PM 20-08-04
The screening verifies the need for care. Receipt of Interagency Certification of Screening Results (Form 2536), indicating the need for care, verifies that the screening is met.
- (Facility, Customer's Physician, or Other Interested Party) Notifies agents of DoA, DHS, or HFS that a Form 2536 needs to be completed and sent to the FCRC.
- (Agent of DoA, DHS, or HFS) Completes Form 2536.
- (Facility) May
use the LTC EDI system (via MEDI or REV) to submit information provided on Form 2536 completed by a screening agency on behalf of a private pay customer applying for assistance.
- (DHS Facility) Enters data in the MMIS LTC subsystem for persons in psychiatric hospitals.
- Optional: Complete Long Term Care Authorization (Form 2299) and Long Term Care Authorization Update Document (Form 2449) for persons in psychiatric hospitals.
- (FCRC) Enters data and changes in the MMIS LTC subsystem for SLF, SNF, ICF, and ICF/MR services.
- Optional: Form 2299 and Form 2449 may be completed for SLF, SNF, ICF, and ICF/MR services.
- (FCRC) If/when received, file copy of Form 2536 in case record.
- (FCRC) Send Notice of Denial of Payment for SLF, SNF, ICF or ICF/MR Services (Form 2537) when Form 2536 (or equivalent data submitted via MEDI or REV) shows that long term care is not needed:
- to customer on the day Form 2536 (or equivalent data submitted via MEDI or REV) is received or on following workday; and
- to facility, if customer is already living in the facility.
