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Meeting Federal Requirements for Nursing Facility Admission of People with DD Diagnosis

This article discusses the process of meeting federal requirements for the admission of individuals with developmental disabilities to nursing facilities. It covers the role of preadmission screening, level of care evaluation, and the importance of appropriate services.

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Meeting Federal Requirements for Nursing Facility Admission of People with DD Diagnosis

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

  2. OBRA SCREENING for people with MI diagnosis See Bulletin 10-53-02

  3. Long-Term Care ConsultationLTCC Bulletin 11-25-02

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

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

  6. OBRA Purpose • Assure appropriate level of care • Assure appropriate services

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

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

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

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

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

  12. LTCC-Level I Exceptions: Waiver Respite VA Responsible

  13. 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:

  14. 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 YYYY 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

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

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

  17. 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.

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

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

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

  21. NEXT: ADHS 06/03/11 10:22:15 MMIS DD SCREENING - ADD4 X123456 06/21/11 PWMW943 DOCUMENT NBR: 1154 900 1 745 DOC STAT: Suspended CM NBR: M10098080 RECIP NAME/ID: Dough John Q 00494066 SEX: M AGE/LA: 237 80 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

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

  23. Under Age 21 • Face-to-Face must be done prior to NF admit • Screened by LTCC team • LTC Doc entered in MMIS – Route to location code 560 • Call 651-431-2441

  24. Resources • CFR 42, Part 483 • Minnesota Statutes, Section 256B. 0911 • Disability Services Program Manual (DSPM) • Screening Document Codebook

  25. CONTACTS John.Fillbrandt@state.mn.us 651-431-2441 Roseann.Faber@state.mn.us 651-431-2390 Resource Center 651-431-2450 (1-888-968-8463)

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