Approving Assisted Living Services:

1. 1. There are designated Assisted Living (AL) SSS’s that determine financial eligibility for all clients requesting assisted living services. The county office SSS’s would request the case be transferred to an appropriate AL worker if it is identified that the client is requesting to move into an ADvantage AL.

Approving new LTC services when the medical (D) section is already in vending status for an existing medical benefit:

1. 1. The “Harmony Procedures – New Application (ADvantage/SSP)” should be followed to either update the authorization line per the appropriate financial decision or assist the client in completing an online application if SSS is the first to know of the client wishes to apply for services.
      • SSP/SLMB/QMBP – cases – once financially eligibility is determined, the worker should code authorizations appropriately. Once HCMN III makes the medical determination in Harmony, the authorizations will be certified / denied appropriately.
      • QI-1 cases – once financial eligibility is determined, the worker should code authorizations appropriately. Once HCMN III makes the medical determination in Harmony; authorizations will be certified / denied appropriately. If client is eligible for services, a change will be made to remove the QI-1 coding by updating the client to LB/R. However, worker will need to mail client a hand generated noticed that Medicare premiums will no longer be paid by OHS.

Note: In any of the above situations, if client is approved by services, Harmony will certify / deny the appropriate authorizations, overlay a change to the D section, code the appropriate F190 if currently null, and M/A client if not already added to medical.