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Provider Notice Issued 02/27/2020

Date:  February 27, 2020                                                               
To:      Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP), Medically Complex for the Developmentally Disabled Facilities (MD/DD) and Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re:      Implementation of New Policy for Long Term Care Admission Processing
This notice informs Long Term Care (LTC) providers that the Department of Human Services (DHS) has implemented a new policy for the processing of LTC admission transactions.  Effective immediately, the additional resource review for LTC services can occur after the initial Medicaid and admission approval. This policy will impact both new and pending admission transactions.
The major changes with this new policy include determining initial eligibility for LTC services without requesting 12 months of bank statements or requesting an Additional Financial Information for LTC Applicants form (HFS 3654). The 3654 form will be sent to the individual after the initial approval of the LTC services.
Individuals that qualify for Affordable Care Act (ACA) coverage not requiring resource information will be initially approved for LTC services and then sent a 3654 form with a 10-day due date.  Extensions may be requested if additional time is needed to complete and return the 3654 form.
Individuals that qualify under Aid to the Aged, Blind or Disabled (AABD) coverage will need to provide current income and resource verifications with statements for each month of backdated eligibility. Individuals qualifying for AABD will be approved for LTC services and then sent a 3654 form with a 10-day due date and availability to request an extension.

In all instances, except when an individual has been on Medicaid for more than six months at the time of admission, failure to return the 3654 form will result in termination of LTC services. In these cases, the individuals could remain eligible for Medicaid, but LTC services will not be available.  The LTC services can be reopened if the 3654 form is returned within 60 days after notification of the termination of LTC services.


Resource reductions due to excess resources can be applied at initial processing or upon review of the 3654 form.  Penalty periods will not be applied to months that providers have already been approved to bill.  Penalty periods will be applied moving forward if transfers are discovered after LTC services have been approved. 


Questions regarding this notice may be directed to the Bureau of Long Term Care at




Kelly Cunningham

Acting Medicaid Director



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