Isabella’s Review Questions

Training Caseload - Page 9a

Isabella’s Review Questions

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

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

Yes, Isabella has completed the appropriate form. Because she is requesting both MA and MA payment of LTC services through the DD waiver the DHS-3531 is the most appropriate form for her to use.

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

Isabella submitted her application on the 25th of last month (LM/25/YY) and an interview was held with her mother, Alicia.

3. Has Isabella requested retroactive coverage?

No, based on the DHS-3531.

4. What waiver program has Isabella been approved for?

5. On what date was Isabella screened?

The 25th of last month.

6. When does Ms. Mead anticipate Isabella’s services to begin?

The 25th of last month.

7. On what date was the DHS-5181 sent?

The 25th of last month (LM/25/YY). You must return a copy of this form to Ms. Mead with the 2nd page completed with information about why eligibility is pending if Isabella’s eligibility had not been approved by the 5th of the current month (based on a 30-day month).

8. What is the begin date of Isabella’s MA-LTC?

The begin date will be the 25th of last month.

9. Did Isabella meet the institutional level of care requirement?

Yes, based on Isabella’s DHS-5181, Isabella meets the case management requirements for DD 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 on page one of Isabella’s DHS-5590, found at the back of her case packet, based on the answers you just provided.

Updated February 6, 2023.
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