Appendix XIX, Nursing Facility Counter Logic
9-2010
The following is the current counter process for counting four months for Nursing Facility (NF) admissions:
Month 1
When a STAR+PLUS member enters an NF for the first time this is considered month one. The number of days the member is in the NF during the first month does not affect the counter.
Month 2
The second month a STAR+PLUS member is a resident in an NF counts as month two. The number of days the member is in the NF during the second month does not affect the counter. The second month does not have to be consecutive with the first month.
Month 3
The third month a STAR+PLUS member is a resident in an NF counts as month three. The number of days the member is in the NF during the third month does not affect the counter. The third month does not have to be consecutive with the first month or second month.
Month 4
The fourth month a STAR+PLUS member is a resident in an NF counts as month four. The number of days the member is in the NF during the fourth month does not affect the counter. The fourth month does not have to be consecutive with the first, second or third months.
Examples:
| Managed Care Organization (MCO) Enrollment Date | Example | Counter | Disenrollment | Rule |
|---|---|---|---|---|
| Jan. 1 | Member is admitted into the NF on Jan. 15 and is discharged from the NF on July 2. | January = Month 1 February = Month 2 March = Month 3 April = Month 4 May = Month 4 | Member is disenrolled from the MCO on April 30. | Disenrollment occurs at the end of the month when the member is in the NF on the last day of the month with a counter of 4 and the first day of the next month. |
| Jan. 1 | Member is admitted into the NF on Jan. 15 and discharged on Jan. 20. | January = Month 1 February = Month 1 March = Month 1 | Member is not disenrolled. | Counter remains at 1 unless the member re-enters the NF. If the member re-enters the NF the counter will begin at 2. |
| Jan. 1 | Member is admitted into the NF on Jan. 31 and is discharged on Feb. 2. | January = Month 1 February = Month 2 March = Month 2 | Member is not disenrolled. | The number of days per month does not affect the counter.
Counter remains at 2 unless the member re-enters the NF. If the member reenters the NF the counter will begin at 3. |
| Jan. 1 | Member is admitted into NF on Jan. 15 and discharged Jan. 20. The member is readmitted on April 5 and discharged on April 29. The member is readmitted on May 2. | January = Month 1 February = Month 1 March = Month 1 April = Month 2 May = Month 3 June = Month 4 July = Month 4 | Member is disenrolled from the MCO on June 30. | Disenrollment occurs at the end of the month when the member is in the NF on the last day of the month with a counter of 4 and the first day of the next month.
The months do not have to be consecutive months. |
| Jan. 1 | Member is admitted into the NF on Jan. 15 and discharged on Jan. 20. The member is readmitted on April 5 and discharged on June 15. Member is readmitted into the NF on Aug. 20. Member discharged on Sept. 7. | January = Month 1 February = Month 1 March = Month 1 April = Month 2 May = Month 3 June = Month 4 July = Month 4 August = Month 4 September = Month 4 | Member is disenrolled from the MCO on Aug. 31. | Disenrollment occurs at the end of the month when the member is in the NF on the last day of the month with a counter of 4 and the first day of the next month.
The months do not have to be consecutive months. |
| Jan. 1 | Member is admitted into the NF on Jan. 15 and discharged on Jan. 20. The member is readmitted into the NF on April 5 and discharged on April 29. The member is admitted on May 2. | January = Month 1 February = Month 1 March = Month 1 April = Month 2 May = Month 3 June = Month 4 July = Month 4 | Member is disenrolled from the MCO on June 30. | Disenrollment occurs at the end of the month when the member is in the NF on the last day of the month with a counter of 4 and the first day of the next month. |
| Jan. 1 | Member is admitted into the NF on Jan. 31 and discharged on April 30. | January = Month 1 February = Month 2 March = Month 3 April = Month 4 | Member is not disenrolled. | Member is not a resident of the NF on the first day of the next month. |
| Jan. 1 | Member is admitted into a NF on Jan. 31 and discharged on April 30. The member re-enters the NF on July 5. | January = Month 1 February = Month 2 March = Month 3 April = Month 4 May = Month 4 June = Month 4 July = Month 4 August = Month 4 | Member is disenrolled from the MCO on July 31. | Disenrollment occurs at the end of the month when the member is in the NF on the last day of the month with a counter of 4 and the first day of the next month. |