Ch. 19, § 7. Medicaid Payment

(a) The Department shall not pay for nursing facility services furnished to an individual until: (i) The completion of the Level I screening which determines Level II screening is not required; or (ii) If the Level I screening determines Level II screening is required, the completion of the Level II screening and a determination that nursing facility placement is appropriate; and (iii) The completion of the evaluation of medical necessity pursuant to Chapter 22 which determined that nursing facility services are medically necessary. (b) Retroactive payments. (i) For individuals that do not require Level II screening, Medicaid payment commences upon the Department's receipt of the Level I screening results if the Department has an evaluation and finding of medical necessity pursuant to Chapter 22. (ii) For individuals who require Level II screening, Medicaid payment commences upon the completion of the Level II screening which indicates that nursing facility services are appropriate, except as otherwise specified in this Chapter. Payment is retroactive to the date of the completion of the Level II screening, provided there was an evaluation of medical necessity pursuant to Chapter 22. Payments for residents permitted to continue to reside in a nursing facility pursuant to the thirty month rule defined in 42 C.F.R. § 483.130, are contingent upon completion of a Level II screening, regardless of whether the screening determines that nursing facility services are appropriate.