Meeting Federal Requirements for Nursing Facility Admission of People with DD Diagnosis John Fillbrandt Age-Disabilities Odyssey June 20, 2011

OBRA SCREENING for people with MI diagnosis See Bulletin

Long-Term Care Consultation LTCC Bulletin

OBRA Omnibus Budget and Reconciliation Act of 1987 Code of Federal Regulations title 42 Part 483

OBRA A component of preadmission screening for people with diagnosis or history of developmental disability or a related condition

OBRA Purpose Assure appropriate level of care Assure appropriate level of care Assure appropriate services Assure appropriate services

Acronyms: PAS – Preadmission Screening PAS – Preadmission Screening LTCC – Long-Term Care Consultation LTCC – Long-Term Care Consultation DD – Developmental Disabilities DD – Developmental Disabilities RC – Related Conditions RC – Related Conditions NF – Nursing Facility (NF I, NF II, S-Bed) NF – Nursing Facility (NF I, NF II, S-Bed) CFR – County of Financial Responsibility CFR – County of Financial Responsibility

Since 1982: Preadmission Screening required for ALL NF admissions REGARDLESS OF FUNDING SOURCE REGARDLESS OF FUNDING SOURCE

PROCESS: NF need identified NF need identified PAS conducted by LTCC team* in county where person seeking NF admission is residing or hospitalized PAS conducted by LTCC team* in county where person seeking NF admission is residing or hospitalized * Or Health Plan if enrolled

PROCESS  PAS includes Level I evaluation (DHS-3426) (DHS-3426) Positive evaluation requires Level II referral to CFR Positive evaluation requires Level II referral to CFR

LTCC-Level I Exceptions: Short Stays (30 days or less)* Short Stays (30 days or less)* Interfacility Transfers Interfacility Transfers Re-admissions Re-admissions

LTCC-Level I Exceptions:  Waiver Respite  VA Responsible

NEXT: ALT2 08/03/09 10:38:35 MMIS LTC SCREENING - ALT1 X /03/09 PWMW935 DOCUMENT NBR: DOC STAT: CURR LOC/DT: OVERRIDE LOC: CLIENT NAME/ID: Dough John Q REF NBR: AGE: 237 LA: 55 DATE SUB: DOB: SEX: M REF DATE: NEXT NF VISIT: ACTIVITY TYPE: 02 ACT DT COS: 999 COR: 999 CFR: 999 LTCC CTY: 999 LEGAL REP STAT: PRIMARY DIAG: SECONDARY DIAG: DD DIAGNOSIS HISTORY: Y DD DIAGNOSIS: V79.8 MI DIAGNOSIS HISTORY: N MI DIAGNOSIS: TBI DIAGNOSIS HISTORY: N TBI DIAGNOSIS: MENTAL HEALTH TARGETED CASE MANAGER:

NEXT: ADD2 05/09/11 15:49:06 MMIS DD SCREENING - ADD1 PWJHF55 05/09/11 PWMW940 DOCUMENT NBR: DOC STAT: CURR LOC/DT: LAST FIRST MI RECIP NAME: Dough John Q RECIP ID: SEX: M CO REF NBR: DATE SUB: DOB( ): AGE: 237 REF DATE: GRDN STAT: 01 PRIV GRDN MAJ PROG: MA LA: 80 DIAG 1-4: 317 CO OF SVC/RES: CFR: 999 CM NAME/NBR: ROBERT C HOLVERSON A RECIP LGL REP CASE MGR QMRP OTHER PRES AT SCRNG(Y/N): Y Y Y Y Y ACTION DT: ACTION TYPE: 01 TEAM CONVENED(Y/N): Y MEDICAL: 05 SITE 24 HR VISION: 02 CORRECTED HEARING: 01 NO IMPAIR SEIZURES: 01 NO HISTORY MOBILITY: 01 NO IMPAIR FINE MOTOR SKILLS: 01 NORML FNCT EXPRESSIVE: 01 EXP NORM RECEPTIVE: 01 REC CONV OVR LOC: 570 LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID

PROCESS: CFR conducts Level II evaluation CFR conducts Level II evaluation (DHS-4248) (DHS-4248) Case scenarios: Known to county, Not Known, No finding of DD

PROCESS CFR enters DD screening doc (01) Case notes document; Case notes document; Agreement with NF level of care need Agreement with NF level of care need Agreement (or not) with DD dx Agreement (or not) with DD dx Expected length of stay Expected length of stay Need for specialized treatment – arrangement Need for specialized treatment – arrangement Waiver out date for people on DD waiver Waiver out date for people on DD waiver

NEXT: ARCP 05/09/11 15:56:47 MMIS CM COMMENTS - ACMG PWJHF55 05/09/11 DOCUMENT NBR: STATUS CD: CM NBR: A RECIP ID: CASE MANAGER COMMENTS John fell and broke his left leg on 6/11/11. In hospital for 1 week following surgery, to Happydale Care Center on 6/17 for rehab for 4 weeks. Waiver exit 6/17/11. Unable to benefit from active treatment at this time. County assures that active treatment needs will be met during NF stay.

PROCESS: DD screening document routed to location 570 for DHS approval DD screening document routed to location 570 for DHS approval If waiver out document required, DHS will complete in conjunction with NF stay approval If waiver out document required, DHS will complete in conjunction with NF stay approval

Timelines:  Less than 30-day stay – Not Required unless waiver  Extended stay – anticipated – 7-9 days from admission - unanticipated – within 40 th day of admission NO NF PAYMENT WITHOUT DD DOCUMENT

ALL NF STAYS ARE TIME-LIMITED 01 Screening is NF Service Agreement Reviewed-renewed at end date Reviewed-renewed at end date Long-term placement (1 year) Long-term placement (1 year)

NEXT: ADHS 06/03/11 10:22:15 MMIS DD SCREENING - ADD4 X /21/11 PWMW943 DOCUMENT NBR: DOC STAT: Suspended CM NBR: M RECIP NAME/ID: Dough John Q SEX: M AGE/LA: DT&H SERV AUTH LEVEL: 02 MODERATE WAIVER NEED INDEX: 005 SPEC MEDICAL SERV (A): Y PHYSICAL THPY (B): Y OCCUPATIONAL THPY (C): Y COMM/SPEECH THPY (D): Y TRANSPORTATION (E): Y EXCESSIVE BEHAVIOR (F): N MENTAL HEALTH (G): N EARLY INTERVENTION (H): N OTHER (I): N FINAL ACTION: RCP/L REP(A): 08 CL NF CASE MGR(B): 08 CM NF QMRP(C): 08 QP NF NF SHORT TERM APPROVAL: BEGIN DATE: THROUGH DATE: MCAID SVC PROG: 05 MA NF CO USE ONLY: CASE MGR SIG: Y QMRP SIG: Y PERSON/LGL REP SIG: Y CFR SIG: Y CFR USER ID: DHS APP CURR: PWCMR99 DHS APP PLANNED: PWJHF99 TIME LTD PMT: N DHS USE ONLY: PMT AUTHORIZED: 01 CM COMMENTS: Y RECIP COMMENTS: N DHS COMMENTS : N

Long-Term Placements Annual Review Required County Options County Options Full-Team Screening Full-Team Screening Annual Update Annual Update LTCC LTCC

Under Age 21 Face-to-Face must be done prior to NF admit Face-to-Face must be done prior to NF admit Screened by LTCC team Screened by LTCC team LTC Doc entered in MMIS – Route to location code 560 LTC Doc entered in MMIS – Route to location code 560 Call Call

Resources CFR 42, Part 483 CFR 42, Part 483 Minnesota Statutes, Section 256B Minnesota Statutes, Section 256B Disability Services Program Manual (DSPM) Disability Services Program Manual (DSPM) Screening Document Codebook Screening Document Codebook

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