See SI 00520.011 for development of confinement in a medical treatment facility. Follow SI SF01415.110B. for development and documentation requirements on determining a facility's State
licensure status. Use the Seattle SSA-8045 Facility Determination site to create and store a SSA-8045 (See SI 00520.800 Facility Determinations).
Per the Medi-Cal Provider Manual, Part 2 Admissions and Discharges, the State requires
Long Term Care (LTC) facilities to complete a Medi-Cal Long Term Care Facility Admission
and Discharge Notification (MC 171) form for individuals upon admission to the facility.
When an SSI recipient enters a Nursing Facility, providers must notify a Social Security
Administration field office of the name, SSN, and date of entry to the facility via
a MC171. Field offices should consider this a first party report of change and must take
prompt action upon receipt.
NOTE: Medicaid payments made under a Home or Community Based Services (HCBS) Medicaid waiver
(as defined by title XIX of the Social Security Act) usually do not result in imposing
the $30 payment limit, even if the Medicaid payment is over 50% of the cost of care.
The residents of a facility whose care is paid for under an HCBS waiver are FLA A
regardless of the percentage of their care being paid by Medicaid funds; OSS A applies.
The payments made by the state are not counted as ISM. For more information on waivers
in these situations, see SI 00520.510D. For information about an exception to this policy, see the second bullet of SI 00520.011C.4.
NOTE: Do not assume that an individual residing in a facility categorized as an Institution
for Mental Disease (IMD) is automatically eligible for FLA A and OSS A. Completion
of a SSA-8045 and contact with the facility to verify whether Medicaid is or is not
paying over 50% of the cost of care is always required. See SI 00520.011 for development of confinement in a medical treatment facility and SI SF01415.110 for state supplementation of FLA A.