Categorically Needy LTC in a Medical Facility – SSI Related (L02)

Created on: 
Oct 16 2017

See ACES Screens and Online Pages for an example of pages or screens used in this chapter

Who is eligible for L02 (Categorically Needy LTC in a Medical Facility – SSI Related) medical?

Clients who meet the eligibility criteria described in the following manual sections may be eligible for L02 medical:

How long is the L02 (Categorically Needy LTC in a Medical Facility – SSI Related) certification period?

L02 is certified for 12 months.

Online Processing

How do I screen L02 (Categorically Needy LTC in a Medical Facility - SSI Related) medical?

To screen an L02 Assistance Unit, take the following steps:

  1. Follow the instructions in Screening a Application.
  • On the Programs page, click the checkmark next to Long Term Care.

How do I process a pending L02 (Categorically Needy LTC in a Medical Facility - SSI Related) Assistance Unit (AU)?

To process a pending L02 AU, take the following steps;

  1. From the Case Actions page, click the Start Interview link in the Pending Application section.
  2. Check Begin Intake on the Pending Applications page to initiate the interview. For more information on completing the intake, see How do I initiate and complete an intake interview?  
  3. On the Contact Information page, add an Authorized Representative/Payees if appropriate. See How do I add an authorized representative (AREP) during screening?
  4. On the AU Details page, complete the Financial Responsibility fields for each Household (HH) member as follows:
     
    • Applicant (PN) - for the applicant
    • Ineligible Spouse (SP)  - for applicant spouse (if applicable)
NOTE: Dependents are coded on the Family Member Allowance page. This allows the correct post-eligibility allowance calculation for the dependents. A dependent is a child, sibling or parent the individual is claiming to the IRS as a dependent.
  1. On the Client Details page update the following information for each HH member:
     
    • Marital Status field - select the valid value for client’s marital status from dropdown.
      • The marital status of both the applicant and spouse must be coded as S - Legally SeparatedP - SeparatedA - Married Living Apart or M - Married for the system to recognize the couple as married. This information is needed for the system to determine if the spouse is a community spouse or an institutional spouse and correctly calculate the spousal allocation.
    • Living Arrangement field – select client’s living arrangement from the living arrangement dropdown menu.
NOTE: If the client is 65 or older, the Disability/Incapacitated/Psychiatric section can be left blank.
  1. On the Income page, add income for each household member.
     
    • On the Earned Income page, complete this page if the client has earned income.
    • On the Unearned Income page, enter the types and amounts of all unearned income.
  1. On the Resources page, enter [client resource information] on the Liquid Resources Vehicle/Vessel, Real Property, Insurance Policy, Other Resources and Transferred Resource pages. For information on how to complete the resource pages, see Resources.
     
  2. On the Institutional Care page:
     
    • If the client’s living arrangement code is outside an At Home (AH) setting, update the  Facilities section with the following information:
      • Type field - Select the facility type from the dropdown.
      • ID field - Enter the [provider ID number] if required. To find the provider’s ID number click on the Search link to go to the Provider Search page. For additional information on Vendor payments, see: How do I inquire on a Vendor?
      • Entry Date field - Enter the [date the client entered the facility].
      • Level of Care field - Select appropriate level of care from the dropdown.
      • Payment Auth Date field -Enter the [date payment to the facility should begin].  This is the date the LTC services are approved and displays on the award letter.
NOTE: If the Payment Auth Date is not entered, it is possible the AU will approve, however, the cost of care is not calculated.
  • Private Rate field - Enter the [facilities private daily rate]. Contact the facility for the rate information.
  • Daily Rate field - Enter the [facilities state daily rate]. Select Details to inquire on the Most Recent Level of Care Rate Amt.
    • For non-medical facilities, use the rate provided by the Home & Community Services (HCS), Developmental Disabilities Administration (DDA), or HCS Social Worker (SW) / Community Nurse Consultant (CNC) case manager.
NOTE: To add details to the Institutional Care Page, click the Add icon from the toolbar.
  1. On the Home and Community Based Services (HCBS) page enter the following information if the client receives waiver, hospice or other services:
     
    • Type field - Select the appropriate waiver or service type from the dropdown.
    • Provider ID field - Enter the [provider ID number] if required, to find the provider’s ID number Search to go to the Provider Search page. See Vendor Payment – How do I search for a vendor?
    • Start Date field - Enter the [date the waiver service begins].
    • Approval Source field - Select approval source from the dropdown menu.
    • Payment Auth Date field - Enter the [date payment is to begin]. This is the date the LTC services are approved and displays on the award letter.
NOTE: If the Payment Auth Date is not entered it is possible the AU will approve, however, the cost of care will not be calculated.
  • For non-medical facilities, use the rate provided by the Home & Community Services (HCS), Developmental Disabilities Administration (DDA), or HCS Social Worker (SW) / Community Nurse Consultant (CNC) case manager.
  • If the HCBS type is Hospice – (H) update the following fields:
  • Private Rate field - Enter the [provider’s private daily rate]. Call the facility to get the current private rate.
  • State Rate field - Enter the [facilities state daily rate].
NOTE: To find the most current state rate for nursing facilities, veteran facilities or hospice care centers go to the MMEN and enter option DProvider Name List.
  1.  If the client has long term care expenses or deductions, update the  Long Term Care Expenses/Deductions page with the following information:
     
    • Type field- Select any qualified expenses or deductions that can be used to reduce participation or excess resources from the dropdown.
    • Amount field - Enter the [amount of the expense/deduction].  
    • End Month field - Enter the [date the expense/deduction ends].
       
  2. If the client has long term care expenses or deductions, update the  Room & Board Exceptions page with the following information;
     
    • Type field - Select any qualified exception that can be used to reduce room and board from the dropdown.
    • Amount field - Enter the [amount of exception]
    • End Month field - Enter the [date the exception ends].
NOTE: Expense type Predictable Ongoing Expense (RP) is NOT a post eligibility deduction. This amount is added to the facility rate and used as recurring medical expenses when calculating the net income in initial eligibility for HCBS waivers in Group 3 - clients who have gross income above the SIL and net countable below the MNIL.
  1. If a client is in a medical facility and has approved Housing Maintenance Allowance, enter the following information:
     
    • Amount field- Enter the housing maintenance amount authorized by HCS or DDA social services.
      • The maximum amount used in the post-eligibility calculation is the one-person MNIL.
    • Begin Month field- Enter the [beginning month & year].
      • This allowance is for six months, starting with the month entered in this field.
         
  2. If the client has dependent(s) enter family member allowance on the Family Member Allowance page.
     
    • Type field: Enter Child (C) – for a dependent living with a community spouse or Other Dependent (O) – for other Dependents not living with a community spouse.
    • Amount field: Enter the gross income amount of the dependent.
      • If the dependent does not have any income, leave the Amount field blank.
         
  3. Complete the Community Spouse Resource Allowance (CSRA) screen(s) if the client has a community spouse and they are getting a CSRA higher than the state rate. If not, only complete the MRCPI or Service Start Date. See Help linkHelp.
NOTE: If the LTC client has a community spouse, shelter expenses must be entered on the spouse’s Shelter Expense page in order to compute the excess shelter portion of the spousal maintenance allowance (and the shelter deduction for the spouse’s Basic Food, when applicable)
  1. After committing the interview data, follow the instructions in the How do I complete Process Application Month for all pending months.
  2. Once the pending months have been processed, follow the instructions in the How do I complete Finalize Application.

Mainframe Processing

 How do I screen L02 (Categorically Needy LTC in a Medical Facility – SSI Related) medical?

To screen an L02 AU, take the following steps:

  1. Follow the instructions in Screening an Application.
     
    • On the Programs page, click the checkmark next to Long Term Care.

 How do I process a pending L02 (Categorically Needy LTC in a Medical Facility – SSI Related) Assistance Unit (AU)?

To process a pending L02 AU, take the following steps:

  1. From the AMEN screen, select Option O - Interview.
  2. On the PEND screen:
     
    • Enter a [Y] – Yes in the Beginning Processing for ALL pending AUs listed with Blank Intake Begin Date? field or enter [Y] – Yes in the S field for each individual AU to initiate the intake interview.
       
  3. On the ADDR screen:
     
    • Enter a [Y] in the Auth Rep/Payee field, if appropriate.
       
  4. On the STAT screen, complete the Finl Resp fields as follows:
     
    • [PN] – Applicant for the applicant.
    • [SP] – Ineligible Spouse/Non-Applying Spouse for the applicants’ spouse.
NOTE: The dependents are coded on the LTCX screen under the Family Member Allowance section. This allows the correct post-eligibility allowance calculation for the dependents. A dependent is a child, sibling or parent the individual is claiming to the IRS as a dependent.
  1. On the DEM1 screen:
     
    • Enter the [valid value for the clients living arrangement] in the Living Arng field. See <F1> Help.
    • Enter the [marital status] in the Marital Status field.
      • The marital status of both the applicant and spouse must be coded as S- Legally Separated, P – Separated, A – Married Living Apart or M – Married for the system to recognize the couple as married. This information is needed for the system to determine if the spouse is a “community spouse” or an “institutional spouse” and correctly calculate the spousal allocation.
         
  2. On the DEM2 screen:
     
    • If the applicant is receiving Medicare Part A or Part B, enter a [Y] - Yes in the Entitled Medicare field.
    • Complete the TPL1 screens. For more information, see How do I process a pending S03 AU?
      • If the client is 65 or older, the Disability / Incapacity section can be left blank.
         
  3. On the INST screen:
     
    • If the client lives in an alternative living or medical facility, use the Facility section to:
      • Enter the [type of facility] in the INST Type field. The facility type must be from the same subset as the living arrangement coded on the DEM1 screen.
      • Enter the [provider number] in the Provider ID field if the provider is one of the following facility types: MD – Nursing Facility – Medicaid, ME – Nursing Facility – Medicare, SN – VA Nursing Facility or HC – Hospice Care Center.
      • Enter the [date client entered the facility] in the Entry Date field.
      • Enter the [client’s level of care] in the Level Care field.
      • Enter the [date payment to the facility should begin] in the Payment Auth Date field. This is the date the LTC services are approved and displays on the award letter.
NOTE: If the Payment Auth Date is not entered it is possible the AU will approve, however, the cost of care is not calculated.
  • Enter the [facilities private daily rate] in the Private Rate field. Contact the facility for rate information.
  • Enter the [facilities state daily rate] in the State Rate field. Press <F20> to access the MMEN for state rates for providers.
    • For non-medical facilities, use the rate provided by the Home & Community Services (HCS), Division of Developmental Disabilities Administration (DDA), or HCS Social Worker (SW) / Community Nurse Consultant (CNC) case manager.
  • In the Home Community Based Service section, enter the following information if the client receives waiver or hospice services:
    • Enter the [appropriate waiver or service type] in the HCBS Type field.
    • Enter the [provider ID number] when using HCBS type [H] – Hospice 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. For more information, see How do I inquire on a vendor?
    • 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.
NOTE: If the Payment Auth Date is not entered it is possible the AU will approve, however, the cost of care is not calculated.
  • 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.
NOTE: To find the most current state rate for nursing facilities, veteran facilities or hospice care centers go to the MMEN and enter option D – Provider Name List.
  1. On the LTCX screen:
     
    • In the LTC Expenses / Deductions section:
      • Enter any [qualified expenses or deductions] that can be used to reduce participation or excess resources in the Type and Amount field.
    • In the Housing Maintenance Allowance section, enter the following information if a client in a medical facility has an approved housing maintenance allowance/MIIE.
      • Enter the [housing maintenance amount] authorized by HCS or DDA social services in the Amount field.
        • The maximum amount used in the post-eligibility calculation is the one-person MNIL.
        • Enter a [Y] - Yes or [N] - No in the Approved field.
        • Enter the [beginning month & year] in the Begin Month field.
        • This allowance is for six months, starting with the month entered in this field.
    • In the Family Member Allowance section, enter the following information if the client has a dependent(s).
      • Enter [C] – Dependent who lives with a community spouse or O – Dependents who does not live with a community spouse in the Type field.
      • Enter the [gross income amount] of the dependent in the Amount field.
      • If the dependent does not have any income, leave the Amount field blank.
    • Enter a [Y] - Yes in the Force Name on Check Rule field, if the client wishes to use the name on the check rule.
    • Enter a [Y] - Yes in the Waive Spousal Allocation field, if the client wishes to waive the spousal portion of the maximum spousal/family allowance.
    • In the Room & Board Exceptions section, enter the following information if the client has an approved R&B exception:
      • Enter the [R&B exception type code] in the Type field.
      • Enter the [amount of the exception] in the Amount field.
      • The exception allowed in the post-eligibility calculation cannot exceed the maximum R&B liability amount.
      • Enter the [R&B exception verification code] in the V field.
      • Enter the [month & year the exception ends] in the End Month field.
NOTE: Expense type RP – PREDICTABLE ONGOING EXPENSE - Added to Facility Rate for MN Initial Elig Cal is not a deduction. This amount is added to the facility rate and used as the “recurring medical expenses” when calculating the income limit in initial eligibility for MN medical for Group (3) clients who have gross income above the SIL and net countable below the MNIL.
  1. Enter [client resource information] on the RES1, RES2 and RES3 screens. For information on how to complete the resource screens, see How do I complete the RES1 screen?
     
  2. If the client has transferred an asset, complete the TRAN screen with the appropriate information. See <F1> and <F2> Help. For more information, see Apple Health eligibility manual – Long-Term Care Program Requirements - Resource Eligibility Index - Transfer of an Asset.
  3. On the EARN screen:
     
  4. On the UNER screen:
     
  1. Complete the CSRA screen if the client has a community spouse. See <F2> Help
  2. On the SHEL screen:
     
NOTE: If the LTC client has a community spouse, shelter expenses must be entered on the spouse’s SHEL screen in order to compute the excess shelter portion of the spousal maintenance allowance (and the shelter deduction for the spouse’s Basic Food, when applicable).
  1. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
  2. Once the pending months have been processed, follow the instructions in the Finalize Application chapter.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.