WAG 20-08-14: Payment

PM 20-08-14.

  1. (Facility) Revised textUses MEDI or REV to enter data formerly provided by completing Report on Resident of Private LTC Facility (Form 26), for an individual:
    • who enters facility; or
    • who applies for aid while living in facility; or
    • who transfers between facilities.
  2. (FCRC) Revised textIf data entered by the facility using the LTC EDI system is incomplete, request missing data from the facility. 
  3. (FCRC) Revised textAfter requesting missing information, approve the application if the customer is eligible but do not approve payment until Revised textall necessary data is submitted and available to the FCRC.Deleted text

The date the facility Revised textsubmits all required information does not affect the effective date for payment.

Example: A customer enters a facility Revised text04/16/13. The screening requirement is met Revised text04/16/13. The FCRC receives Revised textall necessary information 04/25/13. Approve payment effective 04/16/13.

Revised textThe information submitted using MEDI or REV may affect the effective date for payment.

Example: The person enters a facility Revised text04/16/13 and applies for assistance 04/18/13. The person is eligible effective 04/13. The screening requirement is met 04/16/13. The data submitted shows payment has already been made for 04/13 and 05/13. Approve payment starting 06/01/13.

Out-of-State Placement (Long Term Care)

Payment is not to be approved unless prior approval is obtained from BLTC and an appropriate bed cannot be found in Illinois.

  1. Do not approve payment for out-of-state placement when the customer wants the placement for personal reasons.
  2. Advise the customer or family to apply for assistance in the state where the facility is located if they want the customer placed out-of-state for personal reasons.

If the customer becomes ill while temporarily out-of-state:

The FCRC may approve payment to an out-of-state facility.