Current through Register Vol. 48, No. 38, September 20, 2024
a) Long term care providers shall submit all
changes in resident status, including, but not limited to, death, discharge,
requests for enhanced care rates, changes in patient credit, and third party
liability (TPL), to the Department through the Medical Electronic Data
Interchange (MEDI) system or through an Electronic Data Interchange (EDI)
Service Vendor (see Section
140.55)
, formerly known as Recipient Eligibility Verification (REV) system, after the
change occurs, within the following timeframes:
1) Death of a resident - 15 calendar
days.
2) Discharge of a resident -
15 calendar days.
3) Changes in
patient credit - 45 calendar days.
4) Third party liability - 45 calendar
days.
5) Request for enhanced care
rate - 45 calendar days from the effective date of the enhanced rate.
b) Admission data shall be
submitted as follows:
1) For submission of
admission data prior to September 1, 2014, admission data shall be submitted
within 15 business days after the receipt by the long term care provider of the
information contained in the HFS 2536 Interagency Certification of Screening
Results. Admission data shall be submitted through MEDI, REV or EDI, or the
admission documents may be submitted directly to the Department of Human
Services using required admission forms.
2) For submission of admission data on or
after September 1, 2014, admission data, including all screening information,
must be submitted through MEDI, REV or EDI within the same time frame as in
subsection (b)(1). Admission documents submitted directly to the Department of
Human Services shall not be accepted. Long term care providers
shall not be required to submit admission documents directly
to the Department of Human Services as a condition of compliance with this
Section.
3) Effective for
resident admissions on or after January 1, 2018, long term care providers shall
have 45 calendar days to submit resident admission data to the Department by
completing a long term care admission transaction. Confirmation numbers
assigned to accepted long term care admission transactions shall be retained by
a long term care provider to verify timely submittal. Day one of the 45
calendar day period commences on either: the date the long term care provider
receives the required pre-admission screening results (HFS form 2536
(Interagency Certification of Screening Results) or HFS form 3864 (Screening
Verification)) from the screening agent, or the admission date entered by the
provider, whichever is later. Long term care providers shall complete a long
term care admission transaction by submitting admission data through MEDI or
through an EDI Service Vendor. If required, supporting documentation for the
completed long term care admission transaction that cannot be submitted through
MEDI or an EDI Service Vendor shall be submitted to the Department of Human
Services caseworkers that processed the resident's application.
4) Effective for resident admissions on or
after January 1, 2022, in accordance with PA 102-123, long term care providers
shall have 120 calendar days to submit resident admission data to the
Department by completing a long term care admission transaction. Confirmation
numbers assigned to accepted long term care admission transactions shall be
retained by a long term care provider to verify timely submittal. Day one of
the 120 calendar day period commences on either: the date the long term care
provider receives the required pre-admission screening results (HFS form 2536
(Interagency Certification of Screening Results) or HFS form 3864 (Screening
Verification)) from the screening agent, or the admission date entered by the
provider, whichever is later. Long term care providers shall complete a long
term care admission transaction by submitting admission data through MEDI or
through an EDI Service Vendor. If required, supporting documentation for the
completed long term care admission transaction that cannot be submitted through
MEDI or an EDI Service Vendor shall be submitted to the Department of Human
Services caseworkers that processed the resident's application.
5) Any data or hard copy document provided to
a long term care provider by an external entity or created by a long term care
provider, for purposes of documenting a resident's long term care admission,
shall be maintained, electronically or in hard copy, in the resident's file.
This information will be used to verify receipt by the long term care provider
of information contained in the required pre-admission screening
results.
c) Reported
admissions and changes in resident status shall be used for the purposes of
determining Medicaid reimbursement. Income verification for any patient credit
change shall continue to be submitted to the Department of Human Services
caseworker. All admissions and changes in resident status are subject to
Department review.
d) Long term
care providers are responsible for training employees to comply with the
deadlines outlined in this Section and maintaining proof of this training in
accordance with Section
140.590.
Failure to comply with the requirements outlined in this Section may result in
denial or delay of payment or termination or suspension of the long term care
provider's participation in the Medical Assistance Program.
