Approving Admissions (Admits) for Long Term Care Providers

Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

12/08/14

Policy Memo

Summary

  • As a result of PA 98-0651, HFS has changed the requirement for submitting admission (admit) information effective 12/15/14 for Nursing Facilities (NF), Supportive Living Program (SLP) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID);
  • Requires that FCRCs send acopy of notice of decision on application to provider; 
  • Requires providers to submit admit information electronically;
  • Updates time frames for submitting admit information; 
  • Requires caseworkers to adjust admit date for untimely submissions;
  • Clarifies processing admit information received prior to 12/15/14; and
  • Clarifies process for providers to report changes. 
  1. Long Term Care Providers
  2. Notice of Decision on Application
  3. Admit Information Submitted Electronically
  4. Time Frames for Submitting Admit Information
    1. FCRC Sends HFS 3654
  5. Submitting Admit Information After Time Frame
  6. Admit Information Submitted Prior to 12/15/2014
  7. Eligibility Factors that Affect Admit Date
  8. Changes Reported by Providers
  9. Forms Referenced

PA 98-0651 requires all long term care providers to submit admit information electronically within a specified time frame.

Long Term Care Providers

Long Term Care providers include the following:

  • Nursing Facilities (NF)
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), formerly known as Intermediate Care Facilities for Developmentally Disabled (ICF/DD)
  • Supported Living Program (SLP)

Notice of Decision on Application

FCRC is required to send copy of HFS 458LTC, Notice of Decision on Application for Medical Assistance, to provider, on the date of decision.

Upload HFS 458LTC into Integrated Eligibility System (IES) and document the action in case notes.

Admit Information Submitted Electronically

Effective 12/15/2014, LTC facilities are required to electronically submit all admit information through MEDI (Medicaid Electronic Data Interchange) system or one of the EDI (Electronic Data Interchange) systems. 

Electronic admit information includes information found on forms:

  • Long Term Care Facility Notification (HFS 1156); and 
  • Report on Resident of Private Long Term Care Facility (HFS 26); and
  • Interagency Certification of Screening Results (HFS 2536).

FCRC will no longer accept or request hard copy admit forms from providers; HFS 1156, HFS 26 and HFS 2536. FCRC will return, without processing, all hard copy admit forms to the provider.

Effective 12/15/2014, the provider is responsible for retaining the hard copy or electronic version of the HFS 2536 in the resident's file.

The provider will submit to the FCRC income and health insurance verifications. 

Time Frames for Submitting Admit Information

Effective 12/15/2014, LTC providers are required to electronically submit admit information within 15 business days after receipt of:

  • HFS 2536 when the person being admitted is already enrolled in Medicaid; or
  • HFS 2536 when the facility helps the person apply for Medicaid; or
  • Screening Verification Form (HFS 3864) when the person is admitted from another facility and an additional prescreening is not required; or
  • the approval notice, HFS 458LTC, when a person in a LTC facility, who has been paying privately, has been approved for medical assistance; or
  • the approval notice, HFS 458LTC, when a person makes application for medical assistance and the provider has not been made aware of the resident's need for assistance; or
  • the approval notice, HFS 458LTC, when a person's Medicare coverage has ended and they are applying for Medicaid

FCRC Sends HFS 3654

FCRC sends HFS 3654 (R-10-14)(pdf)/HFS 3654S (R-10-14)(pdf) Form HFS 3654, Additional Financial Information for Long Term Care Applicants, PM 01-02-01-a/WAG 01-02-01-a when a person is already on Medicaid when admitted to a LTC facility:

  • from the community; or
  • under Medicare coverage.

Do not clear admit transaction until a decision on the LTC application has been made.

Submitting Admit Information After Time Frame

Use the date of the electronic submission as the admit date when:

  • admit information is received after the required time frame of 15 business days.

Use the admit date when:

  • the provider is unable to timely submit the admit information because the FCRC fails to send the HFS 458LTC; or
  • HFS 2536 is received by the facility prior to the person moving into the facility. 

Admit Information Submitted Prior to 12/15/2014

FCRC will accept and process admit information received electronically or in hard copy form prior to 12/15/2014.

Use the admit date reported electronically or in hard copy form as the date of admit.

If the provider submitted admit information electronically or in hard copy prior to 12/15/2014 and the FCRC adjusted the admit date to a date later than the date of admit reported by the provider:

  • the provider is allowed to resubmit the admit information for correction of the admit date,
  • the FCRC will correct the admit date in MMIS and
  • document the action taken in IES/ACM case notes.

Eligibility Factors that Affect Admit Date

FCRC will adjust the admit date when a person has a penalty period or resource spenddown.

Changes Reported by Providers 

When the provider is made aware of a change and the provider has verification documents to support the change, the provider will electronically report the information through the MEDI system or other EDI system and submit the change verification documents to the FCRC.

[signed copy on file]

Michelle R.B. Saddler

Secretary, Illinois Department of Human Services

Julie Hamos

Director, Healthcare and Family Services

Forms Referenced

  • HFS 1156
  • HFS 26
  • HFS 2536
  • HFS 3864
  • HFS 458LTC
  • HFS 3654 (Rev 10/14)
  • HFS 3654S (Rev 10/14)