Short Stay

Created on: 
Oct 21 2015

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

What is a short stay?

A short stay is when a client enters a medical facility or elects Hospice services for a short time frame. For additional information, see Apple Health eligibility manual - Long-Term Care Short Stay.

Financial workers usually learn about short stays after they have ended and the clients have returned to their regular living situation.

How long can a short stay be?

Up to 29 days for:

Up to 90 days for:

  • Clients who meet non-institutional rules active in a TANF or RF AU.
NOTE: Policy allows 180 days, however, at this time ACES only allows 90 days. See the EA-Z Manual – WAC 388-454-0015 Temporary absence from the home for more information.

When is it appropriate to enter a short stay?

Short stay data can only be entered for:

  • Active medical recipients.
  • After the short stay has ended.
  • Historical months.
  • Stays in a medical institution or for hospice services.
  • Clients who return to their original setting when the short stay ends.
EXAMPLE: Client resides in an Adult Family Home (AFH) and is admitted to a Nursing Facility (NF) for two weeks. The client returns back to the same AFH. This situation should be entered as a short stay.
EXAMPLE: Client resides at home and is active on an SSI Related Categorically Needy (S02) Medical Assistance Unit (AU). Client admits to a NF for three weeks. The client returns home. This situation should be entered as a short stay.
EXAMPLE: Client resides in a NF, and has a medical condition requiring hospitalization. The client discharges from the NF and enters the hospital. After two weeks, the client enters a new NF. This situation would not be considered a short stay because the client entered a different NF. 
EXAMPLE: Client resides in an ALF, and has a medical condition that requires a stay in a NF or hospital for over 29 consecutive days. Client then returns to the same ALF. Since the client was in a NF or hospital for over 29 consecutive days this situation would not be considered a short stay.

Online Processing

How do I enter a short stay?

  1. On the Case Actions page in the Change of Circumstances section take the following steps:
  • Benefit Month field - use the drop down menu to select the appropriate benefit month.
  • Click the Start Changes link. 
  1. On the Institutional Care page:
  • Add a Short Stay page for the client and update the following fields:
  1. Stay Living Arrangement field- Select the appropriate living arrangement using the drop down menu.
  2. Facility Type field - Select the medical facility subset using the drop down menu.
  3. HCBS Type field - Select Hospice (H) if appropriate.
  4. Provider ID field - Enter the [provider ID].
  5. Entry Date and Leave Date fields - Enter the [entry and leave dates].
  • The Entry Date must be for the benefit month being processed.
  • The Leave Date cannot be prior to the Begin Date and can’t exceed the current date.
  • If the short stay spans multiple months, see What if the short stay spans multiple months?
  • When multiple stays exist, the dates cannot overlap, except in the following situations:
    • The Leave Date of one short stay is equal to the Entry Date of the next stay.
    • Hospice services as a short stay in a medical facility can be coded concurrently with an institutional stay when the client has elected Hospice services while in an institution.
    • Hospice service data must be entered in the Home Community Based Service (HCBS Type – H) section as a separate entry from the institutional data in order to capture rates for each provider.
  1. Payment Authorization Date field - Enter the [payment authorization date].
NOTE: If the Payment Authorization Date is not entered it is possible that the Assistance Unit (AU) will approve; however, the cost of care will not be calculated.
  1. State Rate Amount field - Enter the [daily state rate].
  1. Click on Eligibility and then click the Commit Changes button to commit the data.

ACES generates the following letters for authorized short stays:

  • For K or L-track clients - Letter 002-17 (Approval for LTC Services) or Letter 002-18 (Approval for Hospice Services) based on the type of stay.
  • For non-institutional and I-track clients – Letter 002-32 (Approval for Short Stays).
    • This letter is addressed to the client for whom the short stay was entered, regardless of the client’s age or whether or not the client is the Head of Household (HOH).
    • This letter does not generate for hospital short stays.
    • If this letter is generated for a D01 or D02 AU it will only be viewable in aces.online for Foster Care Unit workers.
  • A separate letter generates for each individual stay, unless the stays are for the same provider.

What if a short stay spans multiple months?

When a short stay spans multiple months, the stay must be entered in the month in which the stay begins.

If the user receives message Short Stay spans multiple months - must process each month, other months must be processed and eligibility manually recalculated for each month impacted by the stay.

To recalculate eligibility take the following steps:

  1. On the Case Actions page in the Change of Circumstances section take the following steps:
  • Benefit Month field - use the drop down menu to select the appropriate benefit month.
  • Click the Start Changes link. 
  1. On the Eligibility page click the Calculate Eligibility link.
  2. Click the Details link and the Eligibility Details page displays.
  3. Review the changes and if they are correct, click the Confirm Benefits button.
  4. The Eligibility page redisplays and to commit the data click the Commit Changes button.
NOTE: Each month of a short stay needs to be recalculated individually.

How is participation assigned to a short stay provider?

ACES calculates client cost-of-care responsibility based on data entered on the Short Stays page and the clients circumstances.

Participation is only assigned to short stays with a Payment Authorization Date entry.

Participation is assigned first to providers coded on the Facilities page and if there is any remaining participation, it is assigned to the short stay providers.

NOTE: If the Payment Authorization Date is not entered it is possible that the Assistance Unit will approve; however, the cost of care will not be calculated.

How do I view participation assigned to a short stay provider?

  1. On the Case Actions page in the Change of Circumstances section take the following steps:
  • Benefit Month field - use the drop down menu to select the appropriate benefit month.
  • Click the Start Changes link. 
  1. On the Institutional Care/Expenses page in the Short Stays section click on the short stay provider you want to view participation for and the Short Stay page will display.

In the Cost of Care section the following information displays for 1, 2, or 3 months:

  • Room and Board Amount
  • Participation Amount
  • Third Party Resource Amount
  • Total Payment

Mainframe Processing

How do I enter a short stay?

  1. On the AMEN, select Option R – Interim / Hist Change.
  • In the Benefit Month field - enter the [month the short stay began].
  1. On the STAY screen update the following fields:
  • Liv Arr field - enter the [short stay living arrangement type].
  • Type INST/HCBS field - enter the [medical facility subset valid value or H – Hospice].
  • Provider ID field - enter the [provider id number].
  • Stay Date fields - enter the [entry and leave dates].
    • The Entry Date must be for the benefit month being processed.
    • The Leave Date cannot be prior to the Begin Date and can’t exceed the current date.
    • If the short stay spans multiple months, see What if the short stay spans multiple months?
    • When multiple stays exist, the dates cannot overlap, except in the following situations:
      • The Leave Date of one short stay is equal to the Entry Date of the next stay.
      • Hospice services as a short stay in a medical facility can be coded concurrently with an institutional stay when the client has elected Hospice services while in an institution.
      • Hospice service data must be entered in the Home Community Based Service (HCBS Type – H) section as a separate entry from the institutional data in order to capture rates for each provider.
  • Pymt Auth Dt field - enter the [payment authorization date].
NOTE: If the Payment Authorization Date is not entered it is possible that the Assistance Unit (AU) will approve; however, the cost of care will not be calculated.
  1. Press <TRANSMIT> to commit the data.

ACES generates the following letters for authorized short stays:

  • For K or L-track clients –  Letter 002-17 (Approval for LTC Services) or Letter 002-18 (Approval for Hospice Services) based on the type of stay.
  • For non-institutional and I-track clients – Letter 002-32 (Approval for Short Stays).
    • This letter is addressed to the client for whom the short stay was entered, regardless of the client’s age or whether or not the client is the Head of Household (HOH).
    • This letter does not generate for hospital short stays.
    • If this letter is generated for a D01 or D02 AU it will only be viewable in aces.online for Foster Care Unit workers.
  • A separate letter generates for each individual stay, unless the stays are for the same provider.

What if the short stay spans multiple months?

When a short stay spans multiple months, the stay must be entered in the month in which the stay begins.

If the user receives Edit 2222 - SHORT STAY SPANS MULTIPLE MONTHS - MUST PROCESS EACH MONTH, other months must be processed and eligibility manually recalculated for each month impacted by the stay.  See <F2> help.

To recalculate eligibility take the following steps:

  1. On the AMEN screen: 
  • Select Option R - Interim/Hist Change.
  • Enter the [CLID number] in the Client ID field and the [benefit month the short stay began] in the Benefit Month (MM YY) field.
  1. On the MISC screen:
  • Enter a [Y] - Yes in the Calc Elig field.
  1. Press <TRANSMIT> to commit the data.
NOTE: Each month of a short stay needs to be recalculated individually.

How is participation assigned to a short stay provider?

ACES calculates client cost-of-care responsibility based on data entered on the STAY screen and the clients circumstances.

Participation is only assigned to short stays with a Payment Authorization Date entry.

Participation is assigned first to providers coded on the INST screen and if there is any remaining participation, it is assigned to the short stay providers.

NOTE: If the Payment Authorization Date is not entered it is possible that the Assistance Unit will approve; however, the cost of care will not be calculated.

How do I view participation assigned to a short stay provider?

To view participation assigned to a short stay provider, take the following steps:

  1. On the AMEN screen: 
  • Select Option B – AU/Client Inquiry.
  • Enter the [CLID number] in the Client ID field and the [benefit month the short stay began] in the Benefit Month (MM YY) field.
  1. On the STAY screen:
  • Enter a [Y] - Yes in the Sel field next to the short stay to be viewed.
  • Press <F13> and the SSCC screen displays.
  • The SSCC screen displays the following fields for 1, 2 or 3 months, depending on the length of the short stay:
    • Room & Board
    • Third Party Resources
    • Participation
    • Total Payment

 

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