COVID-19 Level of Care and Notice of Admission, Authorization and Change of Status for Long Term Care (SCDHHS Form 181) Guidance

Thursday, August 27, 2020

The South Carolina Department of Health and Human Services (SCDHHS) has announced updated guidance for providers in nursing facilities, swing bed facilities and intermediate care facilities for individuals with intellectual disabilities.

The Centers for Medicare and Medicaid Services (CMS) has waived the requirement for a three-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay. This change provides temporary emergency coverage of SNF services without a qualifying hospital stay for those people who experience dislocations or are otherwise affected by coronavirus disease 2019 (COVID-19).

As a result of these changes, SCDHHS has amended the current level of care (LOC) and Notice of Admission, Authorization and Change of Status for Long Term Care (SCDHHS Form 181) policies as described below.

These temporary policy updates will only apply to individuals who are under observation, quarantined or have a diagnosis of COVID-19. If COVID-19 does not apply, please adhere to the normal LOC policy. 

COVID-19: LOC

  • LOC determinations must be completed upon admission by community long term care (CLTC) staff.

  • Facilities may change enrollment status to Medicare A (Medicare spell of illness) and a member may remain in the facility under observation, quarantine, or diagnosis of COVID-19 with no transfer to a hospital or discharge to a hospital. When converting back to Medicaid, the facility must reassess the individual and determine whether intermediate or skilled LOC is appropriate. This will be documented on SCDHHS Form 210, Resident Case Mix Classification Change, which can be found in the Healthy Connections Nursing Facility Services provider manual.

  • A copy of this form and supporting documentation must be maintained by the facility.

COVID-19 - Notice of Admission, Authorization and Change of Status for Long Term Care (SCDHHS Form 181)

  • Medicare A (Medicare spell of illness) must be selected for the Healthy Connections Medicaid member.

  • Terminating SCDHHS Form 181must be completed for Medicaid and admitting SCDHHS Form 181must be completed for Medicare spell of illness.

  • When the Medicare spell of illness has ended, the member will convert back to Medicaid status and the COVID-19 LOC policy must be met.

  • The facility must complete Medicaid admission SCDHHS Form 181with COVID or CVD written in the top right-hand corner to indicate that it is a COVID-19 related case.

  • SCDHHS Form 210, Resident Case Mix Classification Change, must be attached instead of SCDHHS Form 185, LOC Certification Letter for Medicaid Sponsored Nursing Home Care.

  • The facility must submit SCDHHS Form 181to Medicaid Eligibility via fax at (888) 820-1204 for processing of Sections III and IV.

  • SCDHHS Form 181must be returned to the provider for further processing.

  • The provider should review the updated SCDHHS Form 181, complete any outstanding information and provide additional information in Section II, if applicable.

  • The provider must mail the completed SCDHHS Form 181to Medicaid Claims Receipt at either of the addresses listed below. Please do not fax the completed SCDHHS Form 181to Medicaid Claims Receipt unless specifically directed to do so.

Medicaid Claims Receipt

NF Claims Section
Post Office Box 100122
Columbia, South Carolina 29202-3122

or

Overnight Mail

MCCS-NF-AW-220
8901 Farrow Road
Columbia, South Carolina 29203-8930

Providers with questions regarding the temporary modified LOC policy should contact their local area CLTC office. Providers should continue to contact the Provider Service Center at (888) 289-0709 for questions regarding claims processing.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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