The following procedures pertain to when an Nursing Facility (NF) application  is received from the facility:

• Gatekeeper or worker (depending on county procedure will review IMS to determine if client has existing case number that is appropriate to be used for LTC services or assign new number using PS1B
• Gatekeeper or worker will place medical section (if not already vending for another medical service) and appropriate NF auth line into “A” status.
• Early each AM the system will look for any LT auth lines added in “A” status the prior day and notify Harmony of the request for the medical decision.

The worker will schedule an interview and send ADM-92 requesting any additional documents or verification required to determine financial eligibility. The interview may be conducted with the client, a family member, Power of Attorney, or an authorized representative and may be face to face in county office, embedded location, in client’s home or by phone.

Review article LTC: Look Back Period for All Assets for LTC. Use form 08MA011E (MA-110 Assessment of Assets to gather asset information. If there is a community spouse, review article LTC: Spousal Impoverishment.

In the process of obtaining information, ask for verification of gross income for the Nursing Facility client to determine if there will be a need to establish a Medicaid Income Pension Trust. Refer to article LTC: Medicaid Income Pension Trust -Establish.

The medical and financial determination of eligibility occurs concurrently.

• The Nurse will receive the request for the medical decision in Harmony and complete the medical review.

*If the required medical documentation, including verification of PASRR clearance with the Oklahoma Health Care Authority, is not received within 10 days of a Medical Information Request, the medical application will be marked in error and no further action will be taken to determine medical eligibility. If medical documentation is received, but not incomplete, an additional 5 days will be given to allow for corrected or missing documentation to be submitted. If/when medical documentation is received by OKDHS, the medical application will be re-initiated and processed by the OKDHS nursing team.

**The FSS can see the details of why the application was marked in error by accessing the Harmony Main System, searching for the Member record, then reviewing the Notes Tab for any notes that indicate “Marked in Error” or “Error for NF”.

***The FSS should continue the financial eligibility determination process even if an NF application is marked in error due to required medical documentation not received from nursing facility.

• Once financial eligibility is determined, worker will either deny (using appropriate denial reason code) if not financially eligible or code authorization into “F” status if financially eligible.
• Once the medical decision is available in Harmony, an auto generated notice of the decision will be sent to the assigned FSS/FSS Supervisor via Outlook email from the Harmony system. Worker will then certify or deny the auth as appropriate.