Current through Register Vol. 48, No. 38, September 20, 2024
Interim services are CCP services provided to participants
age 60 and over on an interim basis, dependent upon the participant's
presumptive eligibility and following prescreening of the participant.
a) Presumptive eligibility shall be based
upon the following criteria:
1) A referral has
been received from a participant age 60 or over, or from the participant's
authorized representative, following prescreening.
2) Notification has been received by the CCU
from a hospital or from a participant/authorized representative or agency in
the community that the participant is at imminent risk of nursing facility
placement within three calendar days.
3) The DON to determine need for long-term
services and supports has been administered.
4) The participant/authorized representative
has provided declared information on all other CCP eligibility
requirements.
5) The
participant/authorized representative has signed a Participant Agreement and
Consent Form.
6) After presumptive
eligibility has been determined, the CCU shall notify the provider within the
next business day and services will start within two business days.
b) When presumptive eligibility
has been determined and interim services are approved in accordance with the
person-centered plan of care, services shall be initiated by the provider to
the participant within two work days after the date of notification to the
provider of the participant's presumptive eligibility.
c) A comprehensive assessment shall be
administered in the residence of the participant by the CCU.
1) When the assessment is not conducted in
the community, the CCU will make the follow-up home visit within 15 calendar
days after the date of the participant's discharge.
2) When the assessment is conducted in the
community, the CCU will make the follow-up home visit within 30 calendar days
after the date of the interim assessment.
3) The formal determination of eligibility
for CCP services shall be completed within 90 calendar days after the date of
receipt of the referral.
d) Interim services may continue up to a
maximum of 90 calendar days after the date of referral, pending finalization of
the formal determination of eligibility by the CCU. Services shall be denied at
any time during the 90 calendar day interim service period:
1) if evidence of ineligibility, based upon
any eligibility requirement, is determined;
2) if the participant/authorized
representative fails to cooperate in the determination of eligibility
process;
3) as specified in Section
240.660, in the event that a
participant's eligibility cannot be determined due to the
participant's/authorized representative's failure to provide accurate and
verifiable documentation regarding eligibility within 90 calendar days after
the date of receipt of the referral; or
4) if a person-centered plan of care cannot
be developed that adequately meets the participant's determined needs (see
Section 240.920(n)).
e) Notification of eligibility or
ineligibility shall be provided in writing. If eligibility is denied, provision
of interim services shall cease on the date of receipt by the provider of the
Participant Agreement - Person-Centered Plan of Care.
