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Long Term Care, Alternate Care, Managed Care & Waiver Services

Revised November 9, 2009

Categorically Needy Home Services (C01) Medically Needy Hospice Services No Spenddown (C95) Medically Needy Hospice Services With Spenddown (C99) Categorically Needy Long Term Care SSI Recipients (L01) Categorically Needy Long Term Care SSI Related (L02) Categorically Needy Long Term Care SSI Related Undocumented Alien (L04) Medically Needy Long Term Care No Spenddown (L95) Medically Needy Long Term Care With Spenddown (L99) Family Long Term Care - Categorically Needy (K01) Family Long Term Care - Medically Needy (K95) Family Long Term Care - Spenddown (K99) Hospice (in Medical Chapter) Medically Needy Residential Waiver (MNRW)

Categorically Needy Home Services (C01) Who is eligible for C01? What programs does C01 cover? How long is the C01 certification period? How do I screen C01 medical? How do I process a pending C01 AU? How do I process a change when a client changes from one waiver program to another waiver program? How do I process a change when a client receiving COPES/waiver services at home is permanently admitted to an Alternate Living Facility? How do I add Hospice to a client receiving waiver services? How do I process a change when a client residing in an Alternate Living Facility enters a Hospice Care Center? How do I change from L-track to C01 when a client elects Hospice or returns home with COPES/waiver services? How do I process a change when a C01 client is permanently admitted to a Nursing Home? How do I close C01 for a client who is deceased? How is Personal Needs Allowance (PNA) determined? Where do I view split participation when there is a split cost of care?

Who is eligible for C01?   ·        A person who meets the criteria in the following WAC/EA-Z Manual sections may be eligible for C01 Medical:   EA-Z Manual WAC 388-513-1315 Eligibility for long-term care (institutional, wavier, and hospice) services.   EA-Z Manual WAC 388-503-0510 How a client is determined "related to" a categorical program. EA-Z Manual WAC 388-513-1350-Defining the maximum amount of resources allowed and determining resources availability for long term care cases. EA-Z Manual WAC 388-515-1505 Community Options Program Entry system (COPES) (2) for COPES cases. EA-Z Manual WAC 388-515-1510 DDD Waivers and Outward Bound Residential Alternatives (2) for DDD Waivers cases.

NOTE: For more information about Home and Community Services, see the Long Term Care Manual.  For more information about the Developmentally Disabled (DDD) Program Waiver, see http://intra.ddd.dshs.wa.gov/WaiverManual/index.shtml.

What programs does C01 cover?   ·        C01 medical provides categorically needy medical and waiver service coverage under these different programs:   Community Options Program Entry System (COPES) - a Medicaid-waiver program that provides an aged or disabled person, who has been assessed as needing nursing facility care, the option to remain at home or in an alternate living facility. See WAC 388-513-1301 Definitions related to long-term care (LTC) services. Division of Developmental Disabilities (DDD) waivers- services provided in the home and community to SSI related individuals who would otherwise require the services provided in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).  See WAC 388-513-1301 Definitions related to long-term care (LTC) services. Hospice – providing a terminally ill client a variety of treatment alternatives that can be received at home, in a nursing facility or a Hospice care center.  See EA-Z Manual - MEDICAL ASSISTANCE PROGRAMS - HOSPICE. o       Program of All-inclusive Care for the Elderly (PACE) - a managed care service provided by contracted providers.  Clients receiving PACE services are identified on the MANC screen after ACES receives the MMIS interface with this information.  See EAZ Manual - Waiver Services - HCS CNP (COPES/New Freedom/PACE/MMIP and WMIP).

How long is the C01 certification period?   ·        C01 medical is certified for 12 months.

How do I screen C01 medical?   To screen a C01 AU, take the following steps:   1.      From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.   2.      On the Applicant page:   Enter the applicant’s name in the Applicant Name field. Enter the applicant’s address under the Residential Address.  If the applicant has a mailing address, click the box next to Mailing Address same as above to remove the checkmark and enter the applicant’s mailing address. Click the AREP/Payee checkbox if an Authorized Representative is needed.  The case manager/social worker managing the service (HCS/AAA or DDD) must be indicated as an Authorized Representative. See Screening aces.online Add AREP.   Click the Next button. 3.      On the Address Validation page:   o       Take the necessary steps to complete the address validation process.  See Screening - Address Validation for additional information.   o        Click the Next button.   4.      On the Programs page:   o       Click the checkbox next to COPES/HCBS Waiver/DDD Waiver/Hospice    5.      Click the Next button, the Add Member – Search Criteria displays.   6.      Add all household members and complete the screening process.  For more information, see Screening – aces.online.

How do I process a pending C01 AU?   To process a pending C01 AU take the following steps:   1.      From the AMEN, select Option O – Interview.    2.      On the STAT screen, complete the Finl Resp fields as follows:   [PN] – Applicant for the applicant.   [NM] – Non-member for any other household members.  3.      On the DEM1 screen:   In the Living Arrangement field, enter the [appropriate valid value based on the client’s situation].  See <F1> Help.

NOTE: ACES will deny C01 for Hospice clients residing in an Alternate Living Facility (ALF). For more information, see EA-Z Manual Medical Assistance Programs - Hospice.

In the Marital Status field, enter the [appropriate valid value]. See <F1> Help.

NOTE: Coding in the Marital Status field may be used to determine the Personal Needs Allowance (PNA) allowed when determining the client’s participation amount.

EXAMPLE When the applicant with living arrangement [AH] – At Home lives at a separate residence from the spouse, code the Marital Status field as [A] – Married Living Apart to give the Federal Poverty Level (FPL) as the PNA. See WAC 388-513-1380 Determine a client's financial participation in the cost of care for long-term care (LTC) services. For HCS CN Waiver (COPES), see WAC 388-515-1505. For DDD Waivers, see WAC 388-515-1510.

4.          On the INST screen complete the appropriate section(s) based on client's circumstances: o       In the Facility section: ¨      If the client does not live at home, enter the [appropriate valid value] in the [INST type] field.  See <F1> Help.   ¨      Enter the [Provider ID number] in the Provider ID field if appropriate.  If the client is receiving Hospice in a Nursing Facility, enter the provider number and rate for the Nursing Facility and the provider number and rate for the Hospice provider.  To find the provider’s ID number press <F20> to go to the MMEN (Vendor Files Submenu) and enter option [A] – Vendor Name List. See Vendor Payment - Inquire on a Vendor Number.

NOTE: Provider numbers are not required for Alternate Living Facilities (ALF), Hospitals, Residential Habitation Centers (RHC) or Institutions for Mentally diseased (IMD).

¨      Enter the [date the client entered the facility] in the Entry Date field.   ¨      Enter the [client’s level of care] in the Level Care field.  See <F1> Help. This mandatory field should match the facility type.  For example, if the Level of Care Code is [L] – Alternate Living Facility (ALF), then the Type Code should be [FH] – Adult Family Home.    ¨      Enter the [date the payment to the facility is to begin] In the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.

NOTE: An entry in the Payment Auth Date field is optional.  However, if the field is blank, LTC services cannot begin

¨      Enter the [facility’s private daily rate] in the Private Rate field. Call the facility to get the current private rate.   ¨      Enter the [facility’s state daily rate] in the State Rate field.  Access the State Rate from the MMEN.   o       In the Home Community Based Service section: ¨      Enter the [appropriate waiver service type] in the HCBS Type field.    ¨      If the HCBS type is [H] – Hospice, enter the [Provider ID number] in the Provider ID field. To find the provider’s ID number press <F20> to go to the MMEN and enter option [A] – Vendor Name List.  See Vendor Payment - Inquire on a Vendor Number.    ¨      Enter the [date the waiver service begins] in the Start Date field.   ¨      Enter the [approval source code] in the Approval Source field.   ¨      Enter the [date payment is to begin] In the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.    ¨      If the HCBS type is [H] – Hospice:   ¨      Enter the [provider’s private daily rate] in the Private Rate field. Call the facility to get the current private rate.   ¨      Enter the [provider’s state daily rate] in the State Rate field.  Access the State Rate from the MMEN.    5.   If the client has expenses or deductions that can be used to reduce participation, excess resources, or Room and Board costs, complete the LTCX screen with the appropriate information.  See <F1> and <F2> Help.   6.   On the RES1, RES2, and RES3 screens, enter client resource information.  See EA-Z Manual WAC 388-513-1350 Defining the maximum amount of resources allowed and determining resources availability for long-term care (LTC) services.   7.   On the EARN screen:   o       Complete this screen if the client has earned income.  See <F1> and <F2> Help.    o       Enter a [Y] in the Sep Prpty field if the applicant and spouse are both receiving LTC services.  This applies the “Name on the Check Rule.” See EAZ Manual WAC 388-513-1330 LTC Available Income.   8.   On the UNER screen:   o       Enter the appropriate types and amounts of the applicant’s unearned income. See <F1> and <F2> Help.   o       Enter a [Y] in the Sep Prpty field if the applicant and spouse are both receiving LTC services.  This applies the “Name on the Check Rule.” See EAZ Manual WAC 388-513-1330 LTC Available Income.     9.  On the LTCD screen:   o       Enter the appropriate types and amounts of the deemor’s income and resources.  See <F1> and <F2> Help.   o       Enter a [Y] in the Sep Prpty field if the applicant and spouse are both receiving LTC services.  This applies the “Name on the Check Rule.” See EAZ Manual WAC 388-513-1330 LTC Available Income.

NOTE: When information is entered on the LTCD screen, users receive Edit 1585 - GO TO THE "SHEL" SCREEN TO ENTER COMMUNITY SHELTER EXPENSES. For L01, the SHEL screen does not need to be coded. Users can <F4> past this edit.

After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the C01 eligibility determination.

NOTE: C01 will trickle to C95/C99 for Hospice clients who reside in a medical institution and have income over the Special Income Level (SIL). C01 will deny for Hospice clients with income over the (SIL) who reside at home or in an (ALF). Edit 2228 - REVIEW CLIENT'S LIVING SITUATION - RESCREEN APPROPRIATE MEDICAL will be generated and workers should review the case for other medical programs. For more information, see EA-Z Manual Long Term Care Medically Needy and EAZ Manual Medical Assistance Programs - Hospice Clarifying Information.

How do I process a change when a client changes from one waiver program to another waiver program? To process the change for the month in which the change occurred, take the following steps: 1. From the AMEN, access the active C01 AU via Option R - Interim / Hist Change and enter the [month of the change] in the Benefit Month field.   2. On the ADDR screen, update the address if appropriate.   3. On the AREP screen, make any needed changes.   4. On the INST screen in the Home Community Based Service section:   o     Enter the [date the services ended] in the End Date field for the existing service.   o     Enter the [new waiver service type] in the HCBS Type field on the next line. See <F1> Help.   o     Enter the [Provider ID number] in the Provider ID field if the HCBS type is H (Hospice). To find the provider's ID number press <F20> to go to the MMEN and enter option [A] – Vendor Name List. See Vendor Payment - Inquire on a Vendor Number.   o       Enter the [date the new waiver service begins] in the Start Date field.   o       Enter the [approval source code] in the Approval Source field.  See <F1> Help.    o       Enter the [date payment is to begin] In the Payment Auth Date field.    o       If the HCBS type is [H] – Hospice:   ¨      Enter the [provider’s private daily rate] in the Private Rate field. Call the facility to get the current private rate.   ¨      Enter the [provider’s state daily rate] in the State Rate field.  Access the State Rate from the MMEN.   5.      Commit the data.     To process the change for the months following the change month(s), take the following steps:   1.      From the AMEN access the active C01 AU via Option R - Interim/Hist Change and enter the [month of the change] in the Benefit Month field.   2.      On the ADDR screen, update the address if appropriate.   3.      On the AREP screen, make any needed changes.   4.      On the INST screen, in the Home Community Based Service section:   o    Enter [Y] – Yes in the Delete field to remove the old HCBS information.   o       Enter the [new waiver service type] in the HCBS Type field on the next line. See <F1> Help.   o       Enter the [new Provider ID number] in the Provider ID field if the HCBS type is [H] – Hospice. To find the provider's ID number press <F20> to go to the MMEN and enter option [A] – Vendor Name List. See Vendor Payment - Inquire on a Vendor Number.   o       Enter the [date the new waiver service begins] in the Start Date field.   o       Enter the [HCBS Approval Source] in the Apprvl Source field. See <F1> Help.   o       Enter the [date payment is to begin] In the Payment Auth Date field.   o       If the HCBS type is H – Hospice:   ¨      Enter the [provider’s private daily rate] in the Private Rate field.  Call the facility to get the current private rate.   ¨      Enter the [provider’s state daily rate] in the State Rate field.  Access the State Rate from the MMEN  <F20>.   5.      Commit the data.   6.      Repeat the above steps for each month after the change month through the ongoing month.

How do I process a change when a client receiving COPES/waiver services at-home is permanently admitted to an Alternate Living Facility? To process the month in which the change occurred, take the following steps:   1.      From the AMEN, select Option R - Interim/Hist Change for the C01 AU for the month of change.    2.      On theADDR screen, update the address if appropriate.   3.      On the AREP screen, make any needed changes   4.      On the DEM1 screen, enter the [appropriate valid value] in the Living Arngmt field.  See <F1> Help.   5.      On the INST screen in the Facility section:   Enter the [appropriate valid value] in the [INST type] field.  See <F1> Help.   Press <F4>  and bypass Edit 1734 UNLESS FIELD IS ENTERED, AU/CLIENT MAY FAIL ELIGIBILITY as Provider numbers are not required for ALF, Hospital, IMR or IMD.    Enter the [date the client entered the facility] in the Entry Date field.   Enter the [client’s level of care] in the Level Care field.  See <F1> Help.   Enter the [date payment is to begin] In the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.   Enter the [facility’s private daily rate] in the Private Rate field. Call the facility to get the current private rate.   Enter the [facility’s state daily rate] in the State Rate field.  Access the State Rate from the MMEN Vendor Files Submenu <F20>.  6.      On the LTCX screen:             Enter [UP] – Prior Cost of Care for In Home Svcs - (One Month Expense) in the LTC Expenses/Deductions Type field.   Enter the [amount] in the amount field.   Enter the [appropriate code] in the V field.  See <F1> Help. 7.     Call DONE and commit the data.

NOTE: For the month of change, the MAFI screen displays the amount client owes for in-home services. The LTCP screen shows participation assigned to in-home services in the first column and the amount owing the ALF in the second column.

8.   Repeat steps 1 through 5, call DONE and commit the data for each month after the leave month through the ongoing month.

How do I add Hospice to a client receiving waiver services?   1.      From the AMEN, access the active C01 AU via Option R – Interim/Hist change for each month the services need to be added.   2.      On the ADDR screen, update the address.   3.      On the AREP screen, add the Hospice agency.  Keep the Waiver service case manager/social worker on the AREP screen as the Waiver service is priority.    4.      On the DEM1 screen, only if the client has entered aHospice Care Center, enter [HC] - Hospice Care Center in the Living Arrngmt field.

NOTE: If a client residing in an (ALF) enters a Hospice Care Center, see How do I process a change when a client in an Alternate Living Facility enters a Hospice Care Center?

5.   On the INST screen:   o       Enter the required Hospice information in the facility section if the client now resides in aHospice Care Center.  See <F1> and <F2> Help.    o       Enter the required Hospice information in the HCBS section if the client resides at home.  See <F1> and <F2> Help.    6.   Call DONE and commit the data.

How do I process a change when a client in an Alternate Living Facility enters a Hospice Care Center?   1.      From the AMEN, access the active C01 AU via Option R - Interim / Hist Change for the month of change.   2.      On the ADDR screen, update the address.   3.      On the AREP screen, make any needed changes.   4.      On the DEM1 screen,   Enter [HC] Hospice Care in the Living Arngmt field.  5.      On the INST screen in the Facilities section:   Enter the [date the client left the ALF] in the Leave field. Enter [NM] - Leaving-Going to a Medical Facility - with/without Hospice in the NAC field. Enter [HC] –Hospice Care Center in the [INST type] field on the next line.  Enter the [Provider ID number] in the Provider ID field.  To find the provider’s ID number press <F16> to go to the MMEN (Vendor Files Submenu) and enter option [A] – Vendor Name List.  See Vendor Payment - Inquire on a Vendor Number.  Enter the [date the client entered the facility] in the Entry Date field. Enter [O] - Hospice in the Level Care field.  See <F1> Help. Enter the [date payment is to begin] In the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.  Enter the [facility’s private daily rate] in the Private Rate field. Call the facility to get the current private rate. Enter the [facility’s state daily rate] in the State Rate field.  Access the State Rate from the Vendor Files Submenu.  6.      Call DONE and commit the data.   7.      From the AMEN, select Option R - Interim / Hist Change for each subsequent month.    8.      On the ADDR screen, update the address.   9.      On the AREP screen, make any needed changes   10. On the DEM1 screen, enter [HC] Hospice Care in the Living Arngmt field.    11. On the INST screen, Follow the same steps as #5 except enter [Y] - Delete History Change in the Del Ind field to delete the ALF information.   12. Call DONE and commit the data.

How do I change from L-track to C01 when a client elects Hospice or returns home with COPES/waiver services?    1.      From the Assistance Unit>>Summary page in aces.online, add C01 program by following the steps in add a program.  See Screening – aces.online.    2.      On the AMEN, access the case in Option O - Interview for the ongoing month.   3.      On the PEND screen, select the C01 to begin processing the pending AU.   4.      On the ADDR screen, update the address if appropriate.     5.      On the AREP screen, update as appropriate.   6.      On the STAT screen for the C01, update the required fields.   7.      On the STAT screen for the L-track AU, enter Reason Code 587 Already Eligible for program in Different AU – For Administrative use Only.   8.      On the DEM1 screen, update the living arrangements if appropriate.   9.      On the INST screen:   Enter [Y] – Yes in theDel Ind field to delete existing Facility information.  If the client is in an ALF or receiving hospice services in a medical facility, enter the new facility information on the next line. Enter the new HCBS information. 10. If the client has expenses or deductions that can be used to reduce participation, excess resources, or Room and Board costs, complete the LTCX screen with the appropriate information.  See <F1> and <F2> Help.   11. On the MISC screen, update the required fields.   12. Call DONE and commit the data. The L-track AU will close with Reason Code 587 Already Eligible for program in Different AU – For Administrative use Only.

NOTE: If there is a related Medicare Savings Program (MSP) AU that closes due to income, reinstate the MSP AU once the program change has been completed.  The MSP AU will spawn to the highest coverage group the client is eligible to receive.

13.      On the AMEN, select Option P – Processing.     14.      On the APP1 screen, enter [Y] – Yes in the Sel field to indicate the benefit month you wish to process.    15.      When processing the month in which the change occurred, take the following steps:   On the INST screen: ¨      Enter the date the client left the facility or elected hospice in the Leave Date field.      ¨      Enter the Next Arrangement Code (NAC) to indicate the client’s new service setting.  See <F1> and <F2> Help.    ¨      If the client is receiving Hospice care in a medical facility, add the new facility information.  If the client has not changed facilities, enter the date the client elected hospice in the Entry Date field.    ¨      Add the new HCBS information.   16.      Call DONE and commit the data.  The L-track AU will close with the appropriate reason code.    17.      When processing months following the month in which the change occurred, take the following steps:   On the STAT  screen for the L-track AU, enter Reason Code 587 Already Eligible for Program in Different AU - For Administrative Use Only. On the INST screen: ¨      Enter [Y] – Yes in theDel Ind field to delete existing Facility information.    ¨      If the client is receiving Hospice care in a medical facility, add the new facility information. If the client has not changed facilities, enter the date the client elected hospice in the Entry Date field.   ¨      Enter the new HCBS information.   Call DONE and commit the data.  The L-track AU will close Reason Code 587 Already Eligible for Program in Different AU - For Administrative Use Only. 18.      After all pending months have been processed, access the C01 AU in Option Q - Finalize Application .

How do I process a change when a C01 client is permanently admitted to a Nursing Facility?

NOTE: Hospice clients who enter a nursing facility remain on C01.  See EAZ Manual Medical Assistance Programs Hospice - ADSA Programs.

When a C01 client is permanently admitted to a nursing facility, you will need to close the C01 and process an L02.

How do I close C01 for a client who is deceased?   Take the following steps to process all months, beginning with the month the client died through the ongoing month:   1.      From the AMEN, select Option R - Interim / Hist Change and enter the [month you want to process] in the Benefit Month field.      2.      On the DEM2screen:   o    Enter the [date the client died] in the Death Date field.    o    Enter the [state where the client died] in the Death State field.  See <F1> Help .   3.      On the INSTscreen:   o    If the client was receiving services in an ALF or Medical facility:   ¨    When processing the month the client died, enter the [date the client died] in the Facility Leave Date field   ¨    Enter  [the date the client stopped receiving services] in the HCBS end date field.  Neither the Facility Leave date nor the HCBS end date on INSTscreen can be greater than the death date entered on DEM2screen.   4.      Call DONE and commit the data.

How is Personal Needs Allowance (PNA) determined?   ·        Clients are allowed the highest personal needs allowance (PNA) in a given month based on living arrangement, authorized service and marital status. For more information, see EA-Z Manual Long Term Care Participation.   ·        Long term care PNA standards: Long Term Care Medical Standards-Personal Needs Allowance (PNA) Charts.

EXAMPLE If a client resided at home the first day of the month and went into a nursing home the same day, allow the in home PNA because the client resided in a home setting at least 1 minute during that given month.

EXAMPLE If a client went from a nursing home to an adult family home on COPES services the first day of the month, allow the COPES ALF PNA as it is the highest allowed.

EXAMPLE Following Example 2, if the client was then discharged home on COPES from the ALF on the last day of the month, the benefit would be recalculated allowing the COPES in home PNA..

Where do I view split participation when there is a split cost of care?   ·        The MAFI screen displays the LTCP indicator next to the Total Payment field.  Workers can access the LTCP screen by pressing <F16> on MAFI.    ·        The LTCP screen is an inquiry only screen and can be called up from any other data collection screen.  It only displays when there is a split participation amount for that benefit month and can display up to 4 different providers/services.    ·        The LTCP screen displays the cost of care for each provider when the client's cost of care for a single month is split between multiple services/providers.  For example, a client moves from one facility to another.    ·        The LTCP screen displays the amount of participation owed to the original (ongoing) provider when there is a split in a short stay month.   ·        The STAY screen displays when a medical client is institutionalized or elects Hospice for a short period of time.  Use the STAY screen to access the SSCC screen that displays the amount the client owes the provider for a specified Short Stay.  The SSCC screen is accessible only from the STAY screen.

Medically Needy Hospice Services No Spenddown (C95) Who is eligible for C95?   How long is the C95 certification period?   How do I screen C95 medical?   How do I process a pending C95 AU?     Who is eligible for C95?   ·         Hospice clients who reside in a medical institution and have countable income that is over the Special Income Limit (SIL) but less than the facility’s private rate plus recurring medical expenses and available income after the Post-Eligibility Treatment of Income (PETI) process that is less than the state hospice care rate may be eligible for C95 medical coverage.   ·         For more information, see EAZ Manual – WAC 388-513-1395 Determining eligibility for institutional or hospice services for individuals living in a medical institution under the medically needy (MN) program.    ·         Hospice clients with income over the SIL who are receiving hospice services at home may be eligible for SSI related medical.  See SSI Related Medical.   ·         Hospice clients who reside in an Alternate Living Facility (ALF), may be eligible for G03. See Non-Institutional SSI related clients living in an adult family home or boarding home (G03).   ·         For additional information, see Hospice.   How long is the C95 certification period?   ·         C95 medical is certified for 12 months. For more information, see EAZ Manual Long Term Care Medically Needy.   How do I screen C95 medical?   ·         A C95 AU is initially screened into ACES as a C01 AU following the instructions in How do I screen a C01 AU?   ·         The C01 AU will trickle to C95 during Finalize, if appropriate, based on income, living arrangements and INST screen coding.    How do I process a pending C95 AU?   ·         While pending, the AU is still C01.  To process, take the following steps:   1.      From the AMEN, select Option O – Interview.    2.      On the STAT screen, complete the Finl Resp fields as follows:   o        [PN] – Applicant for the applicant.     o        [NM] – Non-member for any other household members.    3.      On the DEM1 screen:   o        Enter the [appropriate medical facility valid value] in the Living Arrangement field. See <F1> Help.   4.      On the INST screen complete the appropriate section(s) based on client’s circumstances:    o        In the Facility section:   ¨        Enter the [appropriate medical facility valid value] in the INST type field.  See <F1> Help.   ¨        Enter the [Provider ID number] in the Provider ID field if appropriate. To find the provider’s ID number press <F20> to go to the MMEN (Vendor Files Submenu) and enter option [A] – Vendor Name List. See Vendor Payment - How do I inquire on a vendor?    ¨        Enter the [date the client entered the facility] in the Entry Date field.   ¨        Enter the [O] - Hospice in the Level Care field.    ¨        Enter the [date payment is to begin] In the Payment Auth Date field. This is the date the LTC services are approved and displays on the award letter.    ¨        Enter the [facility’s private daily rate] in the Private field. Call the facility to get the current private rate.   ¨        Enter the [facility’s state daily rate] in the State field.  To access the State Rate from the MMEN Vendor Files Submenu, press <F20>.   o        In the Home Community Based Service section:   ¨        Enter the [H] – Hospice in the HCBS Type field.    ¨        Enter the [Provider ID number] in the Provider ID field. To find the provider’s ID number press <F20> to go to the MMEN (Vendor Files Submenu) and enter option [A] – Vendor Name List. See Vendor Payment – How do I inquire on a vendor?    ¨        Enter the [date the waiver service begins] in the Start Date field.   ¨        Enter [MA] - Health and Recovery Services Administration (HRSA) in the Apprvl Source field.    ¨        Enter the [date payment is to begin] In the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.    ¨        Enter the [provider’s private daily rate] in the Private field. Call the facility to get the current private rate.   ¨        Enter the [provider’s state daily rate] in the State field. To access the State Rate from the MMEN Vendor Files Submenu, press <F20>.    5.      If the client has expenses or deductions that can be used to reduce participation, excess resources, or Room and Board costs, complete the LTCX screen with the appropriate information. See <F1> and <F2> Help.   6.      On the RES1, RES2, and RES3 screens, enter client resource information.  See EAZ Manual WAC 388-513-1350 Defining the maximum amount of resources allowed and determining resources availability for long-term care (LTC) services.   7.      On the EARN screen:   o        Complete this screen if the client has earned income. See <F1> and <F2> Help.   o        Enter a [Y] in the Sep Prpty field if the applicant and spouse are both receiving LTC services. This applies the “Name on the Check Rule.” See EAZ Manual WAC 388-513-1330 LTC Available Income - Clarifying Information.   8.      On the UNER screen:   o        Enter the appropriate types and amounts of the applicant’s unearned income. See <F1> and <F2> Help.   o        Enter a [Y] in the Sep Prpty field if the applicant and spouse are both receiving LTC services. This applies the “Name on the Check Rule.” See EAZ Manual WAC 388-513-1330 LTC Available Income - Clarifying Information.   9.      After committing the interview data, follow the instructions in Process Application Month chapter for all pending months.   10. After all pending months have been processed, follow the instructions in the Finalize Application chapter. The C01 AU trickles to C95 during Finalize based on income, living arrangements, and INST screen coding.

Medically Needy Hospice Services With Spenddown (C99)   Who is eligible for C99?   How long is the C99 certification/base period?   How do I screen C99 medical?   How do I process a pending C99 AU?   How do I authorize spenddown for a C99 AU in M status?   How do I enter spenddown medical expenses for a C99 AU in M status?   How do I initiate an Eligibility Review on a C99 AU?     Who is eligible to receive C99 medical?   ·         Hospice clients who reside in a medical institution and have countable income over the SIL but less than the facility’s private rate plus recurring medical expenses, and available income after the PETI process that is more than the State Hospice Care Rate.  For more information, see EA-Z Manual Long Term Care Medically Needy.   ·         Hospice clients with income over the SIL who are receiving hospice services at home may be eligible for SSI related medical.  See SSI Related Medical.   ·         Hospice clients who reside in an Alternate Living Facility (ALF), may be eligible for G03.  See Non-Institutional SSI related clients living in an adult family home or boarding home (G03).   ·         For additional information, see Hospice.   How long is the C99 certification/base period?   ·         The default certification/base period for C99 is 6 months, which can be shortened to 3 months following the instructions in Spenddown - Set the Spenddown Base Period.   ·         Under certain conditions, the base period can be set to a period other than 3 or 6 months. See EAZ Manual – WAC 388-519-0110 Spenddown of excess income for the medically needy program (4) for these conditions.   How do I screen C99 medical? ·         A C99 AU is initially screened into ACES as a C01 AU following the instructions in How do I screen a C01 AU?   ·         The C01 AU will trickle to C99 during Finalize, if appropriate, based on income, living arrangements and INST screen coding.    How do I process a pending C99 AU?   ·         While pending, the AU is still C01.  To process,   1.      Follow the same steps as outlined in How do I process a pending C95 AU?   2.      After committing the interview data, follow the instructions in Process Application Month chapter for all pending months.   3.      After all pending months have been processed, follow the instructions in Finalize Application.  The C01 AU will trickle to C99 in [M] - MA Spenddown status during Finalize.    ·         For additional information on the spenddown process, see EAZ Manual WAC 388-519-0110 Spenddown of excess income for the medically needy program.     How do I authorize spenddown for a C99 AU in M status?   ·         To authorize spenddown on a C99 AU in [M] - MA Spenddown status, follow the instructions in Spenddown Processing - Update and Confirm Spenddown Information.   How do I enter spenddown medical expenses for a C99 AU in M status?   ·         To enter medical expenses to meet the client’s spenddown liability on a C99 AU in [M] - MA Spenddown status, follow the instructions in Spenddown – Enter Spenddown Medical Expenses.   How do I initiate an Eligibility Review on a C99 AU?   ·         Eligibility reviews can only be initiated on C99 AUs in [A] - Active status.   ·         Complete the eligibility review on an active C99 AU following the instructions in the Eligibility Review/Recertification Process chapter.   ·         A new AU should be screened (or a previously used C01/C95/C99 AU re-opened) to complete an eligibility review on a household whose current C99 AU is in [M] - MA Spenddown status.   o        See How do I screen a C01 AU for instructions on screening a new AU.   o        See Screening – Re-open for instructions on re-opening a previously used AU.

Categorically Needy Long Term Care SSI Recipients (L01) Who is eligible to receive L01 medical? How long is the L01 certification period? How do I screen L01 medical? How do I process a pending L01 AU? How do I code the Authorized Representative / Payee (AREP) screen? What do I do when a client moves from one facility to another? How do I view the participation amounts when it is split between multiple providers? When does ACES issue cash to active L01 AUs? What should I do if the client’s SSI stops? How do I close L01 when a client is deceased?

Who is eligible to receive L01 medical?   ·        A person who receives federal cash benefits under the Supplemental Security Income (SSI) program who also meets the eligibility and institutional criteria as defined in EAZ Manual Long Term Care Chapter may be eligible for L01 medical. See EAZ Manual – WAC 318-513-1301 through 513-1396.

How long is the L01 certification period?   ·         L01 medical has no review end date and is certified for as long as the client is eligible for both Medicaid and institutional Long Term Care (LTC) services.

How do I screen L01 medical?   To screen an L01 AU, take the following steps:   1.      On the Welcome back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.   2.      On the Applicant page:   o       Enter applicant’s name in the Applicant Name field.   o       Enter the medical facility’s address under the Residential Address.   o       If the applicant has a mailing address, click the box next to Mailing Address same as above field to remove the checkmark and enter the applicant’s mailing address.   o       Click the Next button. The Address Validation page displays.   3.      On the Address Validation page:   o       Take the necessary steps to complete the address validation process. See Screening - Address Validation for additional information.   o       Click the Next button. The Programs page displays.   4.      On the Programs  page:   o       Click on the checkbox next to Long Term Care.    o       Under the Program Determination Criteria section, click on the checkbox next to SSI Eligible.    5.      Click the Next button, the Add Member – Search Criteria displays.   o       Add all household members and complete the screening process. For more information, see Screening – aces.online.

How do I process a pending L01 AU?   To process a pending L01 AU, take the following steps:   1.      On the AMEN  screen, enter Option O – Interview in the selection field. 2.      On the STAT screen, complete the Finl Resp fields as follows: o       [PN] - Applicant for the applicant.   o       [NM] – Non-Member for any other household member to ensure they are included in interfaces.    3.      On the DEM1 screen: o       Enter [the appropriate valid value for the type of institution the client is living in] in the Living Arngmt field. See <F1> Help.   o       Enter [the applicant’s marital status] in the Marital Status field. See <F1> Help.   4.      On the DEM2 screen:   o       If the client is receiving Medicare Part A or Part B, complete the TPL1 screen.  See TPL - Third Party Liability Screens - Coding.   o       Enter the applicant’s disability information in the Disability/Incapacity fields. See <F1> and <F2> Help. If the client is 65 or older, the Disability/Incapacity fields can be left blank.    5.      On the INST screen, in the Facility section:   o       Enter the [type of facility] the client lives at in the Type field.  The type of facility must be from the same subset as the living arrangement code on the DEM1 screen.  See <F1> Help.   o       Enter [the Provider ID number] in the Provider ID field if the facility is one of the following types: MD – Nursing Facility – Medicaid, ME – Nursing Facility – Medicare, SN – Veteran’s Facilities, or HC – Hospice Care Center.    ¨      To find the provider’s ID number, press <F20> to go to the MMEN (Vendor Files Submenu) and enter option [A] – Vendor Name List.  See Vendor Payment - Inquire on a Vendor Number.    o       Enter [the date the client entered the facility] in the Entry Date field.   o       Enter [the client’s level of care] in the Level Care field.  See <F1> Help.   ¨      This mandatory field should be appropriate for the type of facility.  For example, if the Level of Care Code is F – Nursing Facility, then the Type Code should be MD – Nursing Facility.    o       Enter the [date the payment to the facility is to begin] In the Payment Auth Date field. This is the date the LTC services are approved and displays on the award letter.   ¨      An entry in this field is optional. However, if the field is blank, LTC Services cannot begin. This field is not used for hospital settings.   o       Enter the [facility's private daily rate] in the Private field of the Rate section. Call the facility to get the current private rate.   o       Enter the [facility's state daily rate] in the State field of the rate section.    o       The state rate for each provider can be located by accessing the provider's inquiry screen from MMEN.  Press <F20> to access MMEN.     6.      If the client has expenses or deductions that can be used to reduce participation or  excess resources, complete the LTCX screen with the appropriate information.  See <F1> and <F2> Help.   7.      On the RES1, RES2, and RES3 screens, enter client resource information.  See EAZ Manual WAC – 388-513-1350 Defining the maximum amount of resources allowed and determining resources availability for long-term care (LTC) services.   8.      On the EARN screen:   o       Complete this screen if the client has earned income.  See <F1> and <F2> Help.   o       Enter a [Y] in the Sep Prpty field if the applicant and spouse are both receiving LTC services.  This applies the “Name on the Check Rule.” See EAZ Manual – WAC 388-513-1330 Determining available income for legally married couples for long-term care (LTC) services.   9.      On the UNER screen:   o       Enter the appropriate types and amounts of the applicant’s unearned income. See <F1> and <F2> Help.   o       Enter a [Y] in the Sep Prpty field if the applicant and spouse are both receiving LTC services.  This applies the “Name on the Check Rule.” See EAZ Manual WAC 388-513-1330 Determining available income for legally married couples for long-term care (LTC) services.   10. Complete the LTCD screen, if the client has a spouse or legal dependents.  See <F1> and <F2> Help.

NOTE: When information is entered on the LTCD screen, users receive Edit 1585 - GO TO THE "SHEL" SCREEN TO ENTER COMMUNITY SHELTER EXPENSES.  For L01, the SHEL screen does not need to be coded.  Users can <F4> past this edit.

11. For additional information on completing the interview, see the Interview chapter. When the interview has been completed, transmit off the DONE screen to commit the interview data.   12. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.   13. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the L01 eligibility determination.

How do I code the Authorized Representative / Payee (AREP) screen? If an Authorized Representative needs to be entered to receive letters or benefits on a client's behalf, take the following steps: 1.      On the ADDR screen: o       Enter a [Y] in the Auth Rep/Payee field.   o       Enter the [facility name] in the Address Line 1 field if the client resides in a medical institution or alternate living facility.   o       Enter [the facility's address] in the remaining address fields.   2.      On the AREP screen for each AU that needs an authorized representative:  o        Enter the [type of representative] in the Rep Type field.  See <F1> Help.   o       Enter the representative's address in the appropriate address fields.  Up to nine authorized representatives can be coded.

NOTE: For clients who live in medical facilities such as nursing homes, it is not necessary to code the facility bookkeeper as an authorized representative in order to have copies of approval and participation letters sent to the facility.  ACES will automatically send copies of appropriate letters to the facility based on the provider ID number entered on the INST screen.

What do I do when a client moves from one facility to another?   ·         If the facility change is the result of a short stay and the client has returned to the original facility, the change should be entered on the STAY screen.  See the Short Stay chapter for instructions on how to enter a short stay.   If the client discharges from one medical facility and admits to another facility, take the following steps:   1.      On the AMEN screen, enter Option R - Interim / Hist Change in the selection field. o       Enter the [benefit month in which the change occurred] in the Benefit Month field when accessing the case. 2.      On the  ADDR screen, update the address to reflect where the client now lives.   3.      On the AREP screen, make any needed changes based on the client's new circumstances.  See How do I code the Authorized Representative / Payee (AREP) screen?   4.      On the DEM1 screen: o       Enter the new living arrangement type (if different than existing type) in the Living Arngmt field. See <F1> Help.   5.      On the INST screen in the Facility section: o       Enter the [date the client left the existing facility] in the Leave Date field. o       Enter the [appropriate code] in the NAC field to insure the client gets the correct PNA for the month of change.  o       On the next line:   ¨      Enter the [Type of Facility] the client moved to in the [INST type] field.  This must be the same subset as on DEM1.   ¨      Enter [the Provider ID number] in the Provider ID field if the facility is one of the following types:  MD – Nursing Facility – Medicaid, ME –Nursing Facility – Medicare, SN – Veteran’s Facilities, and HC –Hospice Care Center.   ¨      To find the provider’s ID number press <F20> to go to the MMEN (Vendor Files Submenu) and enter option [A] – Vendor Name List.  See Vendor Payment - Inquire on a Vendor Number.   ¨      Enter [the date the client entered the facility] in the Entry Date field.   ¨      Enter [the client’s level of care] in the Level Care field.  See <F1> Help.   This mandatory field should be appropriate for the facility type.  For example, if the Level of Care Code is F – Nursing Facility, then the Type Code should be MD – Nursing Facility.    ¨      Enter the [date the payment to the facility is to begin] In the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.  An entry in this field is optional. However, if the field is blank, LTC Services cannot begin.  This field is not used for hospital settings.     ¨      Enter the [private daily rate of the facility] in the Private field of the Rate section. Call the facility to get the current private rate.   ¨      Enter the [state daily rate of the facility] in the State field of the Rate section.  The state rate for each provider can be located by accessing the provider's inquiry screen from MMEN.  Press <F20> to access MMEN.    6.      Commit the data.   7.      From the AMEN, access the active AU via Option R - Interim / Hist Change. o       Enter the [benefit month in which the change occurred] in the Benefit Month field when accessing the case.   8.      On the ADDR screen, update the address to reflect where the client now lives.   9.      On the DEM1 screen: o       Enter the new living arrangement type (if different than existing type) in the Living Arngmt field. See <F1> Help.   10. On the AREP screen, make any needed changes based on the client's new circumstances.  See How do I code the Authorized Representative / Payee (AREP) screen?   11. In the Facility section of the INST screen: o       Delete the facility the client moved out of from line one by entering a [Y] in the Del Ind field. o       Repeat the steps from the "On the Next Line" section in Step 4 above.   12. Commit the data.   13. Repeat Steps 6 through 12 for each month after the leave month through the ongoing month.

NOTE: Participation in the month of the change will be assigned first to the original facility.  Any remaining participation will be assigned to new facilities on INST in chronological order.  If a short stay exists, participation will be assigned to the Short Stay provider/facility last.  See EAZ Manual – WAC 388-513-1380 Determining a client's financial participation in the cost of care for long-term care (LTC) services.

How do I view the participation amounts when it is split between multiple providers?   ·         When the client's cost of care for a single month is split between multiple services/providers, but the client remains eligible on the same AU, the cost of care for each provider will display on the Split Cost of Care LTCP screen.  For example, a client moves from one nursing home to another.  The screen can display up to 4 different providers/services.    ·         The LTCP is an inquiry only screen; there are no updateable fields.     ·         The MAFI screen displays a LTCP indicator next to the Total Payment field when LTCP data exists for the month.    ·         To access the LTCP screen from MAFI, press <F16>.   ·         To access LTCP screen from any other data collection screen, enter LTCP in the screen name field in the upper right corner of the current screen.   ·         When participation is split between providers on INST and short stay providers, the LTCP screen displays the amount of participation owed to the providers on INST.  The participation assigned to the Short Stay provider displays on the SSCC screen.  See the Short Stay chapter for additional information.

When does ACES issue cash to L01 clients?   ·         When SSA determines an SSI only recipient’s stay in a medical facility will exceed three months, the SSI cash payment is reduced to $30 per month. ACES issues a cash supplement to bring the client's income up to the Personal Needs Allowance (PNA) standard.  See EAZ Manual WAC 388-478-0040 Payment Standard for persons in medical institutions.    ·         When a cash benefit is issued from an L01 AU, the program type is set to M – SSI MIL Client/Aged with Cash Payment, N – Blind with Cash Payment or O – Disabled with Cash Payment and the benefit amount will display in the CPI field on MAFI.

What should I do if the client’s SSI stops?   ·         When a client's SSI benefits are terminated and the client is still residing in a medical institution, redetermine the client's medical eligibility for other programs (such as L02) following the processes outlined in Medical Re-Determination.   ·         See EAZ Manual WAC 388-418-0025 Effect of changes on medical.

How do I close L01 when a client is deceased? To close L01 when a client is deceased, take the following steps:   1.      On the AMEN screen, enter Option R - Interim / Hist Change for the month in which the client died.   2.      On the DEM2 screen:   o    Enter [date the client died] in the Death Date field. O  Enter [state where the client died] in the Death State field. See <F1> Help.   3.      On the INST screen, in the Facility section: O  Enter the [date the client died] in the Leave Date field.   4.      Call DONE and commit the data.   5.      From the AMEN, access the case via Option R - Interim / Hist Change for the month following the date of death.   6.      On the DEM2 screen: O  Enter [date the client died] in the Death Date field.  o  Enter [state where the client died] in the Death State field.  See <F1> Help.   7.      On the INST screen: O  Delete institutional information by entering a [Y] in the Del Ind field and pressing <F24>.   8.      Call DONE and commit the data.   9.      Repeat steps 5 through 8 for all months following the date of death through the ongoing month.

Categorically Need Long Term Care SSI Related (L02) Who is eligible to receive L02 medical?   How long is the L02 certification period?   How do I screen L02 medical?   How do I process L02 medical?   How do I code the SHEL screen when there is a community spouse?   How do I process a change when a client changes from one medical facility to another?   How do I change from L01 to L02 when a client stops receiving SSI income?     How do I change from C-track to L02 when a client residing in an Alternate Living Facility (ALF) is permanently admitted to a Medical Facility?   How do I change from L-track to C-track if a client elects Hospice or returns home with COPES/ DDD Waiver services?   How do I close the L02 for a client who is deceased?   How is Personal Needs Allowance (PNA) determined?   Where do I view split participation when there is a split cost of care?     Who is eligible to receive L02 medical?   ·         Clients who meet the eligibility criteria described in EAZ Manual WAC 388-513-1315 Eligibility for long-term care (institutional, waiver, and hospice) services.   How long is the L02 certification period?   ·         L02 is certified for 12 months.    How do I screen L02 medical?   ·         To screen an L02 AU, take the following steps:   1.      On the Welcome back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.   2.      On the Applicant page:   o        Enter the [applicant’s name] in the Applicant Name field.   o        Enter the [medical facility’s address] under the Residential Address field.   o        If the applicant has a mailing address, click the box next to Mailing Address same as above field to remove the checkmark and enter the applicant’s mailing address.   o        To add an Authorized Representative, follow the steps in Screening - aces.online add AREP.   o        Click the Next button and the Address Validation page displays.   3.      On the Address Validation page:   o        Take the necessary steps to complete the address validation process.  See Screening - Address Validation for additional information.   o        Click the Next button and the Programs page displays.   4.      On the Programs page:   o        Click on the checkbox next to Long Term Care.   o        Click the Next button and the Add Member – Search Criteria displays.   5.      Add all household members and complete the screening process.  For more information, see Screening – aces.online.    How do I process L02 medical?   ·         To process a pending L02 AU, take the following steps:   1.      From the AMEN, select Option O – Interview.   2.      On the ADDR screen,   o        Enter a [Y] in the Auth Rep/Payee field, if appropriate.   3.      On the STAT screen, complete the Finl Resp fields as follows:   o        [PN] - Applicant for the applicant.   o        [NM] – Non-Member for any other household member to ensure they are included in interfaces.

NOTE: Income and resources of other household members are tracked from information entered on the INST, LTCD, and CSRA screens.  The spouse’s income should also be coded on his or her separate UNER screen to ensure the spouse’s income is included in interfaces.

4.      On the DEM1 screen:   o        Enter the [appropriate valid value for the type of institution the client is living in] in the Living Arngmt field.  See <F1> Help.   o        Enter the [applicant’s marital status] in the Marital Status field.  See <F1> Help.   5.      On the DEM2 screen:   o        If the client is receiving Medicare Part A or Part B, complete the TPL1 screen.  See TPL - Third Party Liability Screens - Coding.   o        Enter the applicant’s disability information in the Disability / Incapacity fields.  See <F1> and <F2> Help.    ¨        If the client is 65 or older, the Disability / Incapacity fields can be left blank.    6.      On the INST screen:   o        In the Facility section:   ¨        Enter the [type of facility] the client lives at in the Type field.  The type of facility must be from the same subset as the living arrangement code on the DEM1 screen.  See <F1> Help.   ¨        Enter the [Provider ID number] in the Provider ID field if the facility is one of the following types:  MD--Nursing Facility – Medicaid, ME--Nursing Facility – Medicare, SN--Veteran’s Facilities, or HC--Hospice Care Center.   o        To find the provider’s ID number press <F20> to go to the MMEN Vendor Files Submenu and enter Option [A] – Vendor Name List.  See Vendor Payment - Inquire on a Vendor Number.    ¨        Enter the [date the client entered the facility] in the Entry Date field.   ¨        Enter the [client’s level of care] in the Level Care field.  See <F1> Help.   ¨        This mandatory field should match the program type.  For example, if the Level of Care Code is F–Nursing Facility, then the Type Code should be MD–Nursing Facility - Medicaid.    ¨        Enter the [date payment is to begin] In the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.  See <F2> Help.   ¨        An entry in this field is optional.  However, if the field is blank, LTC Services cannot begin.  This field is not used for hospital settings.   ¨        Enter the [facility’s private daily rate] in the Private field. Call the facility to get the current private rate.   ¨        Enter the [facility’s state daily rate] in the State field.  To access the State Rate from the MMEN Vendor Files Submenu, press <F20>. If the facility does not have a vendor number, call the facility for their state daily rate.    7.      If the client has expenses or deductions that can be used to reduce participation or excess resources, complete the LTCX screen with the appropriate information.  See <F1> and <F2> Help.    8.      On the RES1, RES2, and RES3 screens, enter client resource information.  See EAZ Manual WAC 388-513-1350 Defining the maximum amount of resources allowed and determining resources availability for long-term care (LTC) services.   9.      If the client has transferred an asset, complete the TRAN screen with the appropriate information. See <F1> and <F2> Help.  For more information, see EAZ Manual Transfer of an Asset.   10.      On the EARN screen:   o        Complete this screen if the client has earned income.  See <F1> and <F2> Help.   o        Enter a [Y] in the Sep Prpty field if the client and spouse are both receiving LTC services.  This applies the “Name on the Check Rule.”  See EAZ manual WAC 388-513-1330 LTC Available Income for legally married couples for long term care (LTC) services.    11.      On the UNER screen:   o        Enter the appropriate types and amounts of the applicant’s unearned income.  See <F1> and <F2> Help.   o        Enter a [Y] in the Sep Prpty field if the client and spouse are both receiving LTC services.  This applies the “Name on the Check Rule.”  See EAZ manual WAC 388-513-1330 LTC Available Income for legally married couples for long term care (LTC) services.    12.      Complete the LTCD screen if the client has a spouse or legal dependents.  See <F2> and <F1> Help.

NOTE: When information is entered on the LTCD screen, users receive Edit 1585 - GO TO THE "SHEL" SCREEN TO ENTER COMMUNITY SHELTER EXPENSES. .  Users can <F4> past this edit.  See How do I code the SHEL screen when there is a community spouse?

13.      Complete the CSRA screen if the client has a community spouse.  See <F2> and <F1> Help.    14.     After committing the interview data, follow the instructions in the Process Application Month chapter for         all pending months.   15.    After all pending months have been processed, follow the instructions in the Finalize Application chapter         to complete the L02 eligibility determination.

How do I code the SHEL screen when there is a community spouse?   ·         The excess shelter allocation is the amount in excess of the appropriate standard.  See EA-Z Manual WAC 388-513-1380 Determining a client’s financial participation in the cost of care for long-term care (LTC) services.   ·         Enter as a monthly amount the actual rent, mortgage, homeowner’s taxes, homeowners insurance, condo fees, and homeowner association fees.   ·         ACES automatically uses the four-person Standard Utility Allowance (SUA) in this computation.  If utilities are included in the rent, mortgage, maintenance fees or condo fees, deduct that amount of the four-person SUA from these expenses so it will not be allowed twice.

NOTE: If the LTC client has a community spouse who also receives Basic Food assistance on their own, shelter expenses must be entered on the spouse’s SHEL screen in addition to the LTC client’s SHEL screen in order to compute the shelter deduction for the spouse’s Basic Food.  If the institutionalized spouse returns home, be sure to remove the shelter expenses from the appropriate SHEL screen.

What do I do when a client moves from one medical facility to another?   ·         If the facility change is the result of a short stay and the client has returned to the original facility, the change should be entered on the STAY screen.  See Short Stay for instructions on entering STAY screen data.    ·         If the client moves to an alternative living facility on a Waiver, look at a program change to the C01 program   ·         If the client discharges from one medical facility and admits to another medical facility, take the following steps:   1.      From the AMEN, select Option R - Interim / Hist Change.   o        Enter the [benefit month in which the change occurred] in the Benefit Month field when accessing the case.   2.      On the ADDR screen, update the address to reflect where the client now lives.   3.      On the AREP screen, make any needed changes based on the client’s new circumstances.  See How do I code the Authorized Representative/Payee Screen (AREP)?   4.      On the INST screen, in the Facility section:   o        Enter the [date the client left the facility] in the Leave Date field.      o        Enter the [appropriate code] in the NAC field to ensure the client gets the correct PNA for the month of change.    o        On the next line:   ¨        Enter the [type of facility] the client moved to in the INST type field.  This must be the same subset as on DEM1.      ¨        Enter the [Provider ID number] in the Provider ID field if the provider is one of the following types:  MD—Nursing Facility-Medicaid, ME—Nursing Facility-Medicare, SN—Veteran’s Facilities, and HC—Hospice Care Center.   ¨        To find the provider’s ID number, press <F20> to go to the MMEN (Vendor Files Submenu) and enter option [A]—Vendor Name List.  See Vendor Payment – Inquire on a Vendor Number.   ¨        Enter the [date the client entered the facility] in the Entry Date field.   ¨        Enter the [client’s level of care] in the Level Care field.  See <F1> Help.   ¨        This mandatory field should be appropriate for the facility type.  For example, if the Level of Care Code is F—Nursing Facility, then the Type Code should be MD—Nursing Facility.    ¨        Enter the [date the payment to the facility is to begin] in the Payment Auth Date field.  This is the date the LTC services are approved and displays on the award letter.    ¨        An entry in this field is optional.  However, if the field is blank, LTC services cannot begin.  This field is not used for hospital settings.   ¨        Enter the [facility’s private daily rate] in the Private Rate field of the Rate section.  Call the facility to get the current private rate.    ¨        Enter the [facility’s state daily rate] in the State Rate field of the Rate section.  The state rate for each provider can be located by accessing the provider’s inquiry screen from MMEN.  Press <F20> to access MMEN.    5.      Call DONE and commit the data.    6.      From the AMEN, select Option R – Interim/Hist Change.   o        Enter the [month following the month of the change] in the Benefit Month field.    7.      On the ADDR screen, update the address to reflect where the client now lives.   8.      On the AREP screen, make any needed changes based on the client’s new circumstances.  See How do I code the Authorized Representative/Payee Screen (AREP)?   9.      On the INST screen, in the Facility Section:   o        Delete the facility the client moved out of from line one by entering a [Y] in the Del Ind field.    o        Repeat the steps from the “On the Next Line” section in Step 5 above.    10. Call DONE and commit the data.    11. Repeat Steps 7 through 10 for each month after the leave month through the ongoing month.

NOTE: Participation in the month of the change will be assigned first to the original facility.  Any remaining participation will be assigned to new facilities on INST in chronological order.  If a short stay exists, participation will be assigned to the Short Stacy provider/facility last.  See EAZ manual – WAC 388-513-1380 Determining a client’s financial participation in the cost of care for long-term care (LTC) services.

How do I change from L01 to L02 when a client stops receiving SSI income?    ·         To process a change from L01 to L02, take the following steps:   1.      Add the L02 program by taking the following steps:   o        From the Assistance Unit>>Summary page in aces.online, add L02 program by following the steps in add a program.  See Screening.    2.      For the month of change, take the following steps:   o        On the AMEN, select Option P – Process Appl Months for the newly screened L02 AU.    o        On the STAT screen for the L02, update the required fields and enter Reason Code 587 - Already Eligible for Program in Different AU - For Administrative Use Only                   o        On the STAT screen for the S03 AU, enter Reason Code 599 - Other - For User Generation Only.    o        Call DONE and commit the data.   3.      For each subsequent month, still in Option P – Process Apppl Months for the newly screened L02 AU, take the following steps:   o        On the STAT screen for the L02 AU, update the required fields.   o        On the STAT screen for the S03 AU, enter Reason Code 599 -  Other - For User Generation Only.     o        On the INST screen, delete the medical facility information.  This information will be added later in the process.   o        Call DONE and the VERF screen appears.   o        <F4> past the VERF screen for Provider Type.   o        Confirm the L01 closes with Reason Code 201 Living Arrangement - Cash/Medical Assistance.  Override the letter.   o        Confirm the S03 closes with Reason Code 599 - Other - For User Generation Only.   o        Commit the data.   4.      Open L02 by taking the following steps:   o        On the AMEN, select Option O – Interview.    o        On the PEND screen, select the L02 to begin processing the pending AU.   o        On the INST screen, re-enter the previously deleted medical facility information.   o        On the UNER screen, remove the SSI income and add the new income.    o        On the MISC screen, update the required fields.   o        Call DONE and commit the data.    o        After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months after the month the change occurred.   o        After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the L02 eligibility determination.   o        Reinstate the S03 for all months.   How do I change from C-track to L02 when a client receiving COPES/waiver services is permanently admitted to a Medical Facility?

NOTE: Hospice clients who enter a nursing facility remain on C01.  See EAZ Manual Medical Assistance Programs Hospice - ADSA Programs.

·         Add the L02 program by taking the following steps:   1.      From the Assistance Unit>>Summary page in aces.online, add L02 program by following the steps in add a program.  See Screening.    ·         Close the C-Track AU by taking the following steps:   1.      In the month the change occurred, take the following steps:   o        On the AMEN, select Option P – Process Appl Month.    o        On the ADDR screen, update the address if appropriate.     o        Update the AREP screen as appropriate.   o        On the STAT screen for the L02, update the required fields.     o        On the STAT screen for the C01, enter Reason Code 587 - Already Eligible for Program in Different AU - For Administrative Use Only.   o        On the STAT screen for the S03, enter Reason Code 599 – Other - For User Generation Only.   o        On the DEM1 screen, update the living arrangement code if appropriate.  See <F1> Help.   o        On the INST screen:   ¨        Enter the [date the waiver services ended] in the End Date field.    o        On the LTCX screen,   ¨        Enter participation paid for previous COPES providers in the Uncovered Expense Type field.    ¨        Enter a zero (0) amount with expense type [UP] - PRIOR COST OF CARE FOR IN-HOME SVCS - (ONE MONTH EXPENSE) if no money is owed to the in-home care provider.   ¨        If [UP] is not entered, then all participation will be assigned to the in-home care provider.    o        Call DONE and commit the data. The C-track AU will close with the Reason Code 587 - Already Eligible for Program in Different AU - For Administrative Use Only, and the S03 will close with Reason Code 599 – Other - For User Generation Only.   2.      In each month following the month the change occurred, take the following steps:    o        On the AMEN, select Option P – Process Appl Month.   o        On the ADDR screen, update the address if appropriate.     o        Update the AREP screen as appropriate.   o        On the STAT screen for the L02, update the required fields.   o        On the STAT  screen for the S03, enter Reason Code 599 - Other - For User Generation Only.    o        On the DEM1 screen, update the living arrangements.     o        On the INST screen:   ¨        Enter a [Y] - Yes in the Del Ind field to delete the existing HCBS waiver information.   ¨        <F4> past Edit 1734 UNLESS FIELD IS ENTERED, AU/CLIENT MAY FAIL ELIGIBILITY.   o        Call DONE and the VERF screen appears.   o        <F4> past VERF screen for Provider Type and confirm the C01 closes for Reason Code 281 - Waiver not Approved and the S03 closes for Reason Code 599 - Other - For User Generation Only.   o        Commit the data.    3.      Open the L02 by taking the following steps:    o        On the AMEN, access the case in Option O - Interview for the ongoing month.   o        On the PEND screen, select the L02 to begin processing the pending AU.   o        On the INST screen, enter the medical facility information.    o        On the MISC screen, update the required fields.   o        Call DONE and commit the data.    o        On the AMEN, access the case in Option P - Process Appl Month.   o        In the month the change occurred, update the living arrangements on the DEM1 screen.    o        After committing the data, follow the instructions in the Process Application Month chapter for all pending months.   o        After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the L02 eligibility determination.

NOTE: ACES establishes a new 12-month certification period for the L02 AU.  Since the L02 certification period should be the same as on the original C01 case, workers need to change the Rev End Date field to [the last month of the certification period for the C01 AU] when finalizing the application.

4.      Reinstate the S03 for all months.    How do I change from C-track to L02 when a client residing in an Alternate Living Facility (ALF) is permanently admitted to a Medical Facility?

NOTE: Hospice clients who enter a nursing facility remain on C01.  See EAZ Manual Medical Assistance Programs Hospice - ADSA Programs.

·         Add the L02 program by taking the following steps:   1.      From the Assistance Unit>>Summary page in aces.online, add L02 program by following the steps in add a program.  See Screening.    ·         Close the C-Track AU by taking the following steps:   1.      In the month the change occurred, take the following steps:   o        On the AMEN, select Option P – Process Appl Month.    o        On the ADDR screen, update the address if appropriate.     o        Update the AREP screen as appropriate.   o        On the STAT screen for the L02, update the required fields.     o        On the STAT screen for the C01, enter Reason Code 587 - Already Eligible for Program in Different AU - For Administrative Use Only.   o        On the STAT screen for the S03, enter Reason Code 599 – Other - For User Generation Only.   o        On the DEM1 screen, update the living arrangement code if appropriate.  See <F1> Help.   o        On the INST screen, enter the leave date information:   ¨        Enter the [date the client left the ALF] in the Leave Date field.   ¨        Enter the [appropriate code] in the NAC field.  See <F1> Help.   ¨        Enter the [date the waiver services ended] in the End Date field.    o        Call DONE and the VERF screen appears.   o        <F4> past VERF screen for Provider Type.    o        Confirm the C-track AU closes with the Reason Code 587 - Already Eligible for Program in Different AU - For Administrative Use Only  and the S03 closes with Reason Code 599 – Other - For User Generation Only.   o        Commit the data.   2.      In each month following the month the change occurred, take the following steps:    o        On the AMEN, select Option P – Process Appl Month.   o        On the ADDR screen, update the address if appropriate.     o        Update the AREP screen as appropriate.   o        On the STAT screen for the L02, update the required fields.   o        On the STAT  screen for the S03, enter Reason Code 599 - Other - For User Generation Only.    o        On the DEM1 screen, update the living arrangements.     o        On the INST screen:   ¨        Enter a [Y] - Yes in the Del Ind field to delete the ALF and HCBS waiver information.   ¨        <F4> past Edit 2211 - INSTITUTION TYPE NOT VALID FOR LIVING ARRANGEMENT.   o        Call DONE and the VERF screen appears.   o        <F4> past VERF screen for Provider type.   o        Confirm the C01 closes for Reason Code 281 - Waiver not Approved and override the letter.  Confirm the S03 closes for Reason Code 599 - Other - For User Generation Only.   o        Commit the data.    ·         Open the L02 by taking the following steps:    3.      On the AMEN, access the case in Option O - Interview for the ongoing month.   o        On the PEND screen, select the L02 to begin processing the pending AU.   o        On the INST screen, enter the medical facility information.    o        On the MISC screen, update the required fields.   o        Call DONE and commit the data.    o        On the AMEN, access the case in Option P - Process Appl Month.   o        In the month the change occurred, update the living arrangements on the DEM1 screen.    o        After committing the data, follow the instructions in the Process Application Month chapter for all pending months.    o        After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the L02 eligibility determination.

NOTE: ACES establishes a new 12-month certification period for the L02 AU.  Since the L02 certification period should be the same as on the original C01 case, workers need to change the Rev End Date field to [the last month of the certification period for the C01 AU] when finalizing the application.

4.      Reinstate the S03 for all months.    How do I change from L-track to C01 when a client elects Hospice or returns home with COPES/DDD Waiver services?   ·         To change from L-track to C01, follow the procedures in How do I change from L-track to C01 when a client elects Hospice or returns home with COPES/Waiver services?   How do I close the L02 for a client who is deceased?   1.      From the AMEN, select Option R - Interim/Hist Change for the month the change occurred.  2.      On the DEM2 screen:             o     Enter the [date the client died] in the Death Date field.      o     Enter the [state where the client died] in the Death State field, See <F1> Help.  3.      On the INST screen, in the Facility section:             o     Enter the [date the client died] in the Leave Date field  4.      Call DONEand commit the data.  5.      From the AMEN, select Option R - Interim / Hist Change for each month after the           change occurred through the ongoing month.    6.      On the DEM2 screen:             o     Enter the [date the client died] in the Death Date field.             o     Enter the [state where the client died] in the Death State field. See <F1> Help.  7.      On the INST screen: o     Delete institutional information by entering [Y] in the Del Ind field and pressing <F24>.  8.      Call DONE and commit the data  9.      Repeat steps 5 through 8 for all months following the date of death through the ongoing month.   How is Personal Needs Allowance (PNA) determined?   ·         Clients are allowed the highest personal needs allowance (PNA) in a given month based on living arrangement, authorized service and marital status. For more information, see EA-Z Manual Long Term Care Participation.   ·         See Long-Term Care Personal Needs Allowance (PNA) Chart.

EXAMPLE If a client resided at home the first day of the month and went into a nursing home the same day, allow the in home PNA because they were residing in a home setting at least 1 minute during that given month.

EXAMPLE If a client went from a nursing home to an adult family home on COPES services the first day of the month, allow the COPES ALF PNA as it is the highest allowed.

EXAMPLE If that client were then discharged home on COPES from the ALF on the last day of the month, the benefit would be recalculated allowing the COPES in home PNA..

Where do I view split participation when there is a split cost of care?   ·         When the client's cost of care for a single month is split between multiple services/providers, cost of care for each provider will display on the Split Cost of Care LTCP screen.  For example, a client moves from one facility to another.  This AU level screen can display up to 4 different providers/services.    ·         The MAFI screen displays the LTCP indicator next to the Total Payment field when participation for the month has been split between multiple providers.  Workers can access the LTCP screen by pressing <F16> on MAFI.  It can also be called up from any other data collection screen.   ·         When participation is split between providers on INST and short stay providers, the LTCP screen displays the amount of participation owed to the providers on INST.  The participation assigned to the Short Stay provider displays on the SSCC screen.  See Short Stays for additional information.

Categorically Needy Long Term Care SSI Related Undocumented Alien (L04) Who is eligible to receive L04?   How long is the L04 certification period?   How do I screen L04?   How do I process L04?   How do I code the SHEL screen when there is a community spouse?   What do I do when a client moves from one medical facility to another?   How do I close L04 for a client who is deceased?   How is Personal Needs Allowance (PNA) determined?   Where do I view split participation when there is a split cost of care?     Who is eligible to receive L04?   ·         Non-citizen clients who meet the eligibility requirements described in EAZ Manual – WAC 388-513-1315 Eligibility for long term care (institutional, waiver and hospice) services and WAC 388-438-0110 Alien emergency medical (AEM) program.  Non-citizens include undocumented, unqualified aliens, or qualified aliens currently in the five-year ban, so not eligible for other Medicaid programs.     How long is the L04 certification period?   ·         L04 is certified for 3 months.    ·         If additional time is required for treatment of the emergency condition, additional certification periods can be authorized. See EAZ Manual – WAC 388-513-1315 Eligibility for long term care (institutional, waiver and hospice) services. Worker Responsibilities #4.   ·         If income is over the standard for L04, the AU trickles to L95 or L99 and follows MN program certification periods.  See EAZ Manual – WAC 388-438-0110 Alien emergency medical (AEM) program Clarifying Information #3.   How do I screen L04?   ·         An L04 AU is initially screened as an L02 following the instructions in How do I screen L02 medical?   The L02 will trickle to L04 based on citizenship coding.   How do I process L04?   ·         While pending, the AU is still L02.  To process, take the following steps:   1.      Follow steps 1 through 4 in How do I process L02 medical?    2.      On the DEM2 screen:   o         Enter the [appropriate code] for the non-citizen applicant in the citizenship field.  See <F1> help.  For more information, see Who is eligible to receive L04?    o         Enter the applicant’s disability information in the Disability / Incapacity fields.  See <F1> and <F2> help.    ¨        If the client is 65 or older, the Disability / Incapacity fields can be left blank.    3.      On the ALAS screen for the applicant:   o         Enter the applicant’s citizenship/alien status information.  See Interview Group 1 for detailed instructions on completing the ALAS screen.  For more information, see Who is eligible to receive L04?    o         Enter [Y] in the Alien Med Emer field.  This field must be updated at each subsequent certification.   4.      Follow steps 6 through 15 of How do I process L02 medical? to complete the process.    How do I code the SHEL screen when there is a community spouse?   ·         The excess shelter allocation is the amount in excess of the appropriate standard.  See EA-Z Manual WAC 388-513-1380 Determining a client’s financial participation in the cost of care for long-term care (LTC) services.   ·         Enter as a monthly amount the actual rent, mortgage, homeowner’s taxes, homeowners insurance, condo fees, and homeowner association fees.   ·         ACES automatically uses the four-person Standard Utility Allowance (SUA) in this computation.  If utilities are included in the rent, mortgage, maintenance fees or condo fees, deduct that amount of the four-person SUA from these expenses so it will not be allowed twice.

NOTE: If the LTC client has a community spouse who also receives Basic Food assistance on their own, shelter expenses must be entered on the spouse’s SHEL screen in addition to the LTC client’s SHEL screen in order to compute the shelter deduction for the spouse’s Basic Food.  If the institutionalized spouse returns home, be sure to remove the shelter expenses from the appropriate SHEL screen.

What do I do when a client moves from one medical facility to another?   ·         To process a change when a client moves from one medical facility to another, follow the steps in  What do I do when a client moves from one medical facility to another? in the L02 section.    How do I close L04 for a client who is deceased?   ·         To close L04 for a client who is deceased, follow the steps in How do I close the L02 for a client who is deceased? in the L02 section.   How is Personal Needs Allowance (PNA) determined?   ·         For information on how Personal Needs Allowance (PNA) is determined, see How is Personal Needs Allowance (PNA) determined? in the L02 section.   Where do I view split participation when there is a split cost of care?   ·         For information about viewing split participation, see Where do I view split participation when there is a split cost of care? in the L02 section.

Medically Needy Long Term Care No Spenddown (L95) Who is eligible to receive L95?   How long is the L95 certification period?   How do I screen L95?   How do I process L95?     Who is eligible to receive L95?   ·         SSI related clients who reside in a medical institution and have non-excluded income  over the SIL and less than the facility’s department contracted rate.  For more information see EAZ Manual – WAC 388-513-1395 Determining eligibility for institutional or hospice services and for facility care only under the medically needy (MN) program.   ·         Children who are blind or disabled, reside in a medical institution and have non-excluded income over the categorically needy (CN) standard for the children's medical program and less than the facility’s department contracted rate.  For more information see EAZ Manual – WAC 388-513-1395 Determining eligibility for institutional or hospice services and for facility care only under the medically needy (MN) program.   How long is the L95 certification period?   ·         L95 medical is certified for 12 months.  For more information, see EAZ Manual – WAC 388-513-1395 Determining eligibility for institutional or hospice services and for facility care only under the medically needy (MN) program and EAZ Manual – WAC 388-416-0020 Certification periods for non institutionalized medically needy (MN) program.   How do I screen L95?   ·         An L95 AU is initially screened as an L02 following the instructions in How do I screen L02 medical?   ·         The L02 AU will trickle to L95 during Finalize, if appropriate, based on income, living arrangements and INST screen coding.    How do I process L95?   ·         While pending, the AU is still L02 and is processed following the same steps outlined in How do I process L02 medical?   ·         The L02 will trickle to L95 during Finalize based on income, living arrangements and INST screen coding.   ·         If the AU exceeds the income standard for L95, it may trickle to spenddown.  See  Medically Needy Long Term Care With Spenddown (L99).

Medically Needy Long Term Care With Spenddown (L99) Who is eligible to receive L99?   How long is the L99 certification period?   How do I screen L99?   How do I process L99?   How do I authorize spenddown for an L99 AU in M status?   How do I enter spenddown medical expenses for an L99 AU in M status?   How do I initiate an Eligibility Review on an L99 AU?     Who is eligible to receive L99?   ·         Clients who meet the criteria described in EAZ Manual – WAC 388-513-1395 Determining eligibility for institutional or hospice services and for facility care only under the medically needy (MN) program.   How long is the L99 certification period?   ·         The default certification/base period for L99 defaults is 6 months, which can be shortened to 3 months following the instructions in Spenddown – Set the Spenddown Base Period.   ·         Under certain conditions, the base period can be set to a period other than 3 or 6 months.  See EAZ Manual – WAC 388-519-0110 Spenddown of excess income for the medically needy program for these conditions.   How do I screen L99?   ·         An L99 AU is initially screened as an L02 following the instructions in How do I screen L02 Medical?   ·         The L02 AU will trickle to L99 during Finalize, if appropriate, based on income, living arrangements and INST screen coding.    How do I process L99?   ·         While pending, the AU is still L02 and is processed following the same steps outlined in How do I process L02 medical?   ·         The L02 AU will trickle to L99 in [M] - MA Spenddown status during Finalize based on income, living arrangements and INST screen coding.   ·         For additional information on the spenddown process, see EAZ Manual – WAC 388-519-0110 Spenddown of excess income for the medically needy program.     How do I authorize spenddown for an L99 AU in M status?   ·         To authorize spenddown on an L99 AU in M status, follow the instructions in Spenddown Processing – Update and Confirm Spenddown Information.   How do I enter spenddown medical expenses for an L99 AU in M status?   ·         To enter medical expenses to meet the client’s spenddown liability on an L99 AU in M status, follow the instructions in Spenddown – Enter Spenddown Medical Expenses.   How do I initiate an Eligibility Review on an L99 AU?   ·         Eligibility reviews can only be initiated on L99 AUs in A - Active status.   o        Complete the eligibility review on an active L99 AU following the instructions in the Eligibility Review/Recertification Process chapter.   o        To complete a review for a household with a current L99 AU in M – Pending Spenddown status, workers should screen a new AU or use a previous L02/L95/L99 AU. See How do I screen L02 Medical? or Re-open.

Family Long Term Care - Categorically Needy (K01) Who is eligible to receive K01 medical? How long is the K01 certification period? How do I screen K01 medical? How do I process a pending K01 AU? How do I complete the Institution / ALF / HCB (INST) Screen for K01? How do I complete the LTC/HCB/ALF Community Income/Resources (LTCD) Screen for K01? Who is eligible to receive K01 medical? An institutionalized person not receiving medical benefits prior to institutionalization OR a client receiving Family or Children's medical benefits before entering an institution and is expected to stay more than 90 days who meet the criteria in the following WAC/EAZ Manual sections may be eligible for K01 medical: WAC 388-505-0220 Family medical eligibility. WAC 388-505-0210 Children's medical eligibility. WAC 388-513-1315 Eligibility for long-term care (institutional, waiver, and hospice) services. WAC 388-513-1320 Determining institutional status for long-term care (LTC) services. How long is the K01 certification period? The K01 medical program is certified for 12 months. Redetermine eligibility for other medical coverage if the client loses institutional status during their certification period.  How do I screen K01 medical?  From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window. On the Applicant page, enter the applicant's (head of household) Name, Residential and Mailing Addresses. If the applicant is a child, enter the child as the head of household. Click the AREP/Payee checkbox so the hospital can be entered as an authorized representative. To add the hospital as an Authorized Representative, see Screening - aces.online - Authorized Representatives. Continue with the screening process until you reach the Programs page. On the Programs page, click the checkbox next to Long Term Care. Complete the screening process. See Screening a Client. How do I process a pending K01 AU? From the AMEN, access the pending AU via Option O - Interview. On the STAT screen, enter [PN] - Applicant in the Finl Resp field for the applicant. Code any other household members as [NM] - Non Members. On the DEM1 screen, code the Living Arrangement field with [the type of facility the client is living in]. See <F1> Help. For steps to complete the interview follow instructions in the Interview chapter. See below for K01 specific instructions on completing the Institution/ALF/HCB (INST) screen. On the UNER screen, code income contributed to a child from the parents as [OC] - Other Countable Income. When the applicant is a dependent child, only money contributed to the child is counted. See EAZ Manual WAC 388-513-1315 Eligibility for long-term care (institutional, waiver, and hospice) services. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the K01 eligibility determination. If the household income is over the Special Income Level (SIL), determine if the client can be related to the SSI related medical program. See EAZ Manual - WAC 388-475-0050 SSI related medical -- General information. How do I complete the Institution / ALF / HCB (INST) Screen for K01? Information entered on the INST screen determines eligibility for LTC benefits and the level of care so it is important to complete these fields correctly. On the INST screen, take the following steps: In the Type field enter [the type of facility the client is living in]. See <F1> Help. In the Entry Date field enter [the first of the month the client was admitted]. In the Level of Care field, enter [the client's level of care]. See <F1> Help.

EXAMPLE The level of care should match the institution type. For example, if the type code is HS - hospital, the level of care code should be H - hospital.

In the LTC Rate Private field enter [the private daily rate of the facility the client is in]. Call the facility to get the current private rate if it is not known. In the LTC Rate State field enter [the state daily rate of the facility the client is in]. Call the facility to get the current state rate if it is not known. This is used to determine eligibility and participation. Use the Family Member Exemption fields to enter [information to allow deductions related to dependents]. The INST screen allows entry of up to six family members. Enter each family member separately indicating the relationship to the LTC client in the Type code field. In the Family Member Exemption Type field, enter [the type of family member exemption]. See <F1> Help. In the Family Member Exemption Amt field enter [the gross income amount] for Family Member Exemption type. See EA-Z Manual - Long Term Care - K. - Participation ( WAC 388-513-1380) Use the Uncovered Expense Type field to reduce the client's participation by entering [the type of uncovered expense]. See <F1> Help. In the Uncovered Expense Type End Month field enter [the month the client's uncovered expense will end]. Leave this field blank if there is no end month. Use the Other Insurance - Type field to reduce the client's participation by entering [the type of other insurance]. See <F1> Help.