Per policy, an individual in an Intermediate Care Facility (ICF) should be considered institutionalized. Currently the VaCMS will not recognize a client with an ICF living arrangement as institutionalized unless you also complete the Community Based Care (CBC) section on the MA Institutionalized Individual page.

Follow the process below to ensure ICF individuals are properly evaluated by the VaCMS.

Within the VaCMS for ICF individuals:

1. On the Living Arrangement page, select ICF / ID for the Living Arrangement Type.

2. On the Household Clients - Questions page, answer Yes to the MA Institutionalized Individual question.

3. On the MA Institutionalized Individual Information - Details page, enter CBC details.

4. On the MA Institutionalized Individual Information – Details page select the appropriate response to the question: Number of Hours of Service.

5. Complete the remaining screens as appropriate and run eligibility.

6. The patient pay will be calculated using the CBC personal needs allowance with is INCORRECT.         

     7.  Manually calculate the correct patient pay using the NH personal needs allowance and enter the correct patient pay in the Adjusted Patient Pay Amount field.

8.  Document the manual patient pay calculations and the details of the Override Request Details under Case Comments.

TBD

Updated: 09/23/2017