Emily's Review Questions

Emily’s Review Questions

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

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

Yes, Emily has completed the appropriate form. Because Emily is requesting both MA and MA payment of LTC services, and she resides in an LTCF, the DHS-3531 is the most appropriate form for her to use.

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

Emily requested MA-LTC today (CM/CD/CY) based on the “Date Received” field of the DHS-3531.

3. Has Emily requested retroactive coverage?

Yes, based on the DHS-3531, Emily is requesting one month of retroactive coverage (LM/YY).

4. When did Emily enter the LTCF?

Emily resided in two long-term care facilities last month. Her date of entry into an LTCF is the twelfth of last month. The DHS-1503s provide the following information:

Abbott Northwestern Hospital. Based on the DHS-1503 completed by Abbott, Emily was admitted to the hospital on the second of last month. She was transferred to the Sister Kenny Unit of the hospital on the twelfth of last month at which time she began receiving skilled nursing facility services.

Bethany Covenant Home. A second DHS-1503 completed by Bethany Covenant Home indicates Emily was admitted to this facility on the fifteenth of last month after her discharge from Abbott.

5. What is Emily's MA-LTC begin date?

Emily's MA-LTC begin date is the twelfth of last month. Emily was receiving skilled nursing facility services on the twelfth and requested MA-LTC coverage for that month.

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

Yes, Emily meets an institutional level of care requirement. She began receiving LTC services on the twelfth of last month and is not expected to be discharged from Bethany Covenant Home.

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