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INST-STATUS
Institutional Status Indicator. This data element can be used to assist the EWs in identifying a potential recipient of Long Term Care services. If the information comes from Service, Utilization, Review, Guidance, and Evaluation (SURGE), a worker alert will be generated and the appropriate action should be taken. This field can be found on the INQL screen.
The values listed below are presented in the order of assignment. For example, you will not see a value ‘E’ assigned if the conditions for ‘A’ is met.
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Value |
Description |
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Space |
The recipient has not been identified as dual eligible* and has not been included on the MMA Enrollment File sent to CMS. |
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0 |
The recipient has been identified as a dual eligible* and included on the MMA Enrollment File sent to CMS. However, the recipient was not identified as receiving LTC services. |
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A |
The recipient has been identified as a dual eligible* and included on the MMA Enrollment File sent to CMS. The recipient was identified as having an LTC Aid Code on MEDS. |
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E |
The recipient has been identified as a dual eligible* and included on the MMA Enrollment File sent to CMS. The recipient was not identified by “A” above (that is, having an LTC Aid Code); however, the first-digit of the Eligibility Status Code on MEDS is equal to “1” or “2”. |
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S |
The recipient has been identified as a dual eligible* and included on the MMA Enrollment File sent to CMS. The recipient was not identified by “A” or “E” above; however, the recipient did have an SSI/SSP or Redetermination Aid Code with an SSI Living Arrangement Code equal to D. |
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P |
The recipient has been identified as a dual eligible* and included on the MMA Enrollment File sent to CMS. The recipient was not identified by “A,” “E,” or “S” above; however, the recipient did have a paid claim with a LTC Vendor Code. |
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T |
The recipient has been identified as a dual eligible* and included on the MMA Enrollment File sent to CMS. The recipient was not identified by “A,” “E,” “S,” or “P” above; however, the recipient was identified as LTC by a Treatment Authorization Request (TAR) defined in the SURGE application. The SURGE application contains information on any TAR for a Medi-Cal recipient authorized/admitted to a nursing home or other facility. |
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* Eligible for both Medi-Cal and Medicare. |
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