Systems Help: PS2 Instructions – Section K (Long Term Care)

This section is used to authorize approvals for long-term care services including nursing facility, assisted living center and State Plan Personal Care. The section is also used for denial of long-term care services. On denials, enter blocks K1, K4, K8, K12, K16, K40, and K45. (For ADvantage Waiver services other than assisted living and individual provider personal care, see article PS2 Instructions – Section K (Waivered Services)

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Authorization Number.
PS-2 Block: K1
Instructions: Computer-assigned when authorization is entered. On new authorizations enter + to indicate authorization being added.
Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Person Number.
PS-2 Block: K4

Instructions: Enter the appropriate person number from Section F for the person authorized for services.NOTE: For authorizations created using FACS, select from the dropdown the household member about whom you want to collect eligibility determination information for Long Term Care. The person listed in this field is the one the line will be attached to. This person must be listed in the Household Tab to appear here.

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Authorization Type.
PS-2 Block: K8

Instructions: LT = Long Term CareNOTE: This block must be entered when adding a new authorization. For authorizations created using FACS, the computer assigns this code based on the authorization being created using the Auth LT Care Tab.

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Action Taken.
PS-2 Block: K12

Instructions: Enter the appropriate code for action taken on this authorization. This block must be completed each time authorization is updated.

  • A = Application (ELDERS Only)
  • 1 = Open
  • 2 = Deny
  • 6 = Close
  • C = Change of Information
  • F = Financially Eligible (ELDERS Only)
Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Reason.
PS-2 Block: K16

Instructions: Enter the appropriate code from the list below to show why this authorization is being closed or denied.

  • 1 = Death of client.
  • 2 = Client’s request.
  • 3 = Change in level of care – new provider.
  • 4 = Change in providers.
  • 6 = Change in the DHS case number for authorization.
  • 7 = Provider no longer eligible.
  • 9 = Have not cooperated in the delivery of services.
  • 10 = Financial eligibility not met.
  • (11 through 18 used ONLY for ADvantage Waiver, ADvantage Waiver Assisted Living, and Individual Provider Personal Care).
  • 11. Not in targeted group for the ADvantage Waiver.
  • 14. Cost of services exceeds the allowable capitalization.
  • 15. No open ADvantage Waiver slot.
  • 16 = Needs cannot be met through the ADvantage Waiver services.
  • 17 = Harm to self or others.
  • 18 = Household Member or frequent guest threated harm to others.
  • 19 = Personal care services are now provided by a comprehensive home care (CHC) agency.
  • 20 = Medical eligibility not met.
  • 21 = Transfer of resources.
  • 22 = Moved out of state.
  • 23 = Unable to locate
  • 44 = Failed or refused to cooperate in determining eligibility.
  • 45 = Failed or refused to provide necessary verification within the time allowance.
  • 49 = Entered nursing facility.
  • 69 = Other – no notice will be generated.
  • 99 = State Office use only.
Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Level of Care.
PS-2 Block: K20

Instructions: Enter the appropriate code for the level of care approved for this person.

  • AL = Receives services in an Assisted Living Center through ADvantage Waiver with vendor payment approved.
  • AP = Receives personal care in own home by agency provider.
  • IC = Receives nursing facility (NF) care with vendor payment approved.
  • IP = Receives personal care in own home by individual provider.
  • MR = Receives ICF/MR level of care with vendor payment approved – M-S-52 will indicate as level ICF/MR.
  • SA = Receives nursing care as a special needs patient – Acquired Immune Deficiency Syndrome (AIDS) with vendor payment approved.
  • SC = Receives care in Skilled Nursing Facility under Title XVIII and approved for Medicare co-insurance payment only.
  • SS = Receives specialized services in a nursing facility with vendor payment approved.
  • SV = Receives nursing care as a ventilator-dependent patient with vendor payment approved.
Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Provider Number.
PS-2 Block: K40

Instructions: Enter the identification number from the DHS Vendor File for assisted living centers, hospice care facilities and nursing homes. For State Plan Personal Care, leave blank.NOTE: Must be entered on denials.

Vendor/provider numbers will be checked against the DHS vendor file prior to the authorization clearing the update. The provider number may be accessed through the IMS provider Inquiry. From IMS, enter M(sp)PAI for instructions. Make sure you are using the current provider number. This field will be blank for Personal Care providers.

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Begin/Change Date.
PS-2 Block: K45

Instructions: Enter the date payment was approved on behalf of this client either to the nursing care facility, assisted living center or own-home provider. When the level of care or unit type changes, but the provider number remains the same, enter the beginning date for this change. This date cannot be prior to certification date.See Medical Assistance for Adults and Children: Certification for long-term care 317:35-9-75

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: End Date.
PS-2 Block: K47

Instructions: Enter the date client left the facility for this authorization or the date for which Personal Care was discontinued by this provider.NOTE: This can be a prior date. If the client is now in a Nursing Care Facility, this date cannot be any later than the date the client entered the facility. This date must be in the same calendar year as the begin date.

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Number Units.
PS-2 Block: K50

Instructions: Enter the maximum number of quarter hours per month authorized for personal care services.NOTE: Used for NTMC only. If the Unit Type is “Daily Rate” or “Reduced Daily Rate”, enter the maximum number of days per week authorized for NTCM personal care services. Valid entries for NTMC personal care are 1 through 7. If the Unit Type is “Hourly Rate,” enter the maximum number of hours per week authorized for NTMC personal care services. Valid entries for personal care are 1 through 168. Companion block is K55, Unit Type.

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Unit Type.
PS-2 Block: K55
Instructions: Q = Quarterly Hourly Rate – This is the only valid code for Personal Care authorizations at this time.
Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Unit Charge.
PS-2 Block: K60
Instructions: Computer entered for long-term care own-home personal care services based on unit type and level of care.
Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Assessment Date.
PS-2 Block: K62
Instructions: Obsolete

 

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Primary Diagnosis. Secondary Diagnosis.
PS-2 Block: K65
K66
Instructions: Computer entered from information in Section F.
Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Vendor Co-Payment.
PS-2 Block: K70

Instructions: Enter co-payment, even if it is zero, on ABCDH cases. Computer entered from information in Section D on M cases.NOTE: Form MA-2 may be used to help figure Vendor Co-payment. You can enter two vendor co-pays and two vendor co-pay effective dates per update.

Notebook: ELIG
Tab: AUTH LONG TERM CARE
Field: Effective Date.
PS-2 Block: K75

Instructions: Enter effective date of copayment shown in K70 on ABCDH cases. Computer entered from information in Section D on M cases.NOTE: You can enter two vendor co-pays and two vendor co-pay effective dates per update. This cannot be a past date unless the case action is “certify”.

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