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Long-term care (LTC) screening documents and home and community-based services (HCBS) program eligibility spans

Page posted: 8/3/26

In most cases, a comprehensive assessment establishes a person’s HCBS program eligibility. The lead agency records this eligibility in an approved, saved LTC screening document.

If the person also meets other eligibility criteria related to HCBS programs, such as overlapping dates of Medical Assistance (MA) eligibility, MMIS will create one of the following:

· 12-month waiver program eligibility span.

· 365-day span for the Alternative Care (AC) and Essential Community Supports (ECS) programs.

MMIS creates and shows the eligibility span in the recipient subsystem when you save an approved screening document in MMIS. The eligibility span in the recipient subsystem controls the time period during which you may authorize services in MMIS, or during which DHS will pay an Elderly Waiver (EW) capitation to a managed care organization (MCO). For more information about eligibility spans in the recipient subsystem, refer to MMIS LTSS Manual – Recipient screen descriptions.

This page provides information about:

· Reduced eligibility periods.

· Periods of ineligibility for waiver, AC or ECS services.

· Eligibility Verification System (EVS).

· Exception codes related to LTC eligibility.

Reduced eligibility periods

MMIS will not create a 12-month or 365-day eligibility span in the recipient subsystem in the following circumstances:

· Temporary AC (program type 22): Temporary AC is a 60-day program to allow a person to receive some services while applying for MA. MMIS develops a span for 75 days to allow them time to change programs based on their MA determination. You cannot extend the temporary AC program span.

· Pending verification of citizenship for AC and ECS: A person open to the AC or ECS program has a 90-day eligibility period during which they must verify their citizenship if it is not established. If the citizenship field on the ALT6 screen shows the citizenship is pending, MMIS will only create a 90-day span for AC or ECS. For more information, refer to MMIS LTSS Manual – Additional LTC screening document information.

· Eligibility update (activity type 09): When a person opens, reopens or changes an HCBS program using an eligibility update, the length of the program eligibility span is based on the activity date of the in-person assessment (activity type 02 or 04) that preceded the eligibility update. An eligibility update does not produce a 12-month span. For more information, refer to MMIS LTSS Manual – LTC screening document eligibility updates.

· Waiver restart after admission to an institution or residential treatment setting: A person admitted to an institution or residential treatment setting and subsequently exited after 30 days using a temporary waiver exit (assessment result 53) can restart their previous waiver program when the admission was for 121 or fewer days using activity type 07 and assessment result 54 (waiver restart). You cannot use this option for the AC or ECS program. When you use assessment result 54, MMIS creates a partial waiver eligibility span based on the effective date of the last approved screening document with assessment result 01, 10, 11 or 13. This type of waiver restart does not produce a 12-month eligibility span. For more information, refer to CBSM – Temporary waiver exits and restarts: MMIS actions.

· Functional needs update (activity type 10): When you use a functional needs update to update information for a person on AC or EW, MMIS does not extend the current eligibility span. For more information, refer to MMIS LTSS Manual – Use a functional needs update for AC and EW.

· Periods of ineligibility: Some people with periods of ineligibility for LTC have reduced HCBS program eligibility spans. The next section provides more information about this situation.

Periods of ineligibility for waiver, AC or ECS services

A person may be eligible for MA but ineligible for LTC coverage under MA. DHS strongly encourages you to check the recipient subsystem to:

· Verify the person’s eligibility for MA on the RSUM screen.

· Identify if the person has an ineligibility span related to LTC on the RLVA screen.

For instructions to access and use the recipient subsystem, refer to MMIS LTSS Manual – Work with a person’s data.

Reasons for LTC ineligibility include:

· Improper transfer of assets, which makes a person ineligible for waiver, AC, ECS or MA-funded nursing facility services during the penalty period. A person who is ineligible for LTC under MA due to a penalty period cannot access AC or ECS services as a substitute. For more information, refer to the policy in the Health Care Eligibility Programs Manual, section 0909.27.11.

· No documentation of institutional level of care, which is a requirement for both institutional and HCBS MA LTC.

· No determination of LTC eligibility yet.

Ineligible codes in the RLVA screen

The RLVA screen in the recipient subsystem indicates the reason(s) a person is ineligible for LTC using the following codes:

· A: Annuity penalty.

· F: Pending receipt of DHS-3543.
Note: This code was previously used but is no longer valid.

· H: Home equity exceeds limit.

· I: Uncompensated transfer.

· L: Level of care criteria not met.

· N: Person did not cooperate to determine level of care criteria.

· U: Undetermined.

The RLVA screen also shows the dates of the ineligibility period.

For waivers, the county or Tribal Nation eligibility worker determines and records eligibility for LTC based on information in the person’s MA application. They also use this information to determine any period of LTC ineligibility, and the eligibility worker enters it on the RLVA screen.

For AC and ECS, assessors use AC Program Eligibility Worksheet, DHS-2630 (PDF), AC Program Eligibility Worksheet Type A, DHS-2630A (PDF), ECS Program Eligibility Worksheet, DHS-6683 (PDF) and ECS Program Eligibility Worksheet Type A, DHS-6683A (PDF) to determine financial eligibility and any LTC penalty period for these programs. You cannot open or continue AC or ECS during any penalty period established by the assessor using the financial worksheets.

The assessor does not enter AC or ECS penalty period information into the RLVA screen. Completion of the AC or ECS financial worksheets does not result in a calculated penalty period. However, you should still check the RLVA screen for a person applying for AC or ECS. If a person previously applied for MA or had an asset assessment and the eligibility worker established a penalty period, the person cannot access AC or ECS during that period.

U code

The U code is present on the RLVA screen for all people on MA who have not been determined eligible for LTC institutional services or waiver programs. When a person has an assessment and is determined eligible for a waiver program, the assessor uses LTC Communication of Long-Term Supports and Services Eligibility Form, DHS-5181 to notify the eligibility worker that the person meets institutional level of care and is requesting LTC.

The eligibility worker determines the person’s eligibility and returns DHS-5181 to the assessor to communicate the effective date of MA coverage or any penalty time period. The eligibility worker must remove the U code from the RLVA screen before the lead agency can approve a waiver screening document in MMIS.

Eligibility Verification System (EVS)

When the dates of service for waiver, ECS or AC services overlap with a penalty period, the EVS used by providers includes a message for people applying for or currently using waiver, ECS and AC programs. This message says: “This person is ineligible for AC, ECS, waiver and LTC services.”

Exception codes (i.e., edits) related to LTC eligibility

Exception code 937: Ineligible asset transfer

MMIS will post exception code 937 when a waiver screening document has a date in the effective date field that overlaps with a penalty or other ineligibility period, including reassessment documents or documents using administrative activity types.

If MMIS posts this exception code, you should review the RLVA screen for penalty periods and take the appropriate action:

· No penalty period: Contact the eligibility worker to remove the U code.

· Penalty period: Create a waiver, AC or ECS program span that does not overlap with the beginning or end date of the penalty period. For example, you cannot enter an effective date for AC, EW or ECS that is before the beginning of a penalty period.

You can resolve this exception code by changing the effective date to be greater than the ineligibility end date. This may be possible if the end date is within 60 days of the assessment activity type date or within 60 days of a completed eligibility update. If not, the person must have another assessment that uses an allowable effective date.

For more information, refer to MMIS LTSS Manual – Exception codes in the LTC screening document.

Exception code 938: Eligibility overlap with ineligibility period

MMIS will post exception code 938 if the effective date is before the ineligibility period but the end date of the waiver span created on RWVR or the AC/ECS eligibility span on RELG would overlap with the ineligibility period. In this situation, you must create a reduced eligibility span.

To create a reduced eligibility span:

1. Type F on the exception code status to force this exception code. This action allows MMIS to approve the screening document with the eligibility span shortened to one day before the begin date of the ineligibility span on the RLVA screen.

2. Press the transmit key.

3. Enter a service agreement for the reduced eligibility period.

To continue services after the ineligibility period:

1. Enter an exit screening document with an effective date field that does not overlap with the ineligibility period.

2. Complete an assessment and enter a reopening screening document with an effective date field that is after the ineligibility period’s ending date.

3. Enter a service agreement for the new eligibility period.