Library: Policy

317:35-9-48. Determination of medical eligibility for care in public ICF/MR

Revised 6-26-00

(a) DHS, Developmental Disability Services Division (DDSD) evaluation reports provide case material for referral to the LOCEU for determination of the need for ICF/MR level of care/medical eligibility.

(b) The following procedure is used in handling referrals from a public ICF/MR for determination of eligibility for public assistance and/or long-term care in the community or private ICF/MR. The superintendent of the public ICF/MR refers to DHS DDSD those persons who in the judgement of the facility staff can adequately be cared for in the community. The referral includes (in addition to the social and financial information) current medical information on the Report of Physician's Examination form; the Long Term Care Assessment form; psychological information and, if applicable, Form SMR-103-A, Itemized Statement of Charges for Care and Treatment.

(1) The DDSD upon receiving the referral from the facility forwards the information to the Level of Care Evaluation Unit (LOCEU) to determine the medical eligibility for long-term care in the community. LOCEU enters the medical determination on MEDATS.
(2) In instances where referral is from a public ICF/MR for an individual returning to the home and/or Community Based Waiver Services, the DDSD case manager forwards to the worker the medical eligibility determination for HCBW/MR services along with the latest application and redetermination forms used to determine eligibility for long-term care. A new application will not be required. A case number is assigned retaining the application date, certification date and redetermination of eligibility date.
(3) The superintendent of the facility makes a referral to the county where the guardian or responsible relative resides. If there is no guardian or parent, the superintendent of the facility makes the referral to the county where the public ICF/MR is located. The county is responsible for taking the application, determining eligibility, certifying the case and for locating an ICF/MR for the applicant in the appropriate county (this may be within the county or in another county in the State). The date of application on these referrals from the public ICF/MR is the date the superintendent made the referral.
(4) If a facility is located in another county, the complete active case is transferred in the usual manner to the county in which the ICF/MR is located. The transferring county is responsible for notifying the superintendent of the public ICF/MR when an active case is transferred to another county.
(5) When an individual is discharged from a public ICF/MR to return home and/or Community Based Waiver Services, the MRP or MRE case is updated with a discharge date, placed in closed status and retained in the county where the facility is located.