LOC determinations may be made by the Michigan Department of Human Services (DHS),
Department of Community Health (DCH), or private firms subcontracted by DCH after
placement of the individual in a facility. DHS is responsible for the accuracy of
the information provided on all LOC certification forms, even if the determination
is made by another agency.
The Exhibit contains a copy of the Form DHS-3471 (DHA/SSA Referral, Michigan Department
of Human Services), that is used to notify the FO about the LOC certification. This
form is to be considered a protective filing for SSI. Follow SI 00601.005 and GN 00204.001 for procedures used in protective filing situations.
The LOC determination is found under block 18, Part A, Authorization of Level of Care
on the DHS-3471. The determination must be made by one of the authorized agencies
after the individual enters the facility. In some cases, a person not currently under
a certifying agency's jurisdiction may inquire about becoming eligible for one of
these supplements. If such an inquiry is received, the FO should initiate a request
to the authorizing agency, as appropriate. The FO may also initiate a request if it
considers an individual potentially eligible for one of these supplements. No documentation
regarding the referral, or the decision whether to refer, is required.
FO staff should be knowledgeable on the local organizations (those agencies shown
above) in their service area authorized to make LOC determinations.
NOTE: Follow adult procedures (i.e., verification through the local agency) when children
are 17 1/2 years of age. DHS considers an individual to be an adult at this age.