Long Term Care (LTC): ICF/IID Authorizations vs. ICF Authorizations

Correct coding in the Level of Care (LOC) block on the FACS Auth LT Care Tab (PS Block K20) is necessary for LTC facilities to be able to meet the medical requirements as set forth in their contracts with the Oklahoma State Health Department and Oklahoma Health Care Authority. Without proper coding, IID clients are not able to access essential services.

***ICF/IID is The Current Terminology Which Replaces ICF/MR.

Intermediate Care Facility (ICF) vs. Intermediate Care Facility / Individuals With Intellectual Disabilities (ICF/IID):

  • Medical eligibility for ICF and ICF/IID facilities is determined differently.
    • ICF/IID medical approvals are determined by OHCA (LOCEU makes the determination) and they are found on MEDATS (MDL/MDI screens – also known as the M-S-52 screen).
    • ICF medical approvals are determined by AAU Nurses and the approvals are found in ELDERS.

Below are Important Coding Procedures for ICF/IID Authorizations:

  • When the authorization is placed into application/financial status the Level of Care (LOC) code used should by IC.
  • Once the financial and medical eligibility has been determined, then the case is ready to certify (or deny) both in the Medical General tab and on the Auth LTC Care tab. At the approval of the authorization, the LOC coding must be changed from IC to MR. MR in FACS is shown as Receives ICF/MR Level of care with vendor payment approved (MEDATS will indicate level ICF/MR)” Note: Systems has not yet updated these codes to current usage of ICF/IID.
  • If an ICF/IID applicant is approved for ICF rather than ICF/IID, the MEDATS screen will reflect this as well. The case should be approved for ICF care leaving the LOC as IC on the authorization.
  • If the LOC is entered incorrectly on the authorization, a Remedy ticket must be submitted to correct the coding errors. Remedy Help Desk staff will contact OHCA staff to update the LOC. ***It is very important these authorizations are coded correctly.

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