Bulletin. Pre-Admission Screening: Required Activity for Admission to Medicaid- Certified Nursing Facilities TOPIC PURPOSE CONTACT SIGNED

Transcription

1 Bulletin NUMBER # DATE OF INTEREST TO Cunty Directrs Scial Services Supervisrs and Staff Tribal Health Directrs Lng Term Care Cnsultatin Cntacts Nursing Facility Prviders Hspital Discharge Planners Certified Health Care Hme and Clinic Staff Managed Care Organizatins Senir LinkAge Line Staff Area Agency n Aging Directrs ACTION/DUE DATE Please cmplete PAS as required fr NF admissins. EXPIRATION DATE September 24, 2016 Pre-Admissin Screening: Required Activity fr Admissin t Medicaid- Certified Nursing Facilities TOPIC State and federal law require Pre-Admissin Screening (PAS) befre admissin t Medical Assistance (MA)-certified nursing facilities (NF) regardless f payer surce fr services. PAS plicy prhibits any payment fr NF services prvided prir t cmpletin f PAS. PURPOSE Cmmunicate PAS requirements, plicy and practice fr all admissins. Outline Medicaid Management Infrmatin System (MMIS) editing related t PAS fr MA NF claims. CONTACT MBA.DHS@state.mn.us fr PAS plicy and prtcls DSD.RespnseCenter@state.mn.us fr under 65 plicy DHS.ResurceCenter@state.mn.us fr MMIS SIGNED LOREN COLMAN Assistant Cmmissiner, Cntinuing Care Administratin TERMINOLOGY NOTICE The terminlgy used t describe peple we serve has changed ver time. The Minnesta Department f Human Services (DHS) supprts the use f "Peple First" language. Minnesta Department f Human Services PO Bx St. Paul, MN

2 Page 2 I. Backgrund Federal and state laws require that ALL individuals entering a Medical Assistance (MA)-certified nursing facility (NF), a certified barding care facility, r a hspital swing bed receive a Pre- Admissin Screening (PAS), regardless f the anticipated length f stay r the payer surce fr facility services. PAS plicy includes: Timelines fr cmpletin f PAS activities Additinal evaluatins fr peple wh may have a develpmental disability r serius and persistent mental illness Additinal requirements fr peple under age 65 admitted t facilities Certain exemptins frm PAS requirements The 2013 Minnesta Legislature amended Minnesta Statutes, sectin 256B.0911 gverning Lng Term Care Cnsultatin (LTCC) services by deleting the PAS activity and plicy cntained in Minnesta Statutes, sectin 256B.0911, subdivisins 4a 4c and subdivisin 7 gverning reimbursement fr MA-certified nursing facilities and incrprating this plicy and activity under Minnesta Statutes, sectin , subdivisin 7 7c gverning the activities and services carried ut by the Minnesta Bard n Aging. Effective Nvember 1, 2013, Senir LinkAge Line (SLL) staff cnduct PAS activities. This amendment als remved the exemptin frm PAS fr individuals admitted t a NF with a prpsed length f stay f 30 days r less when admitted frm an acute hspital. This bulletin utlines: PAS plicies and requirements, including the 2013 legislative changes and the summary f all related infrmatin published in several past bulletins. This bulletin replaces all previus bulletins issued related t PAS; The redesign f the PAS prcess and rles, nw supprted by the Senir LinkAge Line ; Hw health care prfessinals will initiate the cmpletin f PAS by using nline tls; Cmmunicatin with health care prfessinals, NF prviders, managed care rganizatins (MCOs) and lead agency case managers cmpleted by Senir LinkAge Line ; and Infrmatin related t MMIS dcumentatin required t cmplete a PAS and ensure feefr-service nursing facility payment fr peple participating in Minnesta Health Care Prgrams (MHCP). This bulletin replaces bulletin There are als three attachments included: Minnesta Department f Human Services PO Bx St. Paul, MN

3 Page 3 Attachment A prvides a quick summary f infrmatin cntained in the bulletin related t PAS timelines and requirements. Attachment B includes infrmatin abut MMIS system edits related t PAS fr NF claims. Additinal infrmatin, such as the PAS business prcess mdel, step-by-step instructins and vides develped as part f the statewide training n PAS redesign delivered in August 2013, are available n the Minnesta Bard n Aging website. Attachment C is a table shwing what referrals will be made by SLL staff bth when PAS has been cmpleted by SLL but als includes additinal tasks that must be cmpleted when a PAS is NOT cmpleted by SLL. This table als utlines the respnsibility f the lead agency wh receives the referral. II. Purpse f Pre-Admissin Screening PAS requirements apply t a MA-certified NF, a certified barding care facility, r a hspital swing bed 1. Fr purpses f PAS plicy and requirements, the term facility r NF refers t all three settings thrughut this bulletin. PAS is cmpleted t: Avid unnecessary facility admissins by identifying peple whse needs might be met in the cmmunity and cnnecting them t cmmunity-based services; Screen peple fr mental illness r develpmental disabilities based n the Omnibus Budget Recnciliatin Act (OBRA) f 1987, als referred t as OBRA Level I screening. This screening is cmpleted t identify and refer individuals t ther prfessinals fr evaluatin f the need fr specialized mental health r develpmental disability services as required under federal law. These activities are referred t as OBRA Level II activities 2 ; Determine and dcument the need fr NF services in the Medicaid Management Infrmatin System (MMIS) fr purpses f MA payment fr NF services; Prvide assistance after NF admissin t supprt transitin back t the cmmunity. 1 A swing bed is ne that has been certified as bth an acute hspital and NF bed, and that, under special circumstances, may be used fr Medicare skilled nursing facility days. In additin, in seven hspitals designated as "Sle Cmmunity Prviders," MA nursing facility rm and bard days may be prvided as swing bed days. Requirements fr use f swing beds are utlined in the Minnesta Health Care Prgrams Prvider Manual. All ther requirements fr the use f these beds must be met, regardless f payer surce, including claims prcessing prcedures and Minnesta Department f Health apprval fr stays as needed. 2 OBRA Level II activities and requirements are nt included in this bulletin. Please see Sectin XV fr resurce infrmatin related t OBRA Level II. Minnesta Department f Human Services PO Bx St. Paul, MN

4 Page 4 Unless an admissin meets ne f the exemptins utlined in Sectin VII r VIII belw, PAS must be cmpleted PRIOR t admissin. PAS requirements apply t all admissins t Medicaid-certified facilities, regardless f the payer surce fr facility services r length f stay r age f cnsumer. III. Senir LinkAge Line Respnsibility fr Pre-Admissin Screening Effective Nvember 1, 2013, statewide respnsibility fr PAS was assigned t the Minnesta Bard n Aging, in partnership with the Area Agencies n Aging, thrugh the Senir LinkAge Line. A PAS request is submitted by a health care prfessinal seeking NF admissin thrugh a single nline site and frwarded electrnically t the Senir LinkAge Line cntact center that serves the cunty where the health care prfessinal r prvider wh submits the infrmatin is lcated. The nline PAS referral site shuld be bkmarked fr easy reference. Senir LinkAge Line is respnsible t perfrm PAS fr all individuals except: Thse enrlled int ne f the fllwing prepaid Medical Assistance prgrams; Minnesta Senir Health Optins (MSHO) Minnesta Senir Care Plus (MSC+) Special Needs Basic Care (SNBC) Individuals n a hme and cmmunity-based services waiver r Alternative Care prgram, but nt enrlled int a prgram listed abve; and Individuals under the age f 21. A. PAS fr Peple Enrlled in Prepaid Medical Assistance Prgrams ( Managed Care ) While Senir LinkAge Line is nt respnsible t perfrm PAS fr thse enrlled int prepaid medical assistance prgrams (MSHO, MSC+ and SNBC nly) all PAS referrals fr managed care enrllees must be made nline. The Senir LinkAge Line will retrieve the referral and frward the PAS request fr individuals enrlled in MSHO, MSC+ r SNBC t the individual s managed care rganizatin (MCO) via a secure bx. The qualified prfessinal assigned by an MCO t cmplete PAS activity will then cmplete all necessary actins. Referrals fr PAS shuld nt be made directly t an MCO. Qualified prfessinals, as defined in the cntract between the MCOs and the Minnesta Department f Human Services, r the MCO s qualified designee (which may include cunty staff under cntract with a MCO t perfrm PAS), must fllw the same PAS timelines, prcedures and MMIS dcumentatin requirements as utlined in this bulletin. Please see Sectin XV fr resurce infrmatin abut the mdel cntracts fr each f the prepaid medical assistance prgrams listed abve. Minnesta Department f Human Services PO Bx St. Paul, MN

5 Page 5 Fr peple wh receive their health care services under MSHO r MSC+, the individual s MCO is respnsible t: Perfrm determinatins f the need fr NF level f care; Cmplete OBRA Level I Screening; Prvide dcumentatin f the PAS result t the admitting nursing facility; Frward, if apprpriate, t the cunty fr OBRA Level II activity; Enter PAS infrmatin int MMIS using the Lng Term Care Screening dcument, if the cnsumer is nt a waiver prgram participant at the time f admissin (See Sectin V. fr infrmatin abut admissin f hme and cmmunity-based services waiver r Alternative Care participants); and Prvide relcatin assistance t all f their enrlled members. Fr individuals wh receive their health care services under SNBC, a vluntary managed care prgram fr peple with disabilities, the individual s MCO is respnsible t: Perfrm determinatins f the need fr NF level f care fr facility admissins; Cmplete OBRA Level I Screening; Prvide dcumentatin f the PAS result t the admitting nursing facility; Frward, if apprpriate, t the cunty fr OBRA Level II activity; and Enter PAS infrmatin int MMIS using the Lng Term Care Screening dcument, if the cnsumer is nt a waiver prgram participant at the time f admissin. (See Sectin V. fr infrmatin abut admissin f hme and cmmunity based services waiver r Alternative Care participants.) Cntact infrmatin fr each MCO can be fund n the Minnesta Department f Human Services website r when accessing the MN-ITS eligibility system. Senir LinkAge Line PAS staff access infrmatin abut managed care enrllment in MMIS in the Recipient subsystem n the screen labeled RPPH. Nursing facility prviders can access infrmatin abut an individual s enrllment in these managed care prgrams in the MN-ITS eligibility system. B. Nursing Facility Admissins and Face-t-Face Assessments Sme individuals can be admitted t a nursing facility withut an nline PAS referral t the Senir LinkAge Line. Individuals wh have received a face-t-face assessment cmpleted by a lead agency within 60 days prir t admissin t a facility are nt required t receive PAS thrugh the nline referral system. Lead agency refers t cunties, tribes and managed care rganizatins under cntract with DHS t perfrm LTCC (MnCHOICES) assessments and determine eligibility fr lng term services and supprts. In this case, the lead agency will have entered a Lng Term Care Screening dcument in Minnesta Department f Human Services PO Bx St. Paul, MN

6 Page 6 MMIS that verifies NF level f care is met and OBRA Level I Screening has been cmpleted. OBRA Level I screening cmpleted as part f the face-t-face assessment must be frwarded t the facility by the lead agency. Please nte the updated OBRA Level I Screening Frm (DHS frm 3426) allws the lead agency t dcument NF level f care and the date the frm was cmpleted r updated. Lead agencies d nt need t cmplete a PAS referral nline fr NF admissins that result frm a face-t-face assessment. Any required OBRA Level II activities must als be cmpleted prir t admissin. Nte: See Sectin V fr infrmatin abut admissins fr individuals participating in hme and cmmunity-based waivers r the Alternative Care prgram. IV. Instructins and Infrmatin fr Cmpleting Pre- Admissin Screening A. Online (Frmerly Telephne-Based) Pre-Admissin Screening PAS may be cmpleted nline nly when a health care prfessinal seeking admissin can prvide the Senir LinkAge Line r MCO PAS staff with sufficient infrmatin t determine the need fr NF level f care, and t cmplete OBRA Level I screening via the nline screening tl. Online screening is mst typically used fr acute hspital discharges t facility-based services. Online screening can nly be used t admit peple frm the cmmunity when the request fr admissin is made by a qualified health care prfessinal and sufficient infrmatin is available t determine the need fr NF services and cmplete the OBRA Level I screening. If the health care prfessinal des nt have enugh infrmatin t cmplete the PAS referral nline, he/she can cmplete the nline frm t the best f his/her ability and submit it. The Senir LinkAge Line will then determine whether a face-t-face assessment frm the cunty, tribe r MCO is needed. If a Senir LinkAge Line r MCO PAS staff cannt determine the need fr nursing facility level f care r cmplete the OBRA Level I based n the infrmatin prvided via an nline referral, a facet-face Lng Term Care Cnsultatin r MnCHOICES assessment must be cmpleted in rder t determine the need fr nursing facility level f care and t cmplete the OBRA Level I. This facet-face assessment must be cmpleted within 20 calendar days f the initial request fr screening, and prir t admissin. The face-t-face assessment is required t be cmpleted by the lead agency respnsible t prvide Lng Term Care Cnsultatin services t the individual as defined in Minnesta Statutes, sectin 256B Minnesta Department f Human Services PO Bx St. Paul, MN

7 Page 7 B. Cmpleting a Pre-Admissin Screening Request Online Only a qualified health care prfessinal can determine if admissin t a nursing facility is apprpriate. A qualified health care prfessinal is the physician wh determines the cnsumer needs nursing facility placement and writes the admissin rders. This is limited t physicians within hspitals, clinics and hspice prviders. Hwever, staff assciated with the health care prfessinal, such as staff within the hspital r clinic where the physician wrks, as well as nursing facility staff, may cmplete the nline referral fr a PAS after the health care prfessinal has made this determinatin. Registered husing with services (assisted living) and ther hme care r hme and cmmunity-based service prviders are nt cnsidered qualified health care prfessinals fr the purpses f PAS. The request fr PAS must be made thrugh the nline referral site. Health care prfessinals and prviders are encuraged t bkmark this page fr easy access. Online PAS cmpletin requires that all apprpriate infrmatin be submitted, reducing any delays in cmpletin f PAS due t incmplete data. In additin, an initial nursing facility level f care and OBRA Level I result will be cmmunicated electrnically t the submitter nce all fields are cmpleted and submitted. The PAS utput dcument with these results can be saved r printed by the individual cmpleting the referral fr dcumentatin, alng with a cnfirmatin number. Please ensure the Finish buttn has been selected and an utput frm cntaining a cnfirmatin number appears. If this step is nt cmpleted, the referral will be incmplete and nt submitted t the Senir LinkAge Line. Nte that the cnfirmatin number is nt a required element f the PAS, but prvides cnfirmatin that the PAS was submitted successfully nline, as well as serves as easy reference fr the Senir LinkAge Line if questins arise. It is advised that the health care prfessinal print the referral and results and prvide a cpy t the admitting facility with ther discharge paperwrk t prevent admissin delays. The Senir LinkAge Line will strive t cmplete all PAS requests within ne business day, including referral t a lead agency, if the PAS will nt be cmpleted by the Senir LinkAge Line fr the reasns mentined under Sectin III. A step-by-step fr health care prfessinals n cmpleting the nline referral is available nline. This step-by-step and all ther infrmatin will be updated as changes t the nline site are made. Minnesta Department f Human Services PO Bx St. Paul, MN

8 Page 8 C. PAS and LTCC r MnCHOICES Face-t-Face Assessment The PAS, cmpleted as part f a Lng Term Care Cnsultatin (LTCC) r MnCHOICES face-tface assessment, may ccur prir t admissin fr any individual seeking admissin frm the cmmunity. This prvides an pprtunity fr the LTCC staff 3 t determine whether cmmunitybased supprts, including caregiver supprts, culd delay r prevent admissin. Face-t-face assessment and cmmunity-based services planning are available under the Lng Term Care Cnsultatin prgram fr all peple with lng term r chrnic care needs, regardless f eligibility fr publicly-funded lng term care services. A face-t-face LTCC r MnCHOICES assessment and supprt planning visit must be made within 20 calendar days f a request r referral, and is prvided free f charge. The cunty where the individual is lcated is respnsible t prvide assessment and supprt planning services. An MCO enrllee s care crdinatr is respnsible t prvide assessment and supprt planning services t individuals aged 65 and lder enrlled in MSHO r MSC+. Please see Sectin III.B. abve fr infrmatin regarding hw an LTCC r MnCHOICES assessment relates t the requirement f an nline PAS referral. If the cnsumer is undecided abut admissin t a facility and wants t learn mre abut cmmunity-based supprts, health care prfessinals can refer the cnsumer t the cunty fr a face-t-face assessment. In additin, health care prfessinals r cnsumers can cntact the Senir LinkAge Line at t learn mre and be cnnected t lcal cunty LTCC (MnCHOICES) staff. V. Alternative Care, Hme and Cmmunity-Based Services (HCBS) Waiver Participants and PAS Participants in the Alternative Care (AC), Elderly Waiver (EW), Cmmunity Alternative Care (CAC), Cmmunity Alternatives fr Disabled Individuals (CADI) r the Brain Injury (BI)- NF waiver prgrams n the date f NF admissin wh cntinue t meet NF Level f Care (LOC) criteria are nt required t receive PAS thrugh the nline referral system prir t admissin t a NF. These individuals have the right t chse between hme and cmmunity-based and institutinal 3 Lng Term Care Cnsultants will becme certified assessrs and will perfrm face-t-face assessments using the MnCHOICES sftware beginning in Nvember 2013 fr launched lead agencies. All f the assessment items used t determine NF LOC and cmplete OBRA Level I screening are present in the MnCHOICES assessment tl. Minnesta Department f Human Services PO Bx St. Paul, MN

9 Page 9 services. The lead agency prviding case management must ensure the admitting facility receives the OBRA Level I Screening frm (DHS 3426). Any required OBRA Level II activities must als be cmpleted. This exceptin des nt include individuals participating in the Develpmental Disability (DD) Waiver prgram fr individuals with develpmental disability and an Intermediate Care Facility/Develpmental Disability (ICF/DD) level f care. See Sectin VI fr mre infrmatin abut admissin f individuals with develpmental disabilities. A. When HCBS participants in the prgrams listed abve are admitted t the NF frm the cmmunity: OBRA Level I screening cmpleted as part f the face-t-face assessment must be frwarded t the facility by the lead agency. The DHS-3426 OBRA Level I frm has been updated t include verificatin that the persn cntinues t meet NF LOC at admissin and shuld be re-signed and dated by the lead agency. Lead agencies d nt need t cmplete a PAS referral nline fr NF admissins f waiver clients. Lead agencies fllw the plicy related t exiting individuals frm the waiver r AC prgram if the admissin exceeds 30 days. Fr mre infrmatin abut Temprary Waiver Exits please refer t the Cmmunity Based Services Manual (CBSM). B. When HCBS prgram participants are admitted t the NF frm a hspital r clinic: Mst health care prfessinals submitting the nline PAS request will nt knw if a cnsumer is n an HCBS waiver prgram, and will be submitting nline PAS requests fr all individuals. When an nline PAS referral is cmpleted fr an individual participating in ne f the HCBS prgrams listed abve, the frm will nt be prcessed by Senir Linkage Line and instead: Senir LinkAge Line will frward the utput frm t the apprpriate lead agency t cmmunicate infrmatin abut an admissin f ne f their HCBS participants. When a cnsumer is n a waiver r AC, Senir LinkAge Line staff will nt and cannt cmplete the PAS, nr enter it int MMIS, due t the waiver r AC enrllment. The lead agency must frward a cpy f the DHS-3426 OBRA Level I frm t the NF. If the lead agency has received a PAS utput frm because a health care prfessinal cmpleted an nline PAS referral, this frm can be sent t the NF with the DHS-3426 OBRA Level I frm, but is nt required. Minnesta Department f Human Services PO Bx St. Paul, MN

10 Page 10 The Senir LinkAge Line will als frward a cpy f the utput frm, alng with a letter prviding infrmatin t the nursing facility regarding the referral t a lead agency. This letter will prvide the lead agency cntact infrmatin in the event the nursing facility has questins r cncerns. Please see Attachment C fr mre infrmatin abut cmmunicatins cmpleted by Senir LinkAge Line t ther lead agencies and lead agency respnsibilities and next steps. C. Additinal Referrals and Cmmunicatins Related t PAS 1. Individuals under age 65 Fr individuals under age 65 n a hme and cmmunity-based waiver prgram, but nt enrlled in SNBC, the Senir LinkAge Line will frward the infrmatin submitted n the PAS referral t the individual s cunty f financial respnsibility and the cunty f nursing facility lcatin. The cunty f financial respnsibility is respnsible t prvide a cpy f DHS-3426, and may frward a cpy f the PAS utput frm, if apprpriate, t the admitting nursing facility t ensure they have a cpy f the Pre-Admissin Screening results. The cunty f nursing facility lcatin is respnsible t cmplete the face-t-face assessment within 40 days f admissin as required in Minnesta Statutes, sectin 256B.0911, subdivisin 4d. See Sectin XI fr mre infrmatin abut admissins fr individuals under age 65. Fr individuals under age 65 n a hme and cmmunity-based waiver prgram and enrlled in SNBC, the Senir LinkAge Line will frward the infrmatin submitted n the PAS referral t the individual s cunty f financial respnsibility and the MCO. The cunty is respnsible t prvide a cpy f DHS-3426, and may frward a cpy f the PAS utput frm, if apprpriate, t the admitting nursing facility t ensure they have a cpy f the Pre- Admissin Screening results. The cunty f financial respnsibility is respnsible t send a referral t the cunty f nursing facility lcatin s they may cmplete the face-t-face assessment within 40 days f admissin as required in Minnesta Statutes, sectin 256B.0911, subdivisin 4d. See Sectin XI fr mre infrmatin abut admissins fr individuals under age 65. The cunty f financial respnsibility als prvides relcatin assistance and access t hme and cmmunity-based prgrams and services. Fr individuals under age 65 enrlled in SNBC, but nt participating in a hme and cmmunity-based waiver prgram, the Senir LinkAge Line will frward the infrmatin t the MCO. The MCO is respnsible t cnvey infrmatin btained during the screening and send a cpy f DHS-3426 and may frward a cpy f the PAS utput frm, if Minnesta Department f Human Services PO Bx St. Paul, MN

11 Page 11 apprpriate, t the nursing facility, as well as frward any apprpriate OBRA II referrals t the cunty. The MCO is als respnsible t send a cpy f the PAS t the cunty f financial respnsibility within five (5) wrking days. The cunty f financial respnsibility is then respnsible t send a referral t the cunty f nursing facility lcatin s they may cmplete a face-t-face assessment prir t 40 th day f admissin. The cunty f financial respnsibility als prvides relcatin assistance and access t hme and cmmunity-based prgrams and services. Fr individuals under age 65 admitted t a nursing facility, but nt enrlled in SNBC and nt participating in a hme and cmmunity-based waiver prgram, the Senir LinkAge Line will frward the infrmatin submitted n the PAS referral t the cunty in which the facility is lcated t prvide early ntificatin abut individuals wh will receive a face-t face assessment within 40 days f admissin as required in Minnesta Statutes, sectin 256B.0911, subdivisin 4d. See Sectin XI fr mre infrmatin abut admissins fr individuals under age 65. Senir LinkAge Line staff als will cmplete the PAS, enter int MMIS and frward a cpy f the PAS utput frm, cntaining OBRA Level I, t the admitting facility. The Senir LinkAge Line will frward any apprpriate OBRA Level II referrals t the cunty. 2. Individuals age 65 and lder: Fr individuals age 65 and ver enrlled in SNBC and a hme and cmmunity-based waiver prgram, the Senir LinkAge Line will frward the infrmatin t the MCO and the cunty f residence. The cunty is respnsible t prvide a cpy f DHS-3426, and may frward a cpy f the PAS utput frm, if apprpriate, t the admitting nursing facility t ensure they have a cpy f the Pre-Admissin Screening results. The cunty is als required t prvide relcatin assistance and access t hme and cmmunity-based prgrams and services, as well as cmplete r refer fr apprpriate OBRA Level II assessments. Fr individuals age 65 and ver enrlled in SNBC, but nt a hme and cmmunitybased waiver prgram, the Senir LinkAge Line will frward the infrmatin t the MCO. The MCO is respnsible t cnvey infrmatin btained during the screening and send a cpy f the OBRA Level I Screening Dcument (DHS-3426) and may frward a cpy f the PAS utput frm, if apprpriate, t the nursing facility, as well as frward any apprpriate OBRA II referrals t the cunty. The MCO is als respnsible t send a cpy f the PAS t the cunty f residence within five (5) wrking days. The cunty f residence is required t prvide relcatin assistance and access t HCBS prgrams and services. Minnesta Department f Human Services PO Bx St. Paul, MN

12 Page Individuals age 65 and lder cntinued Fr individuals age 65 and ver enrlled in MSHO/MSC+, but nt a hme and cmmunity-based waiver prgram, the Senir LinkAge Line will frward the infrmatin t the MCO. The MCO is respnsible t cnvey infrmatin btained during the screening and send a cpy f the OBRA Level I Screening Dcument (DHS-3426) and may frward a cpy f the PAS utput frm, if apprpriate, t the nursing facility, as well as frward any apprpriate OBRA II referrals t the cunty. Fr individuals age 65 and lder n a hme and cmmunity-based waiver prgram in fee-fr-service, r in the Alternative Care prgram, the Senir LinkAge Line will frward the infrmatin submitted n the PAS referral t the individual s cunty f residence. The cunty is respnsible t prvide a cpy f the OBRA Level I Screening Dcument (DHS-3426), and may frward a cpy f the PAS utput frm, if apprpriate, t the admitting nursing facility t ensure they have a cpy f the Pre-Admissin Screening results, in additin t perfrming r referring fr apprpriate OBRA Level II activities. Fr individuals age 65 and lder n CAC, CADI, r BI and n MSC+ r MSHO, the Senir LinkAge Line will frward the infrmatin submitted n the PAS referral t the individual s cunty f residence and the MCO. The cunty is respnsible t prvide a cpy f the OBRA Level I Screening Dcument (DHS-3426), and may frward a cpy f the PAS utput frm, if apprpriate, t the admitting nursing facility t ensure they have a cpy f the Pre-Admissin Screening results, in additin t perfrming r referring fr apprpriate OBRA Level II activities. Fr individuals age 65 and lder n EW and n MSC+ r MSHO, the Senir LinkAge Line will frward the infrmatin submitted n the PAS referral t the MCO. The MCO is respnsible t cnvey infrmatin btained during the screening and send a cpy f the OBRA Level I Screening Dcument (DHS-3426) and may frward a cpy f the PAS utput frm, if apprpriate, t the nursing facility, as well as frward any apprpriate OBRA II referrals t the cunty. Please see Attachment C fr mre cmplete infrmatin abut cmmunicatins cmpleted by Senir LinkAge Line t ther lead agencies and lead agency respnsibilities and next steps. Minnesta Department f Human Services PO Bx St. Paul, MN

13 Page 13 VI. Apprval Required fr Admissins f Peple Under Age 21 and/r with a Develpmental Disability Regardless f the exemptins utlined in Sectins VII and VIII belw, r Senir LinkAge Line /lead agency respnsibility utlined elsewhere in this bulletin, DHS must apprve all admissins f peple aged 20 r yunger and peple with develpmental disability. DHS apprval is required regardless f the surce f admissin r payer fr facility services. Individuals Aged 20 r Yunger: Fr all individuals aged 20 r yunger, a face-t-face LTCC r MnCHOICES assessment must ccur befre admissin, regardless f prjected length f stay r admissin surce. This requirement is intended t prevent admissin f this ppulatin whenever pssible by develping cmmunity-based supprt and care plans that will meet the individual s needs in a less restrictive envirnment. At the face-t-face assessment, all cmmunity alternatives must be explred and presented t the persn, his/her family and/r the persn s legal representative. If a NF admissin cannt be prevented, the admissin must be apprved by DHS by calling r tll-free at Individuals with a Develpmental Disability: Admissin f a persn with a develpmental disability t a NF must als be apprved by DHS and must include an apprved length f stay. The lead agency btains this apprval thrugh the fllwing tasks: Cmplete DD Screening in MMIS (Actin Type 01). Cmplete an OBRA Level II Evaluative Reprt based n the utcme f the DD Screening. Recrd the final dispsitin under Sectins I-III f the Evaluative Reprt in the case manager cmment sectin f the DD Screening. Submit the cmpleted DD Screening (Actin Type 01) t DHS via MMIS t verride lcatin 570 fr review and apprval immediately after the Evaluative Reprt and the DD Screening are cmpleted. Once the DD Screening is in Apprved status in MMIS, recrd the Dcument Cntrl Number and the date n which the DD Screening was authrized by DHS n the bttm f the OBRA Level II Evaluative Reprt. Cmplete OBRA screening infrmatin can be fund in the Cmmunity-Based Services Manual (CBSM). Additinally, infrmatin abut DD Screening and DD Screening Dcument cmpletin can be fund n the Minnesta Department f Human Services website. Individuals wh receive services under ne f the DD waivers must have their waiver service agreements clsed as f, r prir t, the date f NF admissin t be exited frm the waiver. Prviders are respnsible fr a new DD screening if the length f stay exceeds the riginal apprved length f stay. Minnesta Department f Human Services PO Bx St. Paul, MN

14 Page 14 VII. Exemptin frm Bth NF Level f Care and OBRA Level I Screening There is ne type f admissin that is exempt frm bth NF level f care determinatin and OBRA Level I screening. This exemptin is based n qualifying inter-facility transfers and applies regardless f payer surce fr facility-based services, including admissins f peple participating in the prepaid medical assistance prgrams listed in Sectin III abve. Qualifying Inter-facility Transfers: There are tw types f qualifying inter-facility transfers: NF-t-NF transfer: A persn des nt need a new PAS if they are transferring frm ne MA-certified nursing facility, hspital swing bed r certified barding care facility in Minnesta t anther MA-certified nursing facility, hspital swing bed r certified barding care facility in Minnesta. NF-t-acute hspital-t-nf transfer: A new PAS is nt required when a persn has transferred frm a MA-certified NF r MA-certified barding care in Minnesta t an acute (nn-psychiatric) hspital and then back t the same r anther MAcertified NF r certified barding care in Minnesta, as lng as the persn des nt return t the cmmunity between these transfers. Please als nte that a PAS may be cnsidered valid fr up t 60 days prir t admissin. If the cnsumer discharges t the cmmunity, but the PAS was cmpleted within 60 days f the secnd admissin, a new PAS wuld nt be needed even if the cnsumer returned t the cmmunity. These are the ONLY types f transfers that are exempt frm PAS requirements. Inter-facility transfers are exempt because it is assumed that apprpriate PAS ccurred at the first facility admissin. Facilities are respnsible t ensure that dcumentatin f previus OBRA Level I screening results accmpany ther recrds frwarded when residents transfer t anther facility, including thse transfers that ccur with an intervening acute hspital admissin. Shuld a cpy f a previus OBRA Level I screening nt be available r the previus screening results are Cannt Be Determined fr level f care, the receiving nursing facility may call the Senir LinkAge Line at r chat nline t request a cpy, r cmplete an nline PAS referral t ensure cmpletin and dcumentatin f the PAS, as well as apprpriate screening fr NF LOC. The 30 Day Exemptin is repealed. Please nte that the 2013 Minnesta Legislature eliminated the PAS exemptin fr shrt term admissins t a facility frm an acute hspital, effective Nvember 1, Effective fr admissins ccurring n r after Nvember 1, 2013, all individuals admitted t a nursing facility frm a hspital, including individuals whse stay is anticipated t be less than 30 days, are required t have a PAS cmpleted prir t admissin, unless the admissin meets the definitin f a transfer as described abve. Minnesta Department f Human Services PO Bx St. Paul, MN

15 Page 15 PAS des nt have t be cmpleted nline fr certain individuals wh have received face-t-face assessment r wh are HCBS prgram participants as described in Sectin III.B and in mre detail in Sectin V. VIII. Exemptin frm Level f Care Determinatin Only In additin t qualifying inter-facility transfers that are exempt frm bth level f care determinatin and OBRA Level I screening as utlined in Sectin VII, certain peple are nt required t have a level f care determinatin cmpleted befre admissin t a facility. These exemptins are utlined in Minnesta Statutes, sectin , subdivisin 7b. This exemptin frm level f care determinatin applies t: Peple participating in certain hme and cmmunity-based prgrams at the time f admissin: Establishing the need fr NF level f care is part f the eligibility determinatin prcess fr NF level f care waiver prgrams funded under Medical Assistance, and fr the AC prgram. It wuld be redundant t require this same activity upn admissin t a facility because these activities were already perfrmed t cmplete the waiver r AC eligibility prcess. This exemptin frm level f care determinatin applies t the EW and the AC prgram fr peple aged 65 and lder, and t peple age 21 r lder participating in the CADI, CAC r the BI-NF prgrams. While these individuals may be exempt frm level f care determinatin, OBRA Level I screening and any required OBRA Level II activities must be cmpleted. When an individual participating in ne f the HCBS prgrams listed abve prir t NF admissin is admitted, the lead agency is respnsible fr ensuring the nursing facility receives a cpy f the OBRA Level I screening (DHS-3426) t dcument that the PAS OBRA Level I screening has been cmpleted and t cnfirm that the persn cntinues t meet NF level f care. This exemptin frm level f care determinatin des NOT apply t individuals wh receive hme and cmmunity-based services under the waiver fr persns with a develpmental disability (DD Waiver). A PAS must still be cmpleted nline fr these individuals. Individuals fr whm the Veteran s Administratin has unlimited respnsibility fr NF services: The Veteran s Administratin (VA) prvides varying degrees f health and lng-term care cverage fr veterans based n when, where, and hw they served in branches f the military. The VA may have cntracts with sme nursing facilities t prvide institutinal care t cvered veterans. These individuals are exempt frm PAS requirements related t level f care determinatins, but must still have OBRA Level I screening cmpleted, since they are nt exempt under federal requirements fr screening fr mental illness r develpmental disability. These admissins still Minnesta Department f Human Services PO Bx St. Paul, MN

16 Page 16 require OBRA Level I screenings t be cmpleted, which must be requested nline. OBRA Level I may als be cmpleted as part f a face-t-face assessment and frwarded t the facility using the OBRA Level I screening, DHS IX. All admissins t a MA-certified VA nursing facility are subject t PAS requirements. PAS requirements are related t the facility s MA certificatin, nt the surce f payment fr facility services. Meeting OBRA Level I Requirements fr Admissin t a Facility Unless previusly cmpleted, an OBRA Level I screening fr mental illness r develpmental disability and OBRA Level II activity if indicated, must still be cmpleted fr individuals wh are exempt frm PAS fr purpses f level f care determinatin described in sectin VIII. When Senir LinkAge Line cmpletes PAS the utput frm includes OBRA Level I screening infrmatin, which is frwarded t the admitting facility. When an MCO cmpletes PAS based n an nline referral frwarded t them by the Senir LinkAge Line, the PAS utput frm includes OBRA Level I screening infrmatin, which is frwarded t the admitting facility by the MCO either thrugh the utput frm r DHS Frm A cpy f DHS Frm 3426, OBRA Level I Screening, r the PAS utput frm frm the nline referral must be frwarded t the admitting facility by the lead agency fr individuals admitted wh are participants in the AC r waiver prgrams. Lead agencies will be ntified that this cmmunicatin is needed when Senir LinkAge Line frwards a PAS nline request received fr a HCBS participant t the lead agency as described abve. Lead agencies are reminded that DHS 3426 OBRA Level I must als be frwarded t the nursing facility when the lead agency wrked directly with a cnsumer admitted frm the cmmunity. Fr any PAS request received thrugh the nline referral site, the Senir LinkAge Line will send a letter and a cpy f the utput frm t infrm the nursing facility f either the results f the PAS r t infrm the nursing facility which lead agency received the referral. OBRA Level II: Any OBRA Level II activities, including evaluatin f the need fr specialized services, must be cmpleted by the cunty prir t admissin fr OBRA Level II fr mental illness r within 10 days f admissin fr OBRA Level II fr DD. Additinal infrmatin abut OBRA Level II requirements fr individuals with develpmental disabilities is available in the Cmmunity Based Services Manual. Additinal infrmatin abut OBRA Level II requirements fr individuals with mental illness is available in bulletin LTCC r MnCHOICES assessments: OBRA Level I screening is cmpleted as part f the face-tface LTCC r MnCHOICES assessment. Many f these assessments result in an individual s Minnesta Department f Human Services PO Bx St. Paul, MN

17 Page 17 participatin in certain HCBS prgrams, as described in sectin V. Other assessments result in the develpment f a cmmunity supprt plan fr individuals wh are nt eligible fr publicly-funded lng-term care prgrams r services. Lead agencies are required t frward a cpy f the mst recent OBRA Level I screening frm (DHS-3426) t the facility when an individual wh has been participating in ne f the HCBS prgrams listed is admitted t a nursing facility, r when an individual wh received an assessment meets level f care and chses facility-based lng-term care services. MMIS Dcumentatin: The agency cmpleting PAS is respnsible t ensure that PAS infrmatin is entered int MMIS. Certain tasks must be cmpleted in MMIS in the Lng Term Care Screening Dcument (LTC SDOC) subsystem t ensure payment t the NF and dcument the persn s admissin. See DHS 4625, Instructins fr Cmpleting and Entering the LTCC Screening Dcuments and Service Agreements int MMIS (and DHS 4669 fr MSHO and MSC+ and DHS 5020A fr SNBC use) fr further infrmatin abut the LTC SDOC subsystem and required dcumentatin, including when a persn participating in the EW, AC, CADI, CAC r BI-NF prgram enters a facility. Please nte: Senir LinkAge Line will nt cmplete MMIS tasks fr HCBS r MCO participants (SNBC, MSHO and MSC+) admitted t facilities. X. Facilities Prviding Hme and Cmmunity-Based Respite Services Neither level f care determinatin nr OBRA Level I screening is required when an individual, enrlled in a waiver prgram r AC is receiving ut-f-hme respite in a nursing facility IF: The facility has enrlled as a waiver r AC respite prvider under MHCP Prvider Enrllment requirements, and The facility has been authrized by the case manager r service r care crdinatr t prvide respite services fr the individual as indicated n the service agreement prduced by MMIS r by the MCO, and The facility is nt prviding r billing fr NF services fr the individual. Fr mre infrmatin abut ut-f-hme respite services under HCBS prgrams, please visit the Minnesta Department f Human Services website. XI. Additinal Activities Required fr Peple Under Age 65 Face-t-face LTCC r MnCHOICES assessment visits are required fr all individuals under age 65, regardless f Minnesta Health Care Prgrams eligibility r participatin, either befre admissin r within 40 days f admissin if the persn was admitted via the nline PAS referral site. See Minnesta Statutes, sectin 256B.0911, subdivisin 4d fr statute language and requirements. Minnesta Department f Human Services PO Bx St. Paul, MN

18 Page 18 The in-persn visit must ccur within 40 days f the admissin date. This requirement applies t admissins t MA-certified barding care facilities, as well as hspital swing beds and MA-certified nursing facilities. At this time if the OBRA Level I screening indicates the need fr further diagnsis and evaluatin, OBRA Level II activities must als be cmpleted befre admissin fr mental illness r within 10 days f admissin fr develpmental disability. Links t the mst updated infrmatin n OBRA Level II requirements can be fund in Sectin XV. In additin, the persn must be visited at least annually if they remain in the facility. These visits must be dcumented in MMIS in rder t cntinue MA fee-fr-service payments t the facility. A persn under the age f 65, with the exceptin f a persn with DD, may chse t receive an LTCC r MnCHOICES assessment every 36 mnths instead f every 12 mnths after the initial face-t-face visit. This chice must be dcumented n the first line f the Case Manager Cmments screen in the Screening Dcument subsystem in MMIS. Senir LinkAge Line will prvide ntificatin t cunty r tribal lead agency staff that an individual under age 65 has been admitted t a nursing facility. This cmmunicatin will supprt lead agencies in the timely cmpletin f fllw up face-t-face assessments fr peple under age 65. This is nly fr individuals under the age f 65 fr whm Senir LinkAge Line has cnducted a PAS. Fr thse enrlled in an MCO when the MCO has PAS respnsibility, the MCO is respnsible t cmmunicate infrmatin abut admissin and the need fr the face-t-face assessment t the cunty r tribe. In additin t this imprvement in cmmunicatin abut admissins fr individuals under age 65, cunties will cntinue t receive tw reprts each quarter that identify peple under the age f 65 wh reside in nursing facilities. One reprt identifies all peple under the age f 65 that are residing in an NF lcated within that particular cunty. The secnd reprt identifies thse persns under the age f 65 that are the financial respnsibility f that particular cunty, regardless f where the NF is lcated. Please g t the Cmmunity-Based Services Manual fr additinal infrmatin abut Lng Term Care Cnsultatin (MnCHOICES) service requirements fr peple under age 65. XII. Additinal Plicy Infrmatin Please nte infrmatin in this sectin is nt new plicy r prcess. PAS referrals must be made nline regardless f length f stay, payer surce r managed care enrllment. PAS referrals are nly made by a qualified health care prfessinal and submitters will be required t cmplete cntact infrmatin when cmpleting the PAS referral. MA prgram participants must apply specifically fr Lng-Term Care services using the Minnesta Department f Human Services PO Bx St. Paul, MN

19 Page 19 MHCP Request fr Payment f Lng-Term Care Services Frm (DHS-3543), if they have nt already dne s. See HCPM MHCP LTC Requests and Applicatins. MA prgram participants wh are already n a hme and cmmunity-based waiver d nt need t cmplete this applicatin, since a MA Lng Term Care applicatin wuld have been previusly cmpleted. Financial wrkers will nt determine MA eligibility fr Lng Term Care services withut dcumentatin that an individual meets an institutinal level f care. Fr purpses f NF LOC, the financial wrker relies n fllwing current prcess: A financial wrker relies n DHS frwarded frm the NF t verify cmpletin f Pre-Admissin Screening. MMIS claims edits lk fr the actual screening dcument that captures PAS and LOC infrmatin as part f claims payment verificatin editing. A financial wrker must receive DHS-5181 frm a LTCC r MnCHOICES assessr t verify NF LOC fr face-t-face assessments r HCBS participatin. Financial wrkers als must receive DHS-5181 when a face-t-face assessment has been cmpleted t determine NF LOC, as part f PAS when NF LOC has nt been able t be established using the nline PAS nline referral site. Financial wrkers will cntinue t cmmunicate financial eligibility determinatins t facility residents using DHS-4915, and t NF prviders using DHS Only LTCC r MnCHOICES assessrs can prvide ntificatin that an individual des NOT meet NF LOC. When NF LOC cannt be determined using the nline PAS prcess, Senir LinkAge Line will make a referral t the cunty where the persn is lcated at the time f the request t schedule and cmplete a face-t-face assessment. MCOs must als cmplete a face-t-face assessment f enrlled members when NF LOC cannt be determined using the infrmatin cllected in the nline PAS referral frm and frwarded by Senir LinkAge Line t the MCO. Nursing facilities are required t prvide each persn admitted with infrmatin abut assistance available t return t the cmmunity, as required under Minnesta Statutes, sectin 256B.0911 gverning Lng Term Care Cnsultatin (MnCHOICES). Facilities prvide this infrmatin using DHS Prmting and Supprting Independent Cmmunity Living. See Sectin XV fr the web link t DHS-4789, Take the Rad t Independence, a cnsumer guidebk fr peple under age 65 years living in a nursing facility and interested in mving t the cmmunity, and t all ther DHS frms cited in this bulletin. When a persn is seeking admissin t a Minnesta MA-certified swing bed, nursing facility r barding care facility and resides in anther state: The Senir LinkAge Line Minnesta Department f Human Services PO Bx St. Paul, MN

20 Page 20 XII. Additinal Plicy Infrmatin cntinued must perfrm PAS fr all persns seeking admissin t a certified facility in Minnesta, regardless f the persn s state f residence. In this case, the health care prfessinal seeking admissin (e.g. Nrth Dakta hspital discharge planner) must cmplete the nline PAS referral t allw the Senir LinkAge Line t cmplete PAS prir t admissin. When a Minnesta resident is seeking admissin t a NF in anther state: The statute gverning PAS and LTCC des nt require the Senir LinkAge Line t perfrm PAS r the lead agency t cmplete a face-t-face assessment fr a Minnesta resident that is being admitted t an ut-f-state NF. In this case, the Minnesta hspital, r ther health care prfessinal seeking admissin shuld fllw the PAS requirements f the state where the facility is lcated. Hwever, if Minnesta MA is ging t be the payer fr the ut-f-state NF care, the ut-f-state facility must cmplete the nline PAS request fr entry int MMIS t allw fr payment. When a persn is transferring frm an ut-f-state facility t a Minnesta facility: A persn wh is currently a resident f an ut-f-state NF and is seeking transfer t a NF in Minnesta is NOT exempt frm PAS. The definitin f an exempt transfer specifies that the transfer must ccur between ne Minnesta-certified facility and anther Minnestacertified facility. The ut-f-state facility seeking admissin t a Minnesta facility must cmplete an nline PAS request. When a NF admissin ccurs withut PAS: Minnesta Statutes, sectin 256B.0911 prhibits MA and private pay payments fr NF services prvided prir t the cmpletin f required PAS. If the admissin is subject t PAS requirements, the first day payment will ccur will be the date PAS is cmpleted. If a persn is nt exempt frm PAS, the NF will nt be paid until the nline screening r, if needed, a face-t-face assessment has been perfrmed and entered int MMIS. Neither the Senir LinkAge Line nr lead agency staff can backdate cmpletin f PAS in MMIS. When a referral is made by Senir LinkAge Line t cmplete an LOC determinatin thrugh a face-t-face assessment, the date the PAS is entered int MMIS is the date f the referral, based n the receipt f the PAS utput frm frm Senir LinkAge Line by the lead agency respnsible t cmplete the face-t-face assessment. When a PAS referral is made nline fllwing an emergency admissin, the date f PAS is the date f admissin, as lng as the nline request is cmpleted the next business day after admissin. Pre-Admissin Screening is valid fr 60 calendar days: If a persn received PAS either nline r thrugh a face-t-face LTCC r MnCHOICES assessment, that PAS is valid fr 60 calendar days. Smetimes, a persn s admissin is delayed after PAS is cmpleted and dcumented in MMIS. If the screener determined NF level f care was needed, and OBRA Level I was cmpleted, and the screening dcument was entered, re-screening is nt needed if the date f admissin t any MA-certified NF in Minnesta (including swing beds and certified barding care) ccurs within 60 calendar days f the date f the PAS. If the Minnesta Department f Human Services PO Bx St. Paul, MN

21 Page 21 persn is under 65 and is admitted via nline screening, the in-persn fllw-up assessment visit is still due within 40 calendar days after admissin. Nursing facilities may cntact Senir LinkAge Line t receive a cpy f the PAS. If the cnsumer is n a hme and cmmunity-based waiver r AC, the nursing facility shuld cntact the lead agency t btain a cpy f the OBRA Level I frm, but may cntact the Senir LinkAge Line if assistance btaining a cpy is needed. Emergency admissin t a certified NF, certified barding care, r swing bed: An emergency admissin is defined in Minnesta Statutes, sectin , subdivisin 7b gverning the Minnesta Bard n Aging. Emergency admissin frm the cmmunity t a certified nursing facility prir t screening is permitted during Senir LinkAge Line nnwrking hurs when all f the fllwing criteria, as specified in Minnesta Statutes, sectin , subdivisin 7b are met: A physician has determined that delaying admissin until PAS is cmpleted wuld adversely affect the persn s health and safety. There is a recent event and the persn is nt able t live safely in the cmmunity, such as sustaining an injury, sudden nset f acute illness, r a caregiver is unable t cntinue t prvide care. The attending physician must authrize the emergency placement and dcument the reasn that emergency placement is recmmended. The Senir LinkAge Line must be cntacted n the first wrking day fllwing the emergency admissin. Hwever, PAS referrals can be made nline 24 hurs a day, including hlidays. Senir LinkAge Line will retrieve the frm n the next business day. The criterin fr an emergency admissin is that it must ccur utside f Senir LinkAge Line business hurs. This applies t a persn wh has had a hspital admissin fr bservatin (e.g., stabilizatin f medicatins), r fr care in an emergency rm withut hspital admissin. Senir LinkAge Line staff will use the admissin date fr the Activity Type (screening) Date fr qualifying emergency admissins when the criteria abve are met. If these criteria are nt met, the date f actual screening is entered. XIII. Dcumentatin f Pre-Admissin Screening Activity in MMIS Senir LinkAge Line staff and MCO staff must dcument PAS activities using the MMIS LTC SDOC subsystem. Data t be entered int MMIS is captured in DHS 3427, DHS 3427T r in the nline PAS referral utput frm. Fr sme individuals, a DD Screening Dcument (DHS-3067) is als cmpleted and entered int MMIS. Senir LinkAge Line cannt and is nt respnsible t enter infrmatin int MMIS fr individuals in managed care prgrams listed in Sectin III, nr fr individuals participating in the hme and cmmunity-based prgrams referenced in this bulletin. Minnesta Department f Human Services PO Bx St. Paul, MN