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Michigan Medicaid Nursing Facility Level of Care DeterminationAgency: Community Health, Department of
All Medicaid-reimbursed nursing facility services, or enrollment in the MI Choice Program or Program of All-Inclusive Care for the Elderly (PACE), are dependent on the beneficiary meeting Michigan's Medicaid medical/functional eligibility criteria. The Michigan Medicaid Nursing Facility Level of Care (LOC) Determination is the assessment tool utilized for that purpose. The LOC Determination is an electronic web-based system accessed through Michigan's Single Sign-On System located at https://sso.state.mi.us .
The LOC Determination is to be completed by the nursing facility, MI Choice, or PACE provider prior to the beneficiary's admission or enrollment. Medicaid services will not be reimbursed unless the beneficiary is determined medically/functionally eligible through the web-based LOC Determination. The web-based LOC Determination must be completed within 14 calendar days from the date of a new admission of a Medicaid beneficiary.
The Nursing Facility LOC Determination User Manual provides step-by-step instructions on registering for the Single Sign-On System, as well as screen-by-screen instructions for completing the web-based LOC Determination. The LOCD TIPs chart provides "If" and "Then" examples of when the LOCD is to be conducted online.
Policy requirements and other related provider-specific information for:
Supplemental information is also available through the following links:
Providers may utilize a hard copy of the LOC Determination to gather information. However, the online LOC Determination must be completed as indicated in the policy* in order for reimbursement to be made.
The LOC Field Definitions provides definitions for each question/answer field in the LOC Determination.
Michigan's Informed Choice Process is part of the LOC Determination. The Informed Choice Process ensures that applicants are informed of all nursing facility level of care program options under Medicaid. It also informs applicants of their right to request an exception to the criteria and provides information on the appeals process.
Michigan's Nursing Facility Level of Care Exception Process is available for applicants who do not meet the LOC Determination criteria, but who demonstrate a significant need for long-term care. To request an exception, contact MPRO.
Refer to the provider-specific policy links above for more information regarding beneficiary notice requirements. For an immediate review of adverse action notices, beneficiaries may contact MPRO.
The Process Guidelines explain the process requirements for admission to Michigan's three primary long-term care programs: Medicaid-reimbursed nursing facility care, Home and Community-Based Services for the Elderly and Disabled (MI Choice Program) and the Program of All-Inclusive Care for the Elderly (PACE).
The Access Guidelines assist providers of long term care services to determine appropriate referrals for applicants seeking long term care services. The guidelines are presented for provider information.
A list of questions that may be used to identify potential in-person assessments are provided in the Telephone Intake Guidelines.
The Telephone Intake Guidelines do not determine program eligibility. The Telephone Intake Guidelines are mandatory for MI Choice Program Agencies when they are currently placing individuals on the MI Choice Program Waiting List. PDF Format WORD Format
If a MI Choice Program applicant refuses to complete the Telphone Intake Guidelines, the waiver agency must schedule a full assessment. The asessment scheduled at the MI Choice Program Agency office and referred to the Department of Human Services (DHS), formerly FIA, to have a formal Medicaid LOC determination. In this instance the individual is placed on the waiting list until such time that a determination has been made by DHS or a full assessment has been conducted by the waiver agent. MI Choice Program Waiting List Quarterly Summary Report Form
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