LTCC Referrals
What do you do when you receive a request for MA-LTC from a person who is not residing in an LTCF and you have not received a DHS-5181 documenting the client meets an institutional level of care?
You must refer the client to your county’s LTCC team.
- Contact the client or the client’s authorized representative to discuss the requirement that the client needs an institutional level of care and that an LTCC is required before MA can pay for LTC services.
- Follow the county procedures for making a referral to the LTCC team. Provide the team with client contact information and request completion of the DHS-5181.
- Document the referral and the referral’s outcome in case notes.
Also refer client’s to the county LTCC team if there is any reason to suspect that the client may benefit from receiving waiver services, even if the client is not requesting MA-LTC.
Example.
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Level of Care Requirement - LTC Screenings - Waivers