This is a measure of how well staff are processing applications relative to the current timeliness standard.
Long Term Care (LTC) Medicaid applications must be processed within the 45-day federal timeliness standard. Some clients cannot access long term supports and services until their LTC application has been processed. Other clients are admitted to nursing facilities (NF) prior to submission of their LTC application. The NF’s depend upon timely processing as they need to know if the client is LTC Medicaid eligible. Additionally, delays in payments for Medicaid eligible LTC services can create revenue issues for the facilities.
Sometimes applications are delayed because the Department of Aging & Independent Living (DAIL) cannot find a clinical placement for the applicant. Sometimes clients do not submit all verification documents within their initial verification due date which requires the worker to send a second verification request. Other delays are the result of the client needing additional time to submit verification documents for the five year look back period (LBP). Finally, since launching the electronic asset verification system (eAVS), LTC workers have experienced higher workloads as explained above.
Applications exceeding 45 days processing time which can be directly attributed to one of these types of delays are not included in this performance measure because the financial eligibility worker has no control over those delays.
The percentage of applications processed within the 45-day federal timeliness standard reflects Vermont’s level of compliance with that federal rule. The higher the level of compliance, the lower the risk of financial penalties related to payment errors for exceeding the federal timeliness standard. This measure receives extensive focus from the LTC Unit, as staff seek to continuously improve in this error through business process efficiencies, worker training and review of casework. Staff workload levels make it very difficult to achieve a 45-day timeliness standard on all LTC cases due to the complex work associated with these cases.
A goal of 100% was established in July 2018 for this performance measure.
CMS suspended 45-day processing time rule requirement for COVID 19 Emergency Period which started on March 1, 2020.
Last updated: 06/15/2020