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Nursing Home and Assisted Living Pre-Admission Screening. Department of Medical Assistance Services www.cns.state.va.us/dmas. Goal.
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Department of Medical Assistance Services
Participants will have a better under- standing of the pre-admission screening process which will:
Participants should be able to properly submit pre-admission screening packages and resolve error messages including:
Emergency Hospital Services
Outpatient Hospital Services
Nursing Facility Care
Rural Health Clinic Services
Federally Qualified Health Center Clinic Services
Lab and X-Ray Services
Home Health Services
Medicare Premiums (Part A) - Hospital; (Part B) - Supplemental Ins. For Categorically NeedyMandatory Services Provided Through Medicaid
Skilled Nursing Facility Services for Individuals under 21 years of age
Clinical Psychologist Services
Certified Pediatric Nurse and Family Nurse Practitioner Services
Home Health: PT, OT, and Speech Therapy
Dental Services for Persons under 21
Physical, Speech & Occupational Therapies
Case Management Services
Mental Health Services
Mental Health Clinic Services
Medicare Part B Premiums for the Medically NeedyOptional Services Provided Through Medicaid
After meet a category must meet income and asset guidelines, as well as non-financial criteria.
Who, What, Where, When, How?
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.
Some Frequently Asked Questions submitted by Pre-Admission Screening Teams
RESPONSE: Individuals can be authorized to receive services under only one Home and Community-Based Care Waiver at any given time.
RESPONSE: If you mark ‘no’ there is no need to complete any of the other questions on the form.
RESPONSE: Skilled units of acute care hospitals are not authorized to complete nursing home pre-admission screenings for any type of service. The acute care hospital must complete the pre-admission screening PRIOR to discharge to the skilled unit of the hospital. The skilled unit of the hospital is the same as any other nursing facility and recipients in that unit are subject to the same rules and regulations.
RESPONSE: Acute care social work staff or discharge planners may not complete the pre-admission screening forms for individuals located in the skilled units of the hospitals once admission has taken place.
RESPONSE: Recipient admitted directly from a VA Hospital to a directly to a nursing facility is not subject to the normal pre-admission screening process. The nursing facility can accept the discharge information from the VA Hospital in place of the pre-admission screening.
RESPONSE: For Home and Community Based Care recipients the local community screening team (consisting of the local department of social services and the local health department) is responsible for authorization of any waiver service.
RESPONSE: Yes, recipient must be given a decision letter that includes appeal information for any decision made by the pre-admission screening teams.
RESPONSE: Only the reviewing physician may sign and date his signature during the completion of a pre-admission screening. Nurse or social worker signatures for the physician are not permitted. The use of rubber stamps for signatures or dating is not permitted.
RESPONSE: NO, the pre-admission screening teams are not permitted to determine the number of hours a recipient may receive under a waivered service.
RESPONSE: A recipient may receive Medicaid Hospice benefits and personal care services under the Elderly and Disabled Waiver or Nursing Facility Services at the same time. For Home and Community-Based Care Waivered Services, pre-admission screening is required. The Community-Based Care provider will coordinate services with the Hospice provider.
RESPONSE: Children are subject to the same rules and regulations regarding pre-admission screening as adults. A pre-admission screening team must consider the risks and place the child in the most appropriate waivered service or an appropriate nursing facility that can address the needs of a child.
RESPONSE: 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.
RESPONSE: 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 Waiver Services Unit at (804) 786-1465.
RESPONSE: The process is very different from referrals for a MI/MR Level I and Level II screening for nursing facility placement. All referrals for nursing facility placement must be made to the DMHMRSAS Contractor. The current contractor is Dual Diagnosis Management, LLC. They may be reached by contacting the project manager at 1-877-431-1388.
RESPONSE: Individuals wishing to appeal determinations made by the hospital or local screening committees should notify the Appeals Division, Department of Medical Assistance Services, in writing, of his or her desire to appeal within 30 days of the receipt of the Committee’s decision letter.
RESPONSE: All decision letters must include the following statement: “You may appeal this decision by notifying, in writing, the Appeals Division, Department of Medical Assistance Assistance Services, 600 East Broad Street, Suite 1300, Richmond, Virginia 23219. This written request for an appeal must be filed within thirty (30) days of the date of this notification.”
General Information to assist with completion of Pre-Admission Screening Packages
DMAS-96 Authorization of Services Form
UAI form (all 12 pages)
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 (Waiver Services Plan of Care)
DMAS-300 form (if applicable)
DMAS-20 form (consent to exchange information)
The Decision Letter
All other forms
Specific Information to assist with completion of Pre-Admission Screening Packages
NOTE: DMAS will not accept medication information on any other type of record such as hospital discharge forms.
General Information Regarding Authorizations for Assisted Living Services
General Information Regarding Case Management Services for Assisted Living Residents
Specific information regarding the services offered through the Long Term Care Division
We look forward to working with you to make this a successful partnership!