Access to Publicly Funded Long-Term Care Programs and Services. (P-03062-03) 11
1. Assuring Access to Publicly Funded Long-Term Care Programs and Services 11
2. Provision of the Long-Term Care Functional Screen (P-03062-04a) 11
3. Enrollment Counseling (P-03062-03a) 11
4. Disenrollment Counseling (P-03062-03b) 12
Access to Publicly Funded Long-Term Care Programs and Services. (P-03062-03)
1. Assuring Access to Publicly Funded Long-Term Care Programs and Services The ADRC must assure that customers who request access to and indicate potential eligibility for publicly fund long-term care are informed about and assisted in accessing these programs, consistent with the requirements in this scope of services and with any additional direction provided by DHS, including but not limited to Wis. Admin. Code § DHS 10.31(6).
2. Provision of the Long-Term Care Functional Screen (P-03062-04a) The ADRC must administer the initial long-term care functional screen to determine a customer’s functional eligibility for managed long-term care and Include, Respect, I Self- Direct (IRIS). Per Wis. Admin. Code § DHS 10.31(6), the ADRC must determine functional eligibility as soon as practicable, but not later than 30 days from the date the ADRC receives a request or expression of interest. If there is a delay in determining functional eligibility, the ADRC will notify the customer in writing that there is a delay, specify the reason for the delay and inform the customer of their right to appeal the delay by requesting a fair hearing under Wis. Admin. Code § DHS 10.55. The ADRC must conduct the long-term care functional screen (LTCFS) for private pay customers interested in purchasing care management or other services from the MCO, private-pay PACE members, or upon request from the income maintenance consortium to start the clock on asset assessments. The ADRC will administer the LTCFS consist with the instruction in the Wisconsin Long- Term Care Functional Screen Instructions (P-00946). The ADRC will send notice of action letters to customers who request full benefits but are found to be functionally ineligible for publicly funded long-term care or eligible for limited services at a non-nursing home level of care. They will also inform them of their appeal rights and include a copy of the Request for Fair Hearing–ADRC (F-00236A).
3. Enrollment Counseling (P-03062-03a) The ADRC must provide enrollment counseling, also known as choice counseling, to customers who have been found to be eligible for and are considering enrolling into publicly funded long-term care. Enrollment counseling must be provided in a setting that ensure the customer’s privacy. DHS’s federally approved SSA §1915 (b) waiver requires that only DHS approved materials be used in the enrollment process and enrollment counseling.
Access to Publicly Funded Long-Term Care Programs and Services. 1. Assuring Access to Publicly Funded Long-
Access to Publicly Funded Long-Term Care Programs and Services
