Provider Notice Issued 03/11/2020

Date:   March 11, 2020

 

To:      Long Term Care Providers - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program providers (SLP), Medically Complex for the Developmentally Disabled Facilities (MC/DD), and Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re:      Implementation of New Policy for Systematic Processing of Facility to Facility Transfer Long Term Care Admissions and Additional MEDI Edits
 
 
This notice informs Long Term Care (LTC) providers that the Department of Healthcare and Family Services (HFS) is implementing new system changes for the processing of LTC admission transactions when an individual is transferring from one LTC provider to another.  LTC admissions that qualify as transfers will be systematically processed and entered into the State’s payment system.  Providers will be able to begin billing immediately for these transactions.
In addition, HFS is incorporating additional front-end edits into the MEDI LTC Admission process to more quickly notify providers of issues that will affect the processing of admission transactions.
Admissions Qualifying as Transfers
A submitted admission transaction will be considered a transfer, that may qualify for systematic processing, if the recipient has a prior LTC admission already on the system that:
Ø  is for a period of 60 days or more, and
Ø  has a discharge date that is within 60 days of the requested admission date.
If the admission qualifies as a transfer and is systematically processed, the message ‘Transaction Accepted and Processed’ will be returned on the MEDI LTC Admission Results above the Transaction Audit Number.
 
NOTE:  Previous admissions that are Provisional Eligibility admissions, Medicare Only admissions or admissions to a State Operated Facility are not considered prior qualifying admissions.
 
Admission Submission Requirements
RINs / SSNs:
Ø  In order to systematically process a transfer admission, the admission must be submitted with either a Recipient Identification Number (RIN) or a Social Security Number (SSN).
Ø  Using the resident’s RIN will provide the greatest assurance that the admission can be systematically processed.
Ø  For admission transactions submitted using only the SSN, it is required that the date of birth also be submitted to be eligible for systematic processing.  This will allow HFS to search and locate the correct RIN.  If a match is located, the RIN will be populated on the MEDI LTC Admission Results.  If the admission qualifies as a transfer, the matching RIN will be used to process the admission.
Ø  SSNs that are associated with multiple RINs will not be systematically processed.
 
Screening Information for Non-Transfers:
For admissions that do not qualify as a transfer, the following fields must be completed:
Ø  Date of Screening
Ø  Screening Results Received Date
Ø  Date of Admission to Facility
Ø  The Screening Attestation Checkbox
Ø  The ‘Screening Certified By’ information
NOTE:  Screening information is not required if the person will be receiving hospice services upon admission or if one of the ‘Post Screening Circumstance Boxes’ is selected, which includes, placement from out-of-state, hospital emergency, or due to loss of caregiver with a pre-existing condition of need for a caregiver.
If the screening information is required but is not submitted, the admission transaction will be rejected with the error message ‘448 – Screening Information Required’.  Providers receiving this message will need to submit an accepted admission transaction with the required screening information. 
Ø  Only “Accepted” or “Accepted and Processed” transactions are considered valid.
Ø  All transactions that receive an error code are considered invalid and are not eligible for any further consideration. 
 
New Screening May be Needed  for Transfers:
For admissions that qualify as a transfer, the previous admission provider type is used to determine if a new screening is required (see the chart below).
 
From Facility
To Facility
Screening Required
Nursing Facility
Nursing Facility
No
Nursing Facility
SMHRF
No
Nursing Facility
SLP/SLPD
No
Nursing Facility
IID
No
SMHRF
Nursing Facility
Yes
SMHRF
SMHRF
No
SMHRF
SLP/SLPD
Yes
SMHRF
IID
Yes
SLP/SLPD
Nursing Facility
Yes
SLP/SLPD
SMHRF
Yes
SLP/SLPD
SLP/SLPD
No
SLP/SLPD
IID
Yes
IID
Nursing Facility
Yes
IID
SMHRF
Yes
IID
SLP/SLPD
Yes
IID
IID
No
 
Ø  When a new screening is required, the same screening requirements listed above apply.  If the necessary screening information is not submitted, the admission transaction will be rejected with the error message ‘448 – Screening Information Required’.
Ø  If the screening date is greater than 90 days prior to the admission date entered, the admission transaction will be rejected with the error message ‘361 – The Screening Date is Missing or Invalid’.
If the admission qualifies as a transfer with a required screening, and the submitted screening date is greater than the submitted admission date, the screening date will be assigned as the processed admission date.
IMPORTANT TO REMEMBER
Ø  The Screening Attestation Checkbox must be selected even when screening information is not required for the transaction.  This assures that screening requirements have been adhered to in accordance with Ill. Adm. Code 140.642.
 
Admissions Systematically Processed as Transfers
The systematic processing of admission transactions will take into consideration the recipient’s eligibility, timely filing rules and previously processed admission records in the system, which may result in the processed admission and discharge dates being modified from those submitted on the transaction. The provider should view the results of the accepted and processed admission transaction immediately via the MEDI LTC Inquiry and note the admission and discharges dates processed.  
If the previous admission is still open, a discharge date will be populated on the previous admission record that is equal to the newly submitted admission date.
If the previous admission is closed, but overlaps the new admission transaction, the submitted admission transaction will not be systematically processed.  It will be accepted and sent to a DHS hub for processing consideration.
A discharge date may be assigned if there is a subsequent admission on the system and a discharge date was not provided with the admission transaction or was greater than the subsequent admission record.  In both instances the discharge date assigned to the accepted and processed admissions will be equal to the admission date of the subsequent admission record.
Admission transactions that are not supported by established Medicaid eligibility for the entire admission period will not be systematically processed.  They will be accepted and sent to a DHS hub for processing consideration.
Transfer admissions will be interrogated to determine if they were submitted timely.  Timely submission guidelines listed in Ill. Admin. Code 140.513 require the admission transaction to be submitted within 45 days of the admission date or the screening results received date, whichever is greater.  If the admission was not submitted timely, it will be auto processed using the submittal date as the assigned admission date.  If the admission was not submitted timely and a discharge date was also submitted that is prior to the submittal date, the admission transaction will be rejected with the error message ‘445 Denied – Timely Filing Requirement Not Met’. No further consideration will be made for rejected transitions.
Patient Credit Assignment:
The patient credit amount assigned to the accepted and processed admission transaction is calculated based on the last patient credit amount listed for the prior admission.  The first partial month will be assigned $0.00 patient credit.  The calculated amount will begin the first day of the first full month following the admission date.  If the assigned patient credit amount is incorrect, the provider can immediately submit a LTC Change in Income via MEDI.  The patient credit amount can be updated automatically for the current or next month by following the instructions in this hyperlink.
 
MEDI Changes:  new front-end edits
Edits have been added in MEDI to reject admission transactions that are duplicates of admissions already on the system.  If there is an admission on the system for the same provider and admission date, the submitted transaction will be rejected with the error message ‘447 – Admission Already on System for Requested Admission Date’.                     
The following note was added below the SSN field, ‘Note:  All admission transactions require a valid Recipient Identification Number or a valid Social Security Number.  Medicare Only admissions require a Recipient Identification Number.’
The following question was added, ‘Has this resident been private pay for more than three months in your facility and applied for Medicaid coverage within three months of this admission transaction submission?’ along with the option to select ‘Yes’ or ‘No’.  If ‘Yes’ is selected, the admit transaction is not a transfer nor auto processed.  A ‘Yes’ selection will also bypass the edit requiring the screening date to be no more than 90 days prior to the admission date.
Level of Care selections are updated.  The options are SNF (Skilled Nursing Facility), ICF (Intermediate Care Facility), ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities), SLP (Supportive Living Program providers), and SLP Dementia.
The Determination of Need Score and the Appropriate/Not Appropriate Service Boxes were replaced with the Screening Attestation Checkbox.
 
Questions regarding this notice may be directed to the Bureau of Long Term Care at
1-844-528-8444.
 
 
 
Kelly Cunningham
Acting Medicaid Director
 

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