Level of Care Process for admission to ICF/MR Facility
For a list of ICF/MR facilities in Ohio, you can go to Index to ICF/MR Facilities in OhioInformation from OAC 5101:3-3-15.3 (modified)
(E) In order to obtain a LOC determination, an ODJFS 3697, 3697 must be completed. It needs to be signed and dated by a physician (see bottom of page 1). Also, ICF/MR LOC must be checked. It can be faxed to 614-466-0652 or scanned and emailed to firstname.lastname@example.org. For assistance with this process, you can contact Mark Holzapfel. Mark's phone # is 614-466-2078. Matt Turner can also assist at times. His phone # is 614-466 2080.
(1) The ODJFS 3697 must include;
(a) Individual’s name; Medicaid number; date of original admission to the facility, if applicable; current address; name and address of residence if current residence is a licensed or certified residential setting or hospital; and county where the individual’s Medicaid case is active.
In addition to the 3697,
(b) A comprehensive medical, social and psychological evaluation of the individual is needed. The psychological evaluation must be made before admission, but not more than three months before admission. Each evaluation must include:
(i) Diagnosis, including medical, psychiatric and developmental diagnoses, including dates of onset, if the date of onset is significant in determining whether the individual has a developmental disability;
(ii) Summary of medical, social and developmental findings;
(iii) Medical and social family history;
(iv) Mental and physical functional capacity;
(vi) The type of services needed including medical treatments, medications, and other professional medical services;
(vii) Evaluation of the resources available in the home, family and community;
(viii) A physician’s certification of the individual’s need for ICF-MR level of care made at the time of admission, or if the individual applies for Medicaid while a resident of an ICF-MR, prior to the initiation of vendor payment (The physician signature on the certification statement at the bottom of page 1 of the 3697 with ICF/MR LOC checked is fine.
(2) In order for a level of Care (LOC) determination to be made, the ODJFS 3697 must be complete when it is submitted to ODJFS. Any entity (a CDJFS, hospital or ICF-MR) who submits a LOC request must ensure that all required components are included before submission.
(a) Following receipt by ODJFS of the ODJFS 3697, ODJFS shall make a determination of whether the ODJFS 3697 is sufficiently complete for its personnel to perform the LOC review. If the ODJFS 3697 is not complete, ODJFS shall notify, in writing, the recipient, the contact person indicated on the ODJFS 3697, and the ICF-MR or any other entity responsible for the submission of the ODJFS 3697, that additional documentation is necessary in order to complete the LOC review. This notice shall specify the additional documentation that is needed and shall indicate that the individual or another entity has twenty days from the date ODJFS mails the notice to submit additional documentation or the ODJFS 3697 will be denied for incompleteness with no LOC authorized. In the event an individual or other entity is not able to complete an ODJFS 3697 in the time specified, ODJFS shall, upon good cause, grant one extension of no more than five days when an extension is requested by the recipient or other entity.
(b) If the ODJFS 3697 is complete upon receipt by ODJFS, or, if within the periods specified in paragraph (E)(2)(a) of this rule, the recipient submits the required documentation, ODJFS shall issue a LOC determination within sixty days of the original receipt of the ODJFS 3697 by ODHS. A LOC determination will be issued pursuant to the criteria specified in rules 5101:3-3-05, 5101:3-3-06 and 5101:3-3-07 of the Administrative Code.
(3) A request for an ICF-MR LOC will not be denied by ODJFS for the reason that the individual does not need ICF-MR services until a qualified professional whose qualifications include being a registered nurse or a qualified mental retardation professional (as specified at 42 CFR 483.430) conducts a face-to-face assessment of the individual, reviews the medical records that accurately reflect the individual’s condition for the time period for which payment is being requested; makes a reasonable effort to contact the individual’s physician; and investigates and documents alternative community resources including resources available in the home and family which may be available to meet the needs of the individual. Authorized personnel other than the person who conducted the face-to-face assessment will review the face-to-face assessment and make the final LOC decision.