0105.025.15.30 MA Vendor Nursing Facility Explanation:

Give copies of the following:

1. Medicaid and You; IM-4 Medicaid
2. Medical Assistance Benefits; IM-4 MA
3. Medical Assistance spend down, if needed; IM-4 SPDN
4. Hearing Rights; IM-4 Hearings
5. Vendor Nursing Care Benefits, if applicable; IM-4 VNC

Complete the following:

1. 1-14 as for other MA.
2. Certification of Need for Psychiatric Services (if under 21 and in a JCAH psychiatric facility); IM-71
3. Declaration and Assessment of Assets (if there is a community spouse); IM-78
4. Intent to Transfer Assets Agreement (if there is a community spouse); IM-79

Explain the following:

1. December 1973 eligibility requirements (see 0105.020.15.50)
2. Need for Institutional level of care and Pre-admission Screening
3. Need (budget)
4. How paying the surplus amount works:
   • Surplus is not due if not in home first of month
   • Surplus is not due if Medicare covers every day of the month
5. Personal Needs allowance
6. Eligibility for any period not covered as vendor
7. Division of assets, if there is a community spouse
8. Allotments to community spouse and dependents
9. Prior quarter coverage
10. Social Security Number
11. Available services and how to access them
12. Hearing rights, including the right to appeal a Division of Assets
13. Estate Recovery