Nf: Eligibility Coordination And Specialized Service Needs

When an individual identified with MI and DD is admitted to a NF, the NF must meet that individual's needs, except for specialized services. (7-1-26) 01. Categorical Determinations. When NF level of care is determined categorical, an individual may IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 477 Page 103 be conditionally admitted prior to completion of a determination for specialized services. However, conditional admissions cannot exceed seven (7) days, except for respite admissions which cannot exceed thirty (30) consecutive days in a calendar year. (7-1-26) 02. Specialized Services. Needs must be documented and included in both the resident assessment and service plan. (7-1-26) 03. Non-Compliance Penalty. No payment is made for any services rendered by a NF prior to completion of a Level I screen and, if required, a Level II screen. (7-1-26) 04. Appeals. A Level I determination of MI or ID is not appealable but may be disputed as part of a Level II determination appeal. (7-1-26) 477. NF: PREPAYMENT SCREEN AND DETERMINATION OF ENTITLEMENT TO MEDICAID PAYMENT FOR NF CARE AND SERVICES. A current Minimum Data Set (MDS) assessment is provided to the Department. Additional supporting information may be requested. In the event a required Level II screen was not completed prior to admission, entitlement for Medicaid payment is not earlier than the date of Level II screen completion, indicating NF placement is appropriate. (7-1-26)