WAG 06-25-05: Long Term Services and Supports (LTSS) for Persons Enrolled in the ACA Adult Group

PM 06-25-05

When an ACA Adult requests LTSS

  • Always use a one person standard.
  • Do not request verification of current resources.
  • Require completion of HFS 3654 and verify resource transfers.
  • Do not send Form IL 444-0008, to Bureau of Collections because lien and estate claims are not applicable to ACA Adult group.

Post-Eligibility Determination

For NH and SLP

  • Completion of HFS 2500 is not required.
  • Community Spouse Maintenance Needs Allowance (CSMNA) is not applicable.
  • Family Maintenance Needs Allowance (FMNA) is not applicable.
  • Enter $0.00 for patient credit amount in MMIS.

Note: SLP residents are still required to pay the facility for their room and board amount but the room and board amount is not entered into MMIS.

For DoA

  • Community Spouse Maintenance Needs Allowance (CSMNA) is not applicable.
  • Family Maintenance Needs Allowance (FMNA) is not applicable.

Lookback Period

  • Lookback period is 60 months unless,
  • can be minimum of 12 months, maximum 60 months.
  • Determine lookback period based on information reported on HFS 3654 and resource documentation provided when LTSS is requested.
  • Verifications should cover the entire lookback period that has been determined.
  • Beginning month of the lookback period is the month prior to the month of application.
  • When medical backdating is requested, the beginning month of the lookback period is still the month prior to the month of application.

Resource Transfer Requirements are Not Met

For NH and SLP

  • Do not treat the person as residing in an NH or SLP.
  • Code item 20 using a 16.
  • Do not process an admit in MMIS.

For DoA

  • Do not treat the person as receiving DoA services.
  • Code item 20 using a 16.

Penalty Period Coding

For NH and SLP

  • Enter code 398 in item 80 with month/year of beginning penalty period
  • Enter Code 399 in item 80 with month/year of ending penalty period

For DoA

  • Code item 20 with 16
  • Set a control to change item 20 coding at end of penalty period