THE ADMISSION PROCESS
We look forward to having you become part of the Lexington Health Network family. We know how important this decision is and appreciate your trust in us. We will do our very best to provide you or your loved one with the care they need and the respect and dignity they deserve. We will make every effort to ensure a smooth transition at Lexington Health Network by guiding you through each step in the admission process, making sure it is clear and understandable.

TRANSITION FROM A HOSPITAL
If you or your loved one is joining us from a hospital, communication with the hospital's discharge staff is necessary. This may require either a verbal or written release from you. By doing so, the hospital can provide us with key medical information which is needed for admission to Lexington Health Network. This information is critical in helping us determine the level of care you will require as well as utilization of your health benefits. If necessary, a member from Lexington can visit for an on-site assessment to assure accuracy, facilitate discharge and answer any questions you may have.
Your attending physician will determine the discharge date with the hospital. If your current physician is unable to continue care after you transfer to Lexington, we will assist you in finding a new physician who meets your health care needs.

Upon the day of admission to Lexington, or any time prior to that day, your review and signature of the Admission Agreement contract is required for all locations. This contract is required and allows us the consent to provide treatment and care. We prefer to meet with you in advance so that we can address your concerns and answer any questions you may have before joining our family.

Prior to or upon admission to Lexington Health Network, please bring the following documents and information:

  • Any advance directive: a living will or power of attorney documents
  • Medicare card
  • Medicaid card or application
  • Medicare Part D card
  • Photo ID
  • Insurance cards
  • Supplemental and/or other insurance information
  • Social Security card
  • Financial information including your assets and income

TRANSITION FROM A NON-HOSPITAL COMMUNITY OR RESIDENCE
This transition includes all non-hospital settings including retirement centers, assisted living centers or your own home. The following 5 steps are necessary before you or your loved one can be admitted:

  1. Pre-screening from a community senior services agency. We can refer you to an agency in your area. As a requirement by the state for any facility (Lexington or non-Lexington), this agency determines the level of need for nursing home care. Once the screening declares long-term care is necessary, you have a 90-day grace period in which you must be admitted to a long-term care setting. If a decision is made after the grace period, a new screening is required.
  2. Submission of a physical taken within 5 days prior to your admittance or within 72 hours after admission to our centers. Your physical must include a current medical history to help us better understand your needs.
  3. A list of current medications that you are taking.
  4. Upon receipt and approval of the above submitted information, we will contact you to set a time and date for admission.
  5. Upon the day of admission, or any time prior to that day, your review and signature of the Admission Agreement contract is required for all long-term care facilities. This contract allows us the consent to provide treatment and care. We prefer to meet with you in advance so that we can address your concerns and answer any questions you may have before joining our family. Advance payment may be required.

Prior to or upon admission to Lexington Health Network Skilled Nursing locations, please bring the following documents and information:

  • Any advance directive: a living will or power of attorney documents
  • Medicare card
  • Medicaid card or application
  • Medicare Part D card
  • Photo ID
  • Insurance cards
  • Supplemental and/or other insurance information
  • Social Security card
  • Financial information including your assets and income



YOUR FINANCIAL CHOICES
Lexington Health Network Skilled Nursing locations are certified for participation in the Medicare and Medicaid programs. We are also able to work with many private insurers and Health Maintenance Organizations (HMO). Our Financial Coordinator is responsible for addressing your questions and helping you understand all of your financial options. Included is a list of frequently asked questions regarding Medicare and Medicaid to help you understand these options.

MEDICARE - FREQUENTLY ASKED QUESTIONS
What is Medicare?

Medicare is a health insurance program for people age 65 and older or for individuals with certain conditions or disabilities under 65.

Does Lexington Health Network Skilled Nursing locations accept Medicare?

Yes, all Lexington Health Network Skilled Nursing locations are certified to accept individuals covered under Medicare.

How do I use my benefits?

Medicare determines eligibility requirements in order to use the benefit in a skilled nursing facility.

What are the eligibility requirements?

  • The individual has Medicare Part A benefits and has spent 3 consecutive nights in an acute-care hospital.
  • Physician certifies patient requires daily skilled care.
  • Upon leaving a hospital, patient is admitted within 30 days to a skilled nursing facility that is certified for Medicare.

What is Skilled Care?

Skilled care is defined as care that is provided under direct supervision of a licensed staff. Medicare does not cover routine care or assistance with activities of daily living such as walking or bathing. Medicare refers to this care as custodial care.

What services does Medicare cover?

Services covered include a semi-private room, therapy, meals, medications, medical supplies, skilled nursing care, medical social services and dietary counseling.

How long will the coverage last?

The individual will begin using the coverage upon admission. The maximum benefit period is 100 days if the qualifying conditions are met. You will be notified when you no longer meet the requirements for skilled care benefits.

What does Medicare pay?

On day 1 through 20, Medicare pays 100% of the covered charges. A daily co-insurance payment will apply on days 21-100.

How is the co-insurance amount covered?

Co-insurance payment can be covered in three ways: Supplemental insurance, private payment or financial assistance from the State of Illinois under the Medicaid program.

What happens when Medicare coverage ends?

If an individual would like to remain in the facility after coverage ends, our Financial Coordinator will discuss payment options. If the choice is to return home, our staff will assist in planning for the care needed.

Where can I obtain additional information on Medicare?

You may contact Medicare at (800) 633-4227 or visit their web site at www.medicare.gov

MEDICAID - FREQUENTLY ASKED QUESTIONS

What is Medicaid?

Medicaid is a state-administered program designed to assist individuals in need of financial assistance for medical care. This program is administered by the Illinois Department of Health Care and Family Services (HFS).  For more information you may contact them at (800) 843-6154.

Does Lexington Health Network Skilled Nursing Locations accept Medicaid?

Yes, all Lexington Health Network Skilled Nursing locations are certified to accept individuals covered under the Medicaid program.

Who can obtain Medicaid assistance?

The Department of Health Care and Family Services (HFS) requires Illinois residency, U.S. citizenship, a need for medical care and the completion of an application. There are certain income and asset requirements that must be met, as set by the State of Illinois.

How do I apply for Medicaid?

We can provide you with an application and assistance in filling it out, as well as supply you with a list of the supporting documentation that HFS requires.

What services does Medicaid cover?

Services covered include room and board, nursing care, meals and certain medications (not all medications are covered by Medicaid). A detailed list is available from our Financial Coordinator.

What happens to a spouse who may reside in the community?

DHS guidelines indicate what money can be retained and what is used toward care and services. This amount is generally adjusted on an annual basis. A detailed list can be obtained from Client Services.
What happens to the resident's Social Security or pension check?
In most instances these checks must be paid to the facility for the resident's portion of the monthly fee.

Where can I obtain additional information on Medicaid?

You may contact HFS or the State of Illinois via their website at www.hfs.illinois.gov (Department of Health Care and Human Services).