The Office of Long-Term Living (OLTL) issued a bulletin today that explains the Functional Eligibility Determination (FED) process, which is used to determine clinical eligibility for Medical Assistance Long-Term Services and Supports (LTSS). Previously, the assessors had used the level of care determination (LCD) tool.

Effective today, OLTL will use the FED process to determine and redetermine whether an individual is nursing facility clinically eligible (NFCE) or nursing facility ineligible (NFI). The FED process is a multi-step process that begins with an assessment and concludes with translating the assessment scores into a determination whether an individual is NFCE.

The bulletin includes details about the various sections of the FED tool itself and provides information on how the assessor enters the information and scores from the FED tool into the Pennsylvania Individualized Assessments (PIA).

Once the assessor enters the scores for an individual into the PIA, the PIA automated program translates the scores into a finding of NFCE or NFI. The bulletin includes a matrix that shows how the scores are translated and also includes examples.

Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.