

NEW PROCEDURE

The following procedures apply to admission transactions submitted:

  • On or after 01/01/18; and
  • transactions submitted prior to 01/01/18 pending processing.

Note: Do not reject (not to be confused with admission transactions already rejected) an admission transaction, after 01/01/18, for failure to return completed form HFS 3654 when the person lived in the community and had an active medical case for 6 consecutive months immediately prior to admission to the facility.

When Form HFS 3654 Is Not Returned

Completion and return of form HFS 3654 is not required when a person or their spouse has NOT transferred resources in the past 60 months or consulted with a financial, estate planner or other professional regarding financial matters. Approve the request for LTSS when form HFS 3654 is not returned by the due date:

  • Establish and approve the LTC NH/SLP or DoA EDG in IES;
  • document actions in case notes; and
  • certify the case.

For NH/SLP, process the admit in LTC Payment system.

When Form HFS 3654 Is Returned

A person is required to complete and return form HFS 3654 when their response to questions on the form include reporting that the person or their spouse transferred resources in the past 60 months or consulted with a financial, estate planner or other professional regarding financial matters.

When form HFS 3654 is returned:

  • Review completed form;
  • request resource verifications, if applicable; or
  • refer to LTC-ADI, if applicable.

For NH/SLP, do not process admit until the review process is completed.

Referral to Long Term Care-Asset Discovery Investigation (LTC-ADI)

Refer cases to LTC-ADI when:

  • Form HFS 3654 is returned; and
  • referral criteria is met.

Data Collection to Establish LTC NH/SLP EDG in IES

Complete fields on Living Arrangement/Domicile - Details page and Facility Detail page

Add Medical Expenses to Facility Details Page

Add medical expenses to the Facility Details Page beginning with the first full month in the facility.

  • Refer to the Medical Expense page to determine which medical expenses to add;
  • only add allowable medical expenses (Medicare and health insurance premiums); and
  • do not re-verify medical expenses already being used.

Income and Resources

For this expedited process, use income and resource amounts:

  • already entered in IES; or
  • verified at last redetermination.

[signed copy on file]

James T. Dimas.
Secretary, Illinois Department of Human Services

Felicia F. Norwood
Director, Healthcare and Family Services

Forms referenced