Application 400-29-30 ML 3269

(Revised 6/1/11 ML #3269)

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(NDAC 75-02-10-03)

 

  1. All individuals wishing to make application for benefits must have the opportunity to do so.  Medicaid recipients may complete a Medicaid Redetermination of Eligibility form to apply for assistance under this program. The application or redetermination must be signed by the applicant, a proper person's, or the applicant’s court appointed guardian.
  2. An application is a request made by a person desiring benefits, or by a proper person seeking such benefits on behalf of another person, to a county agency. 

Note – An applicant for Basic Care Assistance must be eligible for Medicaid to receive benefits under this program.  

  1. An application consists of an application for Medicaid benefits and an application for services received in a licensed basic care facility, which includes a functional assessment.
  1.  An application for the Medicaid and Basic Care Assistance Program on SFN 405, "Application for Assistance," or SFN 958, "Application for Health Care Coverage." A copy of the application is available as an E-form. This application process is completed by the county agency eligibility worker.
  2. An "Application for Services" which includes a completed functional assessment and may require a Personal Care Services Assessment, as described in Service Chapter 670-10 for Expanded SPED Program. This process is completed by the Home and Community Based Service Case Manager or Developmental Disability Services case manager.

Note - When entering information into the Basic Care Resident Payment system, the Effective Date of the Assessment from the Transmittal Form would be entered as the ‘First Functional Assessment Date’.  

 

If the BCAP Eligibility Start Date is for a month prior to the month the assessment was completed,  the date of the functional assessment must equal that date in order for payment so payment can be made back to the start date.

Example: Individual entered Basic Care September 12th and the Functional Assessment Effective Date is October 12th.  The individual was determined eligible from the date of entry. The Functional Assessment was not completed in September due to staffing resource issues. The Functional Assessment Date should be September 12th in the Resident Payment System in this instance or payment will not be made for the month of September.

  1. Application forms must be signed by the applicant, a proper person, or the applicant's court appointed guardian if the applicant has been adjudged incompetent by the court.
  2. Information concerning eligibility requirements, available services, and the rights and responsibilities of applicants and recipients must be furnished to all who require it.
  3. The date of the application is the date the application is signed by an appropriate person, and is received by the county social service board. The date of eligibility is the date of application or the date the individual became eligible for the program, whichever is later.
  4. If a person is already receiving Medicaid benefits, a completed redetermination of eligibility is used to determine eligibility for the Basic Care Assistance Program.
  5. The applicant or guardian of the applicant must provide information sufficient to establish eligibility for benefits, including a social security number,  proof of age, residence, disability,  financial eligibility, and other information as may be required to determine eligibility.

Note - Numident or TPQY may be used as verification for SSN, age and identity, social security benefits received, etc.

  1. A copy of Transmittal Between Units (SFN 21) completed by county social worker to cover room and board services provided in a basic care facility must be in the case file.
  2. A completed Personal Care Services Assessment by a county social worker to cover personal care services provided by a basic care facility must be in the case file.

NOTE: Approval to cover retroactive eligibility up to 3 prior months requires approval by the State Office Medical Services Rate setting unit.

  1. If an individual is private pay and applies Basic Care Assistance, the individual must apply for Medicaid and a functional assessment and a personal care assessment must be completed. If there is a delay in the completion of the assessment pending determination/approval of Medicaid, the Resident Payment System date for the Functional Assessment may need to be backdated to equal the Basic Care eligibility start date for payment purposes.