317:35-19-20

When a client enters Intermediate Care Facility (ICF) or Intermediate Care Facility / Individuals With Intellectual Disabilities (ICF/IID) it is assumed that his/her intent is to remain in the facility 30 days or longer. Once a person has been in ICF or ICF/IID care for 30 days then he/she is considered to be “institutionalized”.

The 30 day ICF or ICF/IID requirement is still met if any of the following applies:

• The ICF or ICF/IID nursing home admission is subsequently interrupted by a hospital and/or Skilled Care stay during the 30 days;
• The nursing home applicant dies before the 30 day period ends (it is assumed the client planned to remain in ICF or ICF/IID care for 30 days);
• The individual received ADvantage Waiver services for at least 30 days and is transitioning to a nursing care facility ICF or ICF/IID.
• See Note below for exemption.

Reminder:A medical decision is required in Harmony before any certification for ICF or in Medical Eligibility and Data Tracking System (MEDATS) before any certification for ICF/IIS.

The income and resource guidelines used for a client who has admitted to ICF or ICF/IID are found on Appendix C-1, Schedule VIII.B and VIII.D (LTC income and resource guidelines).

Note: If a client is on SSP or QMBP they are not required to stay 30 days to be eligible for assistance in paying for ICF or ICF/IID nursing home care as their income is at or under the Schedule VI limit (QMBP). However, QMBP clients must meet the LTC resource limits as outlined on Appendix C-1, Schedule VIII.D for ICF or ICF/IID nursing home payment assistance.