STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

Aging and Long-Term Support Administration

Home and Community Services Division

PO Box 45600, Olympia, WA 98504-5600

H14-080 - Policy/Procedure

November 14, 2014

TO: / Home and Community Services (HCS) Division Regional Administrators
Area Agency on Aging (AAA) Directors
FROM: / Bea Rector, Director, Home and Community Services Division
SUBJECT: /
State-funded Nursing Facility Payment Process
Purpose: / To inform staff of the process for Aging and Long-term Support Administration to pay for a resident’s stay in a nursing facility (NF) when the stay is paid using state-only funds.
Background: / ALTSA currently pays a nursing facility for a resident whose stay is not covered by the Health Care Authority using a Form A-19 Invoice Voucher. ALTSA pays for a short NF stay when an individual:
·  Is placed in a NF through Adult Protective Services (APS)
·  Does not meet nursing facility level of care (NFLOC. ALTSA only pays while the resident’s discharge plan is finalized and implemented).
When ProviderOne goes live, the A-19 payment process will no longer be an option.
What’s new, changed, or
Clarified / When ProviderOne goes live (anticipated date is 11/24/14), staff will authorize payment to a nursing facility for a state-only funded NF stay by authorizing one of the following Recipient Aid Categories (RAC). This will allow the NF to bill through ProviderOne and payment to be made using state-only funds.
ACTION: / 1.  For an individual placed in a nursing facility who meets the criteria for use of state-only APS funds:
a.  Authorize this service only if there are no other options and immediate placement in a nursing facility is the only available and appropriate residential setting to meet the vulnerable adult’s needs.
b.  Document need in an APS SER in CARE.
c.  Inform client of the 30 day limit.
d.  Add the anticipated number of days to the consent form (up to the maximum of 30) and obtain written consent.
e.  Complete or obtain the CARE assessment to verify the NF provider can meet the client’s needs. Consult with the HCS nursing facility case manager or supervisor regarding placement and assessment, as needed.
f.  Obtain APS program manager or HCS Regional Administrator (RA) approval for funding and document in the APS SER.
g.  Locate Medicaid-certified provider and place client.
h.  The APS worker facilitates authorization of RAC 3312 APS NF Placement
i.  The NF can log into ProviderOne to bill for the resident’s stay.
2.  For an individual who does not meet NFLOC:
a.  NFCM authorizes RAC 3301 for HCS State Funded NH Services.
b.  The NF can log into ProviderOne to bill for the resident’s stay (ALTSA’s policy is to pay up to the date of discharge or 30 days, whichever is earlier).
i.  The NFCM should work jointly with the social worker at the NF to discharge the individual in a timely manner.
Related
REFERENCES: / Information regarding eligibility, processes and procedure for these services are found in the APS and Nursing Facility Case Management and Relocation chapters of the LTC Manual, which will be updated to reflect these change.
ATTACHMENT(S): / ProviderOne Talking Points (ADS Intranet site)
ProviderOne: CARE/P1 Training (ADS Intranet site)
CONTACT(S): / Debbie Blackner
Nursing Facility Case Management Program Manager
(360) 725-2557

Mike Wagner,
Adult Protective Services Program Manager
360.725.2616

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