Idaho Admin. Code r. 16.03.10.229

Current through September 2, 2024

Section 16.03.10.229 - NURSING FACILITY: PREPAYMENT SCREEN AND DETERMINATION OF ENTITLEMENT TO MEDICAID PAYMENT FOR NURSING FACILITY CARE AND SERVICES

The level of care for Title XIX and Title XXI payment purposes is determined by the Department. Necessity for payment is determined in accordance with 42 CFR 483 Subpart C and Section 1919(e) (7) of the Social Security Act. In the event a required Level II screen was not accomplished prior to admission, entitlement for Medicaid payment as established by the BLTC will not be earlier than the date the Level II screen is completed, indicating that nursing facility placement is appropriate.

01.Information Required for Medical Evaluation Determination. A current Minimum Data Set (MDS) assessment will be provided to the Department. Additional supporting information may be requested.

02.Information Required for Level I and II Screen Determination. An accurate Level I screen and when required, a Level II screen.

Idaho Admin. Code r. 16.03.10.229

Effective March 17, 2022