Pre-Admission Screening Process

Pre-Admission Screening Process PowerPoint PPT Presentation


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2. What is Pre-Admission Screening?. According to the Code of Virginia defines preadmission screening as the following:

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Pre-Admission Screening Process

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1. 1 Pre-Admission Screening Process Who, What, Where, When, How? Melissa A. Fritzman Program Administration Supervisor II Division of Long-Term Care and Quality Assurance Department of Medical Assistance Services Virginia Department of Medical Assistance Services

2. 2

3. 3 What is Pre-Admission Screening? The Department shall require a preadmission screening of all individuals who, at the time of application for admission to a certified nursing facility as defined in §32.1-123, are eligible for medical assistance or will become eligible within six months following admission. For community-based screening, the screening team shall consist of a nurse, social worker and physician who are employees of the Department of Health or the local department of social services. For institutional screening, the Department shall contract with acute care hospitals.”

4. 4 What is Pre-Admission Screening? The Code of Federal Regulations defines preadmission screening as the following: “§441.302 State Assurances. (b) Financial accountability – The agency will assure financial accountability for funds expended for home and community-based services… (c) Evaluation of need. Assurance that the Agency will provide for the following:

5. 5 What is Pre-Admission Screening? (1) Initial evaluation. An evaluation of the need for the level of care provided in a hospital, a nursing facility, or an ICF/MR when there is a reasonable indication that a recipient might need the services in the near future (that is, a month or less) unless he or she receives home or community-based services. For purposes of this section, “evaluation” means a review of an individual recipient’s condition to determine—

6. 6 What is Pre-Admission Screening? (i) If the recipient requires the level of care provided in a hospital as defined in §440-40 of this subchapter, a NF as defined in section 1919(a) of the Act, or an ICF/MR as defined by §440.150 of this subchapter; and (ii)That the recipient, but for the provision of waiver services, would otherwise be institutionalized in such a facility.

7. 7 What is Pre-Admission Screening? (d) Alternatives. Assurance that when a recipient is determined to be likely to require the level of care provided in an SNF, ICF, or ICF/MR, the recipient or his or her legal representative will be— (1) Informed of any feasible alternatives available under the waiver; and (2) Given the choice of either institutional or home and community-based services.”

8. 8 Why do we do pre-admission screenings? To assure appropriate levels of care (i.e. home care or nursing facility care) To assure appropriate service provision (i.e. specific services to meet individual needs)

9. 9 Who does the pre-admission screening? Medicaid agency has responsibility to safeguard against unnecessary or inappropriate use of Medicaid services – federal requirement (42 CFR 456.3) Local pre-admission screening committees (composed of local health departments, local departments of social services and acute care facilities). The Community Services Boards perform the screenings for the MR and DD Waivers. The Child Development Clinics perform the screenings for the DD Waiver.

10. 10 Who needs to be screened? Individuals in the community or acute care/rehab hospitals who are, a) Already Medicaid eligible, or b) Expected to become eligible for Medicaid within 180-days of admission to the nursing facility Nursing Facilities are responsible for making sure that the 180-day requirements will be fulfilled.

11. 11 Who needs to be screened? Nursing Facilities are under no obligation to admit recipients who have not been pre-screened prior to admission. Individuals entering a nursing facility for a short-term rehabilitation stay are subject to pre-admission screening and should be screened prior to admission. Pre-admission screening is required regardless of the anticipated length of stay of an individual if Medicaid payment is expected.

12. 12 When does a screening need to be done? Prior to admission to a home and community based care wavier service or a nursing facility if you expect Medicaid to provide payment. NOTE: Individuals must be screened by the pre-admission screening team and deemed eligible for services. A complete assessment must be made before screeners can determine service options.

13. 13 Why do we do pre-admission screenings? To assure appropriate levels of care (i.e. home care or nursing facility care) To assure appropriate service provision (i.e. specific services to meet individual needs)

14. 14 General Information - UAI All completed pre-admission screening packages must be submitted directly to First Health Services for processing. The address is: First Health Services Post Office Box 85083 Richmond, Virginia 23285-5083

15. 15 General Information - UAI “Each pre-admission screening package sent to DMAS for reimbursement is reviewed for accuracy, completeness and adherence to DMAS policies and procedures. An incomplete, illegible, or inaccurate package will not be processed for payment. Reimbursement will be made only with a screening which includes all the required forms that have been correctly completed and submitted to the Department of Medical Assistance Services.”

16. 16 General Information - UAI Pre-admission screening forms must be submitted to the Department of Medical Assistance Services within 30 days of the assessment date to assure prompt reimbursement. To expedite the reimbursement process for pre-admission screening, submit the pre-admission screening package with the contents in the following order:

17. 17 General Information - UAI DMAS-96 form UAI form DMAS-113A and DMAS-113Bforms (if applicable) DMAS-95 MI/MR Supplemental form (if applicable) DMAS-101A and DMAS-101B forms (if applicable) DMAS-97 form DMAS-300 form (if applicable) The Decision Letter All other forms

18. 18 General Information - UAI No additional reimbursement will be paid for updating the assessment during the same pre-admission screening process. For example, if an individual is in an acute care hospital and a nursing facility pre-admission screening is required, the hospital will be reimbursed for only one pre-admission screening per hospital admission.

19. 19 General Information - UAI There will be no reimbursement for screenings received by the Department of Medical Assistance Services 12 months or more after the date of the completion of the screening.” No reimbursement for completed pre-admission screenings will be made for screenings completed by non-approved DMAS pre-admission screening teams. Neither Waiver Providers nor Nursing Facility staff can complete pre-admission screenings.

20. 20 Records Retention: All pre-admission screenings forms must be retained for a period of not less than five years from the date of the screening.

21. 21 Specific Information - UAI Page One - Date portion of form is required. Section – Identification/Background (page 1) Required items for completion are: Client Name Client Social Security Number Address (which includes street, city, state and zip) City/County Code

22. 22 Specific Information - UAI Section – Demographics (page 1) Required items for completion are: Birthdate (includes month, date and year) Sex Marital Status Race Communication of Needs

23. 23 Specific Information - UAI Section - Financial Resources (page 2) Required items for completion are: Medicare Number Medicaid Number (must include number or ‘pending’)

24. 24 Specific Information - UAI Section – Physical Environment (page 3) Required items for completion are: Must complete the appropriate section under the following questions: Where do you usually live? Does anyone live with you? Section – Function Status (page 4) Required items for completion are: This entire page must be completed. Both sections must be completed.

25. 25 Specific Information - UAI Section – Diagnosis and Medication Profile (page 5) Required items for completion are: Diagnosis Codes/Diagnosis must be present on the UAI form. NOTE: DMAS will not accept diagnosis information on any other type of record such as hospital discharge forms.

26. 26 Specific Information - UAI Total Number of Medications must be answered How do you take your medicine(s) must be answered NOTE: DMAS will not accept medication information on any other type of record such as hospital discharge forms.

27. 27 Specific Information - UAI Section – Physical Status (page 6) Required items for completion are: Joint Motion section must be completed Fractures/Dislocations must be completed Missing limbs must be completed Paralysis/Paresis must be completed

28. 28 Specific Information - UAI Section – Nutrition (page 6) Required items for completion are: Height Weight Recent Weight Gain/Loss (indicate which and amount)

29. 29 Specific Information - UAI Section – Current Medical Services (page 7) Required items for completion are: Questions related to Therapies must be completed Questions related to Medical Procedures must be completed Questions related to pressure ulcers must be completed

30. 30 Specific Information - UAI Section – Medical/Nursing Needs (page 7) Required items for completion are: Questions must be completed Narrative portion must be completed Section – Psycho-Social Assessment (page 8) Required items for completion are: Orientation portion must be completed Behavior Pattern must be completed

31. 31 Specific Information - UAI Section – Assessment Summary (page 11) Required items for completion are: Questions must be completed related to Caregiver Assessment Section – Client Case Summary (page 12) Required items for completion are: Narrative portion must be completed

32. 32 Specific Information - UAI Section – Unmet Needs (page 12) Required items for completion are: Questions must be completed Section – Assessment completed by (page 12) Required items for completion are: Section must be completed

33. 33 Specific Information - UAI Outlined above are specific items that must be completed on each UAI that is submitted to DMAS for reimbursement. However, DMAS must stress that this form must be completed in its entirety or an error letter back to the provider seeking correction will be sent.

34. 34 When is a DMAS-101A and DMAS-101B completed? Upon completion of the UAI Assessment for a Home and Community-Based Care Waiver Service, if there is a diagnosis of Mental Illness, Mental Retardation or a Related Condition, then a referral for a DMAS-101A must be made to the local Community Services Board (CSB). The local CSB will then complete the DMAS-101B form and will return the completed package back to the originating screening team.

35. 35 When is a DMAS-101A and DMAS-101B completed? No service authorization can be made prior to the completion of both the DMAS 101-A and DMAS 101-B. Depending on the outcome of the completed DMAS 101-B, the screening team needs to review and authorize the most appropriate waiver. If you have questions, please call the Community-Based Care Section at (804) 786-1465.

36. 36 When is a DMAS-101A and DMAS-101B completed? The process is very different from referrals for a DMAS-95 Level I and Level II screening for nursing facility placement. All referrals for nursing facility placement must be made to the DMHMRSAS Contractor that is currently Dual Diagnosis Management or DDM. DDM may be reached by contacting 1-888-869-9230.

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