Padma’s Review Questions

Answer the following questions based on reviewing Padma’s request for MA-LTC.

1. Has Padma completed the appropriate MA-LTC request form?

Yes, Padma has completed the appropriate MA-LTC request form. She completed the Application for Certain Populations (DHS-3876), on the eighteenth of last month (LM/18/YY). She also completed the Request for Long-Term Care Services (DHS-3543) and provided it when the application was submitted.

2. What is the date of Padma’s request for MA-LTC?

Padma requested MA-LTC on the 18th of last month (LM/18/YY) based on the Date Received field of the Application for Certain Populations.

3. Has Padma requested retroactive coverage?

No, based on the Application for Certain Populations, Padma is not requesting retroactive coverage prior to last month.

4. Was an LTCC completed?

Yes, Padma’s case manager, Zach Benson, completed the DHS-5181. He indicated that the LTCC was completed on the fifteenth of last month and showed the anticipated start date for EW services. The DHS-5181 also indicates that Padma was hospitalized from the seventh to the twenty-eighth of last month and that she did not receive skilled nursing facility services while there.

5. What is the begin date of Padma’s MA-LTC?

The begin date will be the date services are to begin as listed on the DHS-5181. For Padma this is LM/ 15/ YY.

6. Did Padma meet the institutional level of care requirement?

Yes, based on Padma’s DHS-5181, Padma meets the case management requirements for EW services, and an institutional level of care is a component of those case management requirements.

To Do: Update the fields found in the first section of page one of Padma’s DHS-5590, found at the back of her case packet, based on the answers you just provided.