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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
5.8.1.1 Institutions for Mental Disease
For MA purposes, “institution” means medical institution. A medical institution can be, but is not limited to, skilled nursing facilities (SNF), intermediate care facilities (ICF Intermediate Care Facility), institutions for mental disease (IMD Institute for Mental Disease), and hospitals.
Medical institution means a facility that:
Is organized to provide medical care, including nursing and convalescent care,
Has the necessary professional personnel, equipment, and facilities to manage the medical, nursing, and other health needs of patients on a continuing basis in accordance with accepted standards,
Is authorized under State law to provide medical care, and,
Is staffed by professional personnel who are responsible to the institution for professional medical and nursing services.
IMDs are medical institutions that care for persons with mental illness. See the list of IMDs (5.8.11).
IMD residents under age 21 and over age 64 may be MA eligible. Persons aged 21 through 64 are not eligible unless they were IMD residents immediately prior to turning age 21. If they were, they are eligible until discharge or until turning age 22, whichever comes first.
A person aged 21 through 64 can go on conditional release from an IMD or convalescent leave and become eligible for MA while on leave.
Conditional release means a temporary release from an IMD for a trial period of residence in the community.
The trial period must last no less than four days. It must be no longer than 30 days.
The trial period begins after the initial three days of community residence following discharge.
A person under age 22 who leaves the IMD for a trial period remains eligible as an IMD resident until s/he is unconditionally released from the IMD.
For purposes of MA, conditional release is permitted only once every calendar year.
Convalescent leave means a period of time following inpatient admission of a resident of an IMD to a general hospital for the purpose of treatment for a physical medical condition of a severity which medically contraindicates treatment of the condition in the IMD.
Hospitals are medical institutions that:
Provide 24-hour continuous nursing care,
Provide dietary, diagnostic, and therapeutic services, and,
Have a professional staff composed only of physicians and surgeons, or of physicians, surgeons and doctors of dental surgery.
A person residing in a hospital is an institutionalized person (5.8.4.1) if s/he:
Has resided in a medical institution for 30 or more consecutive days, or
Is likely to reside in a medical institution for 30 or more consecutive days.
The 30-day period includes situations in which the person resides in more than one medical institution during 30 or more consecutive days.
When a minor applies for MA after being discharged from the IMD, certify the individual as a recipient, if eligible, for the inpatient IMD days only. Certify for the remainder of the month if s/he would be eligible after being tested for Family MA with his/her parents and siblings.
This page last updated in Release Number : 04-03
Release Date: 08/02/04
Effective Date: 08/02/04