1. (a) On receipt of a complete medical need assessment packet (Forms DHS-703, DMS-787, and if applicable the DMS-780, and any other necessary documentation), the information received will be reviewed by the Office of Long-Term Care, and the office will make a determination as to the individual's need for nursing home placement.

2. (b)

   1. (1) If the office determines that the individual meets medical criteria for nursing home placement and recommends placement, the office will determine the level of care and a date to be reviewed when applicable.
   2. (2) The office will then forward the determination (Form EMS-704) to the nursing facility and to the county Department of Human Services office for completion of the financial eligibility and routing of applicable forms.

3. (c)

   1. (1) (c)(1) If the office determines, based on the information submitted, that the individual does not meet medical criteria for nursing home placement and recommends that placement be denied, the office will then notify the nursing facility and the department county office.

   2. (2)

      1. (A) (2)(A) Once the nursing facility is notified of the denial, the facility may send any additional information/comments that might impact the office’s decision and recommendation.
      2. (B) Any additional comments sent in for reconsideration must be received by the office within ten (10) days of the date of the denial notice.
   3. (3) Upon receipt of the information, the office will determine, based on the information submitted, whether the individual meets medical criteria for nursing home placement and recommend whether placement be approved or denied.
   4. (4) The office will then notify the nursing facility, and will notify the department county office only if the determination changes as a result of the reconsideration.
   5. (5) If additional information is received and results in approval for NF placement, notification will be sent to the nursing facility.
   6. (6) If additional information is not received or is not sufficient to indicate a medical necessity for nursing home placement, the local department county office and the nursing facility will be notified of the denial on the EMS-704.

4. (d)

   1. (1) Determinations that individual applicants do not meet medical criteria for nursing home placement are subject to the appeals and fair hearings process.
   2. (2) Appropriate forms and information regarding appeal timeframes may be obtained from the local county department office.

Codification Notes: "NF" means nursing facility.