Nursing Facilities

Long Term Care Overview

Long term care services are those services related to nursing facilities, chronic hospitals, medical day care and other waiver programs targeted toward seniors and/or the disabled. Generally, entry into a long term care service is contingent upon establishing medical eligibility as well as financial eligibility. See Long Term Care Overview for more details on eligibility.

Nursing Facility

Form: 3871B and PASRR

• Certification: Initial certification 30 days; PASRR must be sent with initial certification
  • Please note that if a patient enters the hospital for a period of 15 days or less, a new level of care is not needed, even if the patient is at a higher level of care. A new level is needed only when being discharged to a different nursing facility.
  • Bed holds for nursing facilities are effective for 15 days. A new LOC must be requested if a patient is hospitalized for greater than 15 days.
• Recertification: Nursing facility recertification occurs every 3 months. Nurse reviewers performing the recertification or continued stay review complete the following activities:
  • Review the MDS or MMDS for the prior three months and the most recent MDS/MMDS assessment.
  • Perform PASRR compliance audits of all Medicaid clients admitted during the prior three months.
  • Perform billing reconciliation (services, therapies and level of care rendered to patients and billed by the facility).
  • Facilities should have the following information prepared for review:
    • Previous census from prior three months
    • PASRR forms for all patients admitted over the prior three months.
    • List of all non-Medicaid patients admitted and/or discharged within the prior three months
    • All administrative day request forms

• Verify eligibility to assure Medicaid eligibility for requested services; if the patient has submitted a Medicaid application, include the date the application was sent to Medicaid.
• Use iEXCHANGE to submit review forms. This helps get your review determination quicker. This also eliminates the chance that the form(s) will not be received by KePRO.
• Submit the PASRR via iEXCHANGE by ensuring completion of questions 71 through 87 on the 3871b/PASRR questionnaire
• Provide an explanation for all new LOCs that are requested prior to the continued stay review date.
• Complete all questions on the appropriate form for which the provider is seeking the LOC. Failure to complete all the questions may result in the form being returned to the provider

Waiver Programs – Medical Day Care, Older Adult Waiver, Living at Home Waiver

Initial Certification: the 3871b is completed

• AERS offices and hospitals are permitted to submit for initial Medical Day Care levels of care
• AERS offices submit for Older Adult Waiver and Living at Home Waiver initial levels of care

Recertification: the 3871b is completed

• Medical Day Care providers may submit for annual recertification
  • Annually the Recertification 3871B cannot be sent for recertification review prior to 60 days before the recertification date.
  • When requesting continuing stay review certification for waiver programs, the provider must submit an updated 3871B. Without updated information, a level of care cannot be rendered.
• AERS offices submit for Older Adult Waiver and Living at Home Waiver annual recertifications

• Verify eligibility to assure Medicaid eligibility for requested services; if the patient has submitted a Medicaid application, include the date the application was sent to Medicaid.
• Use IEXCHANGE to submit review forms. This helps get your review determination quicker. This also eliminates the chance that the form(s) will not be received by KePRO.
• Provide an explanation for all new LOCs that are requested prior to the recertification date.
• Complete all questions on the appropriate form for which the provider is seeking the LOC. Failure to complete all the questions may result in the form being returned to the provider