The LOC Determination is to be completed by the nursing facility, MI Choice, or PACE provider prior to the beneficiary's admission or enrollment, except for residents of counties participating in the  Long Term Care Connection Demonstration Project .  Medicaid services will not be reimbursed unless the beneficiary is determined medically/functionally eligible through the web-based LOC Determination.  The web-based LOC Determination must be completed within 14 calendar days of the admission.

The Nursing Facility LOC Determination User Manual   provides step-by-step instructions on registering for the Single Sign-On System, as well as screen-by-screen instructions for completing the web-based LOC Determination.

Policy requirements and other related provider-specific information for:

• Nursing Facilities, can be found in the  Medicaid Provider Manual ,  Nursing Facility Coverages chapter, Beneficiary Eligibility and Admission Process.
• PACE can be found in the  Medicaid Provider Manual , PACE chapter, Eligibility and Enrollment
• MI Choice Eligibility Waiver and Admission Process Policy - Updated May 2005

Supplemental information is also available through the following links:

• Nursing Facility LOC Determination  Contact Information
  • LOC Determination Provider Helpline
  • Michigan Peer Review Organization
  • Nursing Facility Transition Team
• Nursing Facility LOC Determination Form
• Nursing Facility LOC Determination Field Definition Guidelines
• Freedom of Choice Form
• Nursing Facility LOC Exception Process
  • LTC Adverse Action Notices
  • Adequate Action
  • Advance Action
  • Hearing Request
• Nursing Facility LOC Determination Process Guidelines
• Access Guidelines to State Services for Persons w/LTC Needs
• Telephone Intake Guidelines
• All documents are provided in Acrobat format.  To install Acrobat Reader, click on the icon.

Long-Term Care Connection Demonstration Project and the Counties Served:  

Michigan's Long-Term Care Connections, as part of a demonstration project, will conduct the Michigan Medicaid Nursing Facility Level of Care Determination for nursing facility providers and MI Choice Program agencies according to Policy Bulletin  MSA 07-45 , in the following counties beginning November 1, 2007:

Detroit/Wayne:  Serves City of Detroit, Grosse Pointe (GP), GP Farms, GP Park, GP Shores, GP Woods, Hamtramck, Harper Woods, Highland Park

Southwest Michigan:  Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren

West Michigan:  Allegan, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa

Upper Peninsula:  Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Ontonagon, Schoolcraft

Additional information on the Long-Term Care Connection demonstration project may be found on the Office of Long-Term Care Supports and Services website located at www.michigan.gov/ltc  >> Long-Term Care Connections.

Nursing Facility Level of Care Determination Contact Information

LOC Determination Form  

Providers may utilize a hard copy of the LOC Determination to gather information.  However, the online LOC Determination must be completed as indicated in the policy* in order for reimbursement to be made.

LOC Determination of Field Definitions    

The LOC Field Definitions provides definitions for each question/answer field in the LOC Determination. 

Freedom of Choice Form

Michigan's Informed Choice Process is part of the LOC Determination.  The Informed Choice Process ensures that applicants are informed of all nursing facility level of care program options under Medicaid.  It also informs applicants of their right to request an exception to the criteria and provides information on the appeals process.  

Nursing Facility Level of Care Exception Process

Michigan's Nursing Facility Level of Care Exception Process is available for applicants who do not meet the LOC Determination criteria, but who demonstrate a significant need for long-term care.  To request an exception, contact MPRO.

Long Term Care Adverse Action Notices

Refer to the provider-specific policy links above for more information regarding beneficiary notice requirements.  For an immediate review of adverse action notices, beneficiaries may contact MPRO.

• Adequate Notice
  An Adequate Notice must be sent when the new applicant appears to be ineligible for services based on the Michigan Medicaid Nursing Facility Level of Care Determination. It also applies to MI Choice new applicants who request a Level of Care Determination, but the program is currently at capacity.
  Nursing Facility        MI Choice Program  
  
• Advance Action Notice
  An Advance Action Notice must be sent when the current applicant is receiving program services, but is no longer functionally eligible for services based on the Nursing Facility Level of Care Determination process and attempts at discharge planning have failed.  The Nursing Facility Transition Team is available to assist.
  Nursing Facility        MI Choice Program  
  
• Request for an Administrative Hearing Form (DCH-0092)
  The provider must supply a copy of the DCH-0092 to the applicant when the applicant believes a decision is inappropriate.   DCH-0092 .    Administrative Tribunal website

Michigan Medicaid Nursing Facility Level of Care Determination Process Guidelines

The Process Guidelines explain the process requirements for admission to Michigan's three primary long-term care programs:  Medicaid-reimbursed nursing facility care, Home and Community-Based Services for the Elderly and Disabled (MI Choice Program) and the Program of All-Inclusive Care for the Elderly (PACE). 

Access Guidelines to State Services for Persons with Long Term Care Needs

The Access Guidelines assist providers of long term care services to determine appropriate referrals for applicants seeking long term care services.  The guidelines are presented for provider information. 

Telephone Intake Guidelines

A list of questions that may be used to identify potential in-person assessments are provided in the Telephone Intake Guidelines. 

The Telephone Intake Guidelines do not determine program eligibility. The Telephone Intake Guidelines are mandatory for MI Choice Program Agencies when they are currently placing individuals on the MI Choice Program Waiting List.   PDF Format    WORD Format

If a MI Choice Program applicant refuses to complete the Telphone Intake Guidelines, the waiver agency must schedule a full assessment.  The asessment scheduled at the MI Choice Program Agency office and referred to the Department of Human Services (DHS), formerly FIA, to have a formal Medicaid LOC determination.  In this instance the individual is placed on the waiting list until such time that a determination has been made by DHS or a full assessment has been conducted by the waiver agent.   MI Choice Program Waiting List Quarterly Summary Report Form