10/30/98 (TN #257)
MSSICS 010.011 Institution Residence Data (LINS)
You use this screen to record the type of institution and data about special payment decisions such as 9115 and 1619/1611E. The claimant may select either the 9115 or 1619/1611E continuing payment provisions if eligibility factors for both are met.
If CONFINEMENT REASON [15-M] = 3 (emerg shelter), the case is a MSSICS processing exclusion because the FO must control and force pay the claim.
If ELIGIBLE FOR AND CHOOSES SPECIAL INSTITUTION PAYMENTS -1619/1611E
[21-M] = Y, the case is a MSSICS processing exclusion.
Reference: Application Taking Exclusions and Limitations, MSOM MSSICS 001.003
If INSTITUTION [14-M] is "1" (public) and CONFINEMENT REASON [15-M] = 1 (medical/psych), 5 (prisoner) or 6 (other), the system will display page 2.
If INSTITUTION [14-M] is "2" (private) and OVER 50% MEDICAID PAYMENTS [16-C] = "Y", the system will display page 2.
If INSTITUTION [14-M] is "2" (private) and OVER 50% MEDICAID PAYMENTS [16-C] = "N" or blank (not required), the system will not display page 2.
If claimant is eligible couple, facsimile 2 will be displayed (if required). Otherwise, facsimile 3 will be displayed (if required).
If IF NO, ELIGIBLE FOR AND CHOOSES CONTINUING PAYMENT - 9115 [22-C] = Y, the screens necessary to record the household changes from the permanent household residence beginning with Household Composition (LHHC) will be added to the path in order that the changes can be recorded as well as the institution data since payment is made as though the claimant was still residing at the household residence.
Caution: Do not record permanent residence changes that occur while the claimant is in the institution. Only record changes to the permanent residence at the time of institutionalization. If the permanent residence changes, then you must process the case outside of MSSICS. All of the institution determinations are keyed from the residence start date. When 9115 applies, all residence start date changes should apply to changes involving the institution.
If IF NO, ELIGIBLE FOR AND CHOOSES CONTINUING PAYMENT - 9115 [22-C] = Y, and at the end of the 9115 eligibility period, the claimant is not discharged from the institution, you must enter "Y" for IF NOT DISCHARGED, CONTINUED PAYMENT PERIOD ENDED [26-C]. When this is completed, the system will default to FLA "D" or Payment Status N02 (as appropriate).
When 9115 continued payments are made, the physician's certification and home expense statement must be received by the discharge date or 90 days from admission date (whichever is earlier). This documentation is now captured on page 2 of this screen.
C. FACSIMILE 1: LINS - INSTITUTION RESIDENCE DATA
MSSICS INSTITUTION RESIDENCE DATA PAGE 1 OF LINS
SSS-SS-SSSS SSSSS SSSSSSSSSS PERIOD BEGAN: SS/SS/SSSS TRANSFER TO: XXXX
INSTITUTION NAME: BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
ADDRESS: PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP
CITY: PPPPPPPPPPPPPPPPPPPPPP STATE: PP ZIP: PPPPP
COUNTRY: XXXXXXXXXXXXXXXXXXXXXX
TELEPHONE: PPP PPP PPPP
ADMISSION DATE (MMDDYY): SS/SS/SS DISCHARGE DATE (MMDDYY): 999999
VERIFIED (Y/N): X
DATE INSTITUTIONALIZATION BEGAN (MMDDYY): SS/SS/SS
INSTITUTION: 9 1=PUBLIC CONFINEMENT REASON: 9 1=MEDICAL/PSYCH
2=PRIVATE 2=EDUCATION/VOC
3=EMERG SHELTER
4=PUB COMM RES
[16-C] 5=PRISONER
OVER 50% MEDICAID PAYMENTS (Y/N): B 6=OTHER
PRIVATE HEALTH INSURANCE (Y/N): B
INSTITUTION FOR FOOD STAMP PURPOSES (Y/N): P
REMARKS (Y): X
D. FACSIMILE 2: LINS - INSTITUTION RESIDENCE DATA
MSSICS INSTITUTION RESIDENCE DATA PAGE 2 OF LINS
SSS-SS-SSSS SSSSS SSSSSSSSSS PERIOD BEGAN: SS/SS/SSSS TRANSFER TO: XXXX
INSTITUTION TEMPORARY (Y/N): X
ELIGIBLE FOR AND CHOOSES SPECIAL INSTITUTIONAL PAYMENTS - 1619/1611E (Y/N): X
IF NO,
ELIGIBLE FOR AND CHOOSES CONTINUING PAYMENT - 9115 (Y/N): X
IF YES, TYPE OF CARE: 9
CARE OPTIONS 1=ACUTE CARE 2=INTERMEDIATE CARE (MENTAL)
3=INTERMEDIATE CARE (NON-MENTAL) 4=SKILLED NURSING CARE
HOME EXPENSE STATEMENT DATE FOR SSSSS SSSSSSSSSS: 999999
HOME EXPENSE STATEMENT DATE FOR SSSSS SSSSSSSSSS: 999999
PHYSICIAN'S CERTIFICATION DATE FOR SSSSS SSSSSSSSSS: 999999
PHYSICIAN'S CERTIFICATION DATE FOR SSSSS SSSSSSSSSS: 999999
IF NOT DISCHARGED, CONTINUED PAYMENT PERIOD ENDED (Y): X
WHICH MEMBER OF COUPLE: X 1=SSSSS SSSSSSSSS
2=SSSSS SSSSSSSSS
3=BOTH
IF NO, 9115 INELIGIBILITY DECISION CODE: X
REMARKS (Y): X
E. FACSIMILE 3: LINS - INSTITUTION RESIDENCE DATA
MSSICS INSTITUTION RESIDENCE DATA PAGE 2 OF LINS
SSSSSSSSS SSSSS SSSS-SS-SSSS PERIOD BEGAN: SS/SS/SSSS TRANSFER TO: XXXX
INSTITUTION TEMPORARY (Y/N): X
ELIGIBLE FOR AND CHOOSES SPECIAL INSTITUTIONAL PAYMENTS - 1619/1611E (Y/N): X
IF NO,
ELIGIBLE FOR AND CHOOSES CONTINUING PAYMENT - 9115 (Y/N): X
IF YES, TYPE OF CARE: 9
CARE OPTIONS 1=ACUTE CARE 2=INTERMEDIATE CARE (MENTAL)
3=INTERMEDIATE CARE (NON-MENTAL) 4=SKILLED NURSING CARE
HOME EXPENSE STATEMENT DATE FOR SSSSS SSSSSSSSSS: 999999
PHYSICIAN'S CERTIFICATION DATE FOR SSSSS SSSSSSSSSS: 999999
IF NOT DISCHARGED, CONTINUED PAYMENT PERIOD ENDED (Y): X
IF NO, 9115 INELIGIBILITY DECISION CODE: X [19-O]
REMARKS (Y): X
You entered "N" for MEETS LEVINGS REQUIREMENT on Eighth Judicial Circuit Data (LEJC); or
You entered "6" (institution) for RESIDENCE TYPE on Residence Address (LRES) and the STATE on LRES was not one of the Eighth Judicial Circuit states (Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota or South Dakota).
| File Type | application/msword |
| File Title | 10/30/98 (TN #257) |
| Author | Al Fatur |
| Last Modified By | Naomi |
| File Modified | 2006-08-18 |
| File Created | 2006-08-18 |