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Level of Care Redetermination
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Is a referral needed?
Submitter Information
Nursing Facility Resident
Quarterly MDS Assessment
Additional ADL's
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Results
Nursing facility referral required if a resident is: On MA, and is classified as a PA1 or PA2 on the first quarterly MDS assessment or Applying for MA and is a PA1 or PA2 on the last MDS quarterly assessment prior to MA eligibility start date.
Is a referral needed?
Is the person 21 or older?
If no, the referral is not needed
Yes
No
Is the person currently on Medical Assistance (MA)?
Yes
No
Did the first quarterly MDS assessment result in a RUG classification of PA1 or PA2?
Yes
No
Has the person submitted an application for MA?
Yes
No
For those applying for MA, did the most recent quarterly MDS assessment result in PA1 or PA2?
Yes
No
SLL Referral
PAS
LOC Redetermination
