meeting federal requirements for nursing facility admission of people with dd diagnosis john...
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Meeting Federal Meeting Federal Requirements for Nursing Requirements for Nursing
Facility Admission of Facility Admission of People with DD DiagnosisPeople with DD Diagnosis
John Fillbrandt John Fillbrandt Age-Disabilities Odyssey Age-Disabilities Odyssey
June 20, 2011June 20, 2011
OBRA SCREENING OBRA SCREENING
for people with MI diagnosisfor people with MI diagnosis
See Bulletin 10-53-02See Bulletin 10-53-02
Long-Term Care Long-Term Care ConsultationConsultation
LTCCLTCC
Bulletin 11-25-02Bulletin 11-25-02
OBRAOBRA
Omnibus Budget and Reconciliation Omnibus Budget and Reconciliation Act of 1987Act of 1987
Code of Federal Regulations title 42Code of Federal Regulations title 42Part 483Part 483
OBRAOBRA
A component ofA component of
preadmission screening preadmission screening
for people with diagnosis or for people with diagnosis or history history
of developmental disability or of developmental disability or
a related conditiona related condition
OBRA PurposeOBRA Purpose
Assure appropriate level of careAssure appropriate level of care
Assure appropriate servicesAssure appropriate services
Acronyms:Acronyms:
PAS – Preadmission ScreeningPAS – Preadmission Screening LTCC – Long-Term Care ConsultationLTCC – Long-Term Care Consultation DD – Developmental DisabilitiesDD – Developmental Disabilities RC – Related ConditionsRC – Related Conditions NF – Nursing Facility (NF I, NF II, S-Bed)NF – Nursing Facility (NF I, NF II, S-Bed) CFR – County of Financial ResponsibilityCFR – County of Financial Responsibility
Since 1982:Since 1982:
Preadmission Screening required for Preadmission Screening required for
ALL NF admissionsALL NF admissions
REGARDLESS OF FUNDING SOURCEREGARDLESS OF FUNDING SOURCE
PROCESS:PROCESS:
NF need identifiedNF need identified PAS conducted by LTCC team* in PAS conducted by LTCC team* in
county where person seeking NF county where person seeking NF admission is residing or admission is residing or hospitalizedhospitalized
**Or Health Plan if enrolledOr Health Plan if enrolled
PROCESSPROCESS
PAS includes Level I evaluationPAS includes Level I evaluation
(DHS-3426)(DHS-3426)
Positive evaluation requires Positive evaluation requires Level II referral to CFRLevel II referral to CFR
LTCC-Level I Exceptions:LTCC-Level I Exceptions:
Short Stays (30 days or less)*Short Stays (30 days or less)*
Interfacility TransfersInterfacility Transfers
Re-admissionsRe-admissions
LTCC-Level I Exceptions:LTCC-Level I Exceptions:
Waiver RespiteWaiver Respite
VA ResponsibleVA Responsible
NEXT: ALT2 08/03/09 10:38:35 MMIS LTC SCREENING - ALT1 X127377 08/03/09 PWMW935 DOCUMENT NBR: 1366 900 1 546 DOC STAT: CURR LOC/DT: OVERRIDE LOC: CLIENT NAME/ID: Dough John Q 01020304 REF NBR: 14222191 AGE: 237 LA: 55 DATE SUB: 080309 DOB: 07041776 SEX: M REF DATE: 052309 NEXT NF VISIT: ACTIVITY TYPE: 02 ACT DT 061111 COS: 999 COR: 999 CFR: 999 LTCC CTY: 999 LEGAL REP STAT: PRIMARY DIAG: 724.00 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: 1366 901 1 592 DOC STAT: CURR LOC/DT: LAST FIRST MI RECIP NAME: Dough John Q RECIP ID: 01020304 SEX: M CO REF NBR: DATE SUB: 011207 DOB(07041776): AGE: 237 REF DATE: 010385 GRDN STAT: 01 PRIV GRDN MAJ PROG: MA LA: 80 DIAG 1-4: 317 CO OF SVC/RES: 999 999 CFR: 999 CM NAME/NBR: ROBERT C HOLVERSON A873515800 RECIP LGL REP CASE MGR QMRP OTHER PRES AT SCRNG(Y/N): Y Y Y Y Y ACTION DT: 070411 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:PROCESS:
CFR conducts Level II evaluationCFR conducts Level II evaluation
(DHS-4248)(DHS-4248)
Case scenarios: Known to county, Case scenarios: Known to county, Not Known, No finding of DDNot Known, No finding of DD
PROCESSPROCESSCFR enters DD screening doc (01)CFR enters DD screening doc (01)
Case notes document;Case notes document; Agreement with NF level of care Agreement with NF level of care
needneed Agreement (or not) with DD dxAgreement (or not) with DD dx Expected length of stayExpected length of stay Need for specialized treatment – Need for specialized treatment –
arrangementarrangement Waiver out date for people on DD Waiver out date for people on DD
waiverwaiver
NEXT: ARCP 05/09/11 15:56:47 MMIS CM COMMENTS - ACMG PWJHF55 05/09/11 DOCUMENT NBR: 1366 901 1 629 STATUS CD: CM NBR: A873515800 RECIP ID: 01020304 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:PROCESS:
DD screening document routed DD screening document routed to location 570 for DHS approvalto location 570 for DHS approval
If waiver out document required, If waiver out document required, DHS will complete in conjunction DHS will complete in conjunction with NF stay approvalwith NF stay approval
Timelines:Timelines:
Less than 30-day stay – Not Less than 30-day stay – Not Required unless waiverRequired unless waiver
Extended stayExtended stay
– – anticipated – 7-9 days from anticipated – 7-9 days from admission admission
- unanticipated – within 40unanticipated – within 40thth day of day of admissionadmission
NO NF PAYMENT WITHOUT DD DOCUMENTNO NF PAYMENT WITHOUT DD DOCUMENT
ALL NF STAYS ARE ALL NF STAYS ARE TIME-LIMITEDTIME-LIMITED
01 Screening is NF Service Agreement01 Screening is NF Service Agreement
Reviewed-renewed at end dateReviewed-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 X123456 06/21/11 PWMW943DOCUMENT NBR: 1154 900 1 745
DOC STAT: Suspended CM NBR: M10098080RECIP NAME/ID: Dough John Q 00494066 SEX: M AGE/LA: 237 80DT&H SERV AUTH LEVEL: 02 MODERATE WAIVER NEED INDEX: 005 SPEC MEDICAL SERV (A): Y PHYSICAL THPY (B): Y OCCUPATIONAL THPY (C): YCOMM/SPEECH THPY (D): Y TRANSPORTATION (E): Y EXCESSIVE BEHAVIOR (F): NMENTAL 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 PlacementsLong-Term Placements
Annual Review RequiredAnnual Review Required
County OptionsCounty Options Full-Team ScreeningFull-Team Screening Annual UpdateAnnual Update LTCCLTCC
Under Age 21Under Age 21
Face-to-Face must be done prior Face-to-Face must be done prior to NF admitto NF admit
Screened by LTCC teamScreened by LTCC team
LTC Doc entered in MMIS – Route LTC Doc entered in MMIS – Route to location code 560to location code 560
Call 651-431-2441Call 651-431-2441
ResourcesResources
CFR 42, Part 483CFR 42, Part 483 Minnesota Statutes, Section 256B. Minnesota Statutes, Section 256B.
09110911 Disability Services Program Manual Disability Services Program Manual
(DSPM)(DSPM) Screening Document CodebookScreening Document Codebook
CONTACTSCONTACTS
651-431-2441651-431-2441
651-431-2390651-431-2390
Resource CenterResource Center
651-431-2450 (1-888-968-8463)651-431-2450 (1-888-968-8463)