OPS-22-03-01 - Revised CAO Procedure for Inter-County Transfers (ICT) , April 12, 2024
When an MA LTC Services recipient is admitted to a hospital, but not officially discharged from the facility, the CAO will not take any immediate action because a recipient can be eligible for a maximum of 15 days consecutive bed hold days due to hospitalization.
The individual continues to be a resident of the county where the LTC Services were originally being received even if the hospital is in another county or state.
The LTC Service providers and the Office of Long Term Living are responsible for correct billing and payment to the LTC provider.
NOTE: The LTC facility may not bill the individual separately or at the private pay rate for his payment towards the cost of LTC facility services for those days he is in the hospital,unless they used the MA 103 to report discharge.
An LTC facility will send a Long Term Care Admissions and Discharge Transmittal (MA 103) to CAO staff within three working days of a transfer or discharge from the facility. An MA 103 must be completed by the LTC facility and sent to CAO staff within three working days for:
a transfer to another LTC facility or any other residence;
a discharge from the LTC facility to another LTC facility, a hospital or any other residence; or
a discharge due to the MA recipient's death.
An LTC facility is not required to send an MA 103 for an MA LTC recipient admitted to a hospital from the LTC facility. The MA 103 is only required if the LTC facility discharges the recipient when admitted to the hospital. An HCBS provider is not required to send a PA 1768 for a MA LTC recipient admitted to a hospital from the community. The PA 1768 is only required if the individual is terminated from eligibility for HCBS. If an individual is discharged from an LTC facility or terminated from an HCBS program, the CAO will determine continued eligibility for other MA programs.
If an MA LTC Services recipient dies, the LTC facility will notify the CAO with an MA 103 and the HCBS provider will notify the CAO with a PA 1768. The CAO will send a notice to the individual’s representative and to the LTC Services provider for notification of discontinuance of MA LTC eligibility effective the date of death. The CAO will close the case effective the day for which the deadline can be met.
An LTC facility may discharge an individual for nonpayment of his payment towards the cost of LTC Facility Services when:
42 CFR § 483.12 028 Pa. Code § 201.29(f)
The LTC facility has provided reasonable and appropriate notice.
The LTC facility has demonstrated that it made reasonable efforts to collect the debt.
The individual’s health improved to the point where LTC facility services are no longer needed.
The individual’s health has deteriorated requiring care which the facility is unable to provide.
When an LTC facility discharges an individual or transfers the individual to another facility, the former facility must give the individual 30 days advance written notice, and, if known, a copy of the notice to the individual’s representative.
Exception: The notice is not required for an emergency or an urgent need for medical services which the facility cannot provide.
The facility must make arrangements for the safe and orderly transfer and must prepare the individual for the transfer.
The LTC facility will notify the CAO of the discharge or transfer with an MA 103 and a copy of the Facility's Notice of Discharge. The facility is required to send the appropriate form to the CAO within three working days of the date the facility administrator, designee or the Registered Nurse Assessment Coordinator (RNAC) signs the MA 103.
NOTE: The MA 103 must be completed. It must include the effective date of discharge and must be signed and dated by the administrator, designee, or the RNAC of the LTC facility. If the MA 103 is not completed, signed, dated, or is missing the effective date, the CAO will advise the LTC facility of what is missing. The CAO can accept verbal statements from the administrator, designee or RNAC of the LTC facility of the effective date of discharge until the MA 103 is received. The CAO will monitor the receipt of the MA 103 and narrate any outreach attempts to obtain the form. Verbal verification does not negate the LTC Facility’s responsibility to provide the MA 103. The CAO can update the case without the MA 103 if collateral contact was made and narrated. After the appropriate case updates were made the CAO should contact the LTC facility one more time to request the completed MA 103 and narrate all contact information.
The individual or the individual’s representative has the right to appeal a discharge or transfer. There is no specific form that an individual or the individual’s representative must complete to file an appeal. However, the appeal request must contain the following:
the name of the individual on whose behalf the appeal is being filed.
the name and address of the LTC facility involved.
the reason for the appeal.
the name of the individual or the individual’s legally authorized representative filing the appeal.
The appeal must be received by the CAO within 30 days of the date of the facility's notice to the individual of discharge. The appeal must be filed with the Bureau of Hearings and Appeals. The CAO will send a copy of the appeal request to the Office of Long Term Living (OLTL) at the following address:
Office of Long Term Living
Bureau of Provider Support
P. O. Box 8025
Harrisburg, PA 17105
(717) 772-2570
A copy of the appeal request must also be sent to the LTC facility. If the appeal involves a dispute with the recommendations of the individual’s physician, a copy must also be sent to the physician.
If the CAO has reason to believe that an individual’s appeal rights are being violated or the discharge is inappropriate or illegal, it should refer the situation by telephone to the Office of Long Term Living, Bureau of Provider Support, (717) 772-2570.
If an individual transfers from one LTC facility to another, a new PA 600L is not required. The new LTC facility will complete the MA 103 and send to the new CAO to establish the continuing need for LTC facility services.
NOTE: In cases of inter-county transfers, the receiving county should complete a partial renewal. See Chapter 476, Renewal .
If an individual is discharged to the community from an LTC facility, the CAO will send a notice advising the individual that he is no longer eligible for LTC services. The CAO will send a copy to the LTC Services provider. The CAO will determine eligibility for other MA programs.
If an LTC facility resident is discharged from a hospital and does not return to the LTC facility, the CAO will determine eligibility for continuing MA in the community.
If the individual moves to the community in another county, the CAO will process an intercounty transfer. The CAO will send the individual a notice advising him that MA remains open in the new county and that he must contact the CAO in the new county for continued MA. See the Medical Assistance Eligibility Handbook, Chapter 323, Residence, for procedures for the intercounty transfer of MA.
When an MA recipient is discharged from an LTC facility, the CAO needs to update the facility screen (CAIFAC) in CIS or Facility Placement screen in eCIS:
The CAO worker will enter the following information on the CAIFAC screen (CIS) or Facility Placement Screen (eCIS):
The effective date when the MA recipient was determined ineligible for LTC facility services payment or discharged from the LTC facility;
One of the following discharge codes provided by the facility in the comments section of the MA 103 "Long Term Care Admission and Discharge Transmittal" form when a MA recipient is determined ineligible for LTC facility services payment or discharged from an LTC facility;
01—Routine Discharge
02—Discharged Against Medical Advice
03—Expired, No Autopsy
04—Expired, Autopsy
05—Discharge/Transfer to Another Hospital
06—Discharge/Transfer to an LTC Facility
07—Discharge/Transfer to a Rehabilitation Facility
08—Discharge/Transfer to a Psychiatric Facility
09—Discharge/Transfer to a Boarding Home/DC Facility
10—Still a Patient
11—Discharged Hospital Home Care
12—Other
13—Automated MFP
NOTE: For those MA individuals who transfer from one type of facility to another type of facility within the same county, the old facility code must be end dated. The discharge code and the new facility code must be entered with a begin date.
NOTE: For those MA individuals who transfer to the same type of facility within the same county and remain eligible for MA, a new facility code is not needed.
NOTE: For an MA individual who transfers to the same type of facility in a new county or a new type of facility in the new county, the old facility code must be end dated. The discharge code and the new county code and new facility code must be entered with a begin date.
NOTE: For those MA individuals determined ineligible for an LTC facility services payment by the Department and the facility did not provide a reason for the discharge, the CAO worker will enter a discharge code of 12.
NOTE: There are 13 discharge codes in CIS, or eCIS. Discharge code 13 (Automated MFP) pre-populates with the date the individual's 365-day time limit will expire after submitting the Facility Placement screen in eCIS. Discharge code 13 is a system-generated code only and should never be entered manually.
The HCBS Provider will notify the CAO of the termination of eligibility for HCBS or transfer with a PA 1768 . The HCBS Provider is required to send the form to the CAO within 3 days of the individual’s change in status.
NOTE: The PA 1768 must be complete. It must include the effective date of termination/transfer and must be signed and dated by the HCBS Provider. If the PA 1768 is not completed, signed, dated or is missing the effective date, the CAO will advise the HCBS provider of what is missing.
If an individual transfers from one HCBS Provider to another within the same county, a new PA 600L is not required. The new HCBS Provider will forward a PA 1768 to the CAO and a copy to the former service provider. The CAO will provide a copy of the Notice discontinuing the former HCBS and authorizing eligibility for the new HCBS to the individual, the former HCBS Service provider and the new HCBS Service provider.
NOTE: If eCIS fails to generate a notice when an individual transfers from one waiver to another, the following notice text and citations must be included on the manual notice:
You no longer qualify for Home and Community-Based Services (HCBS) in the <losing waiver> effective <losing waiver code end date>. Starting <gaining waiver code start date> you qualify for payment of HCBS in the <gaining waiver>. You continue to qualify for Medical Assistance.
PAW/PJW/PMW 66 & 80 SSA 1915 § (c)(4)(A) 62 PS § 441.8
55 Pa. Code § 140.201 141.71 178.1 181.1 181.11
PAW/PJW/PMW 00 SSA 1915 § (c)(4)(A) 62 PS § 441.8
55 Pa. Code § 141.71 178.1 181.1 181.11
If an individual transfers from one HCBS Provider to another outside of the current county, a new PA 600L is not required.
If an individual is terminated from HCBS and enters an LTC facility, a new application is not required. The LTC facility must submit a MA 51 MA 51 to verify eligibility for the Home Maintenance Deduction (HMD) and MA 103 to verify admission to the facility. The CAO will end the waiver medical category and reauthorize in a nursing home category.
NOTE: The CAO should request the MA 51 but should not reject LTC facility services for a HCBS recipient who enters a LTC facility when a MA 51 is not provided. If questions 20A-C of the MA 51 are completed the CAO should review for the Home Maintenance Deduction (HMD). If the MA 51 is not provided the client is not eligible for the HMD but may still be eligible for payment of LTC facility services because the client was already determined Nursing Facility Clinically Eligible (NFCE) during the HCBS assessment.
When an LTC facility/HCBS recipient transfers to a new county, eligibility will continue from the former county for a limited period of time (two semimonthly benefit eligibility periods). The new county will review the resident’s eligibility for continued MA within the limited time period.
The FORMER CAO will:
1. Complete any renewal that is due in the month of transfer or the following month.
2. Access the case via case maintenance in eCIS.
3. Enter the following information on the Household screen:
Update the residential and mailing addresses.
Check the “Case Close” checkbox and select “099—Inter-County Transfer” in the “Close Reason” dropdown in the “Case Action” section. Enter the gaining transfer county and district in the “Case Action” section.
4. Select the “Next” button to save the information.
5. Access the Waiver or Facility Placement screen via the left-hand navigation panel.
6. Enter the end date and discharge code for the former county’s waiver or facility information.
7. Click “Add more” and enter the waiver or facility information for the gaining county.
REMINDER: The waiver/facility placement begin date in the new county must be the day after the waiver/facility placement close date in the former county so that there is no lapse in coverage.
8. Run eligibility.
9. Send a copy of the notice to the losing LTC Provider, the gaining LTC Provider, recipient and recipient’s representative.
10. E-mail the record to the gaining CAO within 5 work days.
A transfer to a new LTC services provider does not require the individual to be re-assessed for functional need.
NOTE: The former LTC facility will bill for LTC Facility Services up to but not including the date of discharge. The new LTC facility may begin billing effective the date of admission. The new LTC facility may bill using the Eligibility Verification System (EVS) to verify eligibility.
The NEW CAO will:
1. Review the case record and other information submitted by the individual or the individual’s representative to determine if the individual remains financially, non-financially and functionally eligible for LTC Services. If needed the CAO will calculate the individual’s payment towards the cost of LTC Facility Services.
2. Review the MA 103 / PA 1768 submitted by the new LTC Provider to determine if the individual still needs LTC Services.
3. If the individual remains eligible for LTC Services, the new CAO will authorize eligibility effective the day after the closure date. Provide a notice to the individual, individual’s representative and LTC Provider. The CAO will send a notice of payment towards the cost of LTC Facility Services, if the individual is residing in an LTC facility.
REMINDER: The renewal date should be adjusted in CIS to remain the same as in the former CAO.
4. Send a notice advising that LTC Services will not be continued in the new county if the individual is not eligible or fails to submit the required information to the CAO.
If an application is being held pending admission and the CAO learns that the individual has been admitted to an LTC facility in another county, the CAO will forward the PA 600L, the MA 51, and all other information to the CAO in the new county. The new CAO will determine eligibility based on the date the PA 600L was received in the former CAO.
NOTE: The new CAO will determine eligibility for MA as well as LTC Services. If all requirements are met, the new CAO will authorize retroactive MA to cover medical expenses incurred during the retroactive period while the individual resided in another county.
Updated August 22, 2019, Replacing December 19, 2014