IM-117 10/24/97 PRE-ADMISSION SCREENING AND ELIGIBLITY
|PRE-ADMISSION SCREENING AND ELIGIBLITY|
|This memorandum announces a change in
the way Pre-Admission Screening (PAS) affects eligibility dates for vendor
Prior policy required that the physician's signature date on the DA-124C dictated one of the limits to the beginning date of vendor eligibility. For example, if a claimant were admitted to a nursing facility on March 18 and the attending physician did not sign the DA-124C until April 5, then vendor benefits could not begin before April 5. This policy no longer applies.
Effective immediately upon receipt of this memo, if a claimant requires a level 2 screening and is found to be mentally retarded, mentally ill, or developmentally disabled (MR, MI, or DD), vendor eligibility may begin with the latest of these dates:
A DA-124C is still required for anyone entering a Medicaid-certified bed in a nursing facility. If the results of the pre-admission screening process (DA-124C in all cases, and level 2 screening, if needed) have not been received by the DFS county office, no vendor eligibility can be approved, no IM-62 sent, and no IM-5 entered in the system. When a properly completed DA-124C (together with a level 2 screening, if one was needed) has been forwarded to the DFS county office from Division of Aging Central Office Medical Review Unit (DA-COMRU), the eligi-bility can be entered and the IM-62 sent. If a level 2 screening was required, DA-COMRU will have attached the results of that screening. If a level 2 screening was not required, there will be no such attachment to the DA-124C.
This policy applies to all approvals determined after receipt of this memo, including those in which applications are currently pending.
Example: The claimant was admitted on March 18. The worker completed the eligibility determination on April 10. The claimant was found to be eligible on all factors as of the date of admission, March 18. The DA-124C was signed by the attending physician on April 5. No level 2 screening was required. The DA-124C was received at the DFS office on April 20. On April 20, the worker could issue the IM-62 approving the case and could enter the approval on IMU5. The beginning date of eligibility is March 18, with a surplus due for April.
Example: The claimant was admitted on June 5. The DA-124C was completed the same day, and it indicated the need for a level 2 screening. The level 2 screening was completed June 12. It showed the claimant was not MR, MI, or DD. If the claimant was otherwise eligible, the begin date is June 5.
Example: The claimant was admitted on August 12. The DA-124C was completed the same day, indicating the need for a level 2 screening. The level 2 screening was completed August 20. It showed that the claimant was MI, but that the claimant's needs could be met at this facility. Because the claimant was found to be MI, the begin date cannot be before the level 2 screening was completed. If the claimant was otherwise eligible, the begin date is August 20, even though she was admitted August 12 and was found to need no specialized services.
Previously approved vendor cases
Identifying potentially affected cases: It is not necessary to review lists of previously approved cases for discrepancies between begin dates of coverage and admission dates. However, a facility may present reason to believe a previously established begin date for a particular case could be affected by this policy change. Other cases may be discovered in the usual course of business.
If a previously approved vendor case is found to have a begin date that would have been earlier under the policy announced in this memorandum, then the case is potentially affected, subject to review by state office. This includes only those cases in which the date could have been earlier for the sole reason of the change in pre-admission screening policy. That is, either the physician's signature date must have been later than the admission date on the DA-124C or a level 2 screening which found the claimant not MR, MI, or DD must have been completed after the admission date.
Submitting cases for confirmation: Begin dates must not be changed without review and confirmation by DFS state office, IM Program and Policy. Obtain confirmation by submitting a memo to state office with the needed information. For your convenience, a memo with blanks for the needed information has been included with this memorandum. Copy it as needed. Be certain to check the Reason for Change. If there is any question whether a level 2 was required, you may submit copies of the DA-124C and related materials together with the request for authorization.
Processing confirmed cases: If the change is confirmed, state office will enter the changed date in the system and return the confirming memo to the DFS worker. The DFS worker will issue a revised IM-62, enabling the facility to bill for the previously uncovered days. If the admission date was in a month prior to the date the screening was completed, do not change the month that any surplus payment is due.
Example: In November, 1997, it comes to the worker's attention that a vendor case was approved with a begin date of May 3, 1997, and surplus effective June 1, 1997. May 3 was the date the DA-124C was signed. A level 2 screening was not required. The claimant was admitted April 25, 1997, and was otherwise eligible on April 25. The worker submits the information about the case to state office. When a confirming memo has been received by the county office, a revised IM-62 may be issued, showing April 25, 1997, as the begin date. It should continue to show a surplus due for June, 1997; no surplus will be due for May 1997. State office will have already updated the system to show the begin date as April 25, 1997.Handling unconfirmed cases: If the proposed change is denied, state office will return the requesting memo showing the denial to the DFS worker. The DFS worker should take no action on the case. If the proposed change was at the request of the nursing facility, notify the facility of the denial. No revised IM-62 should be issued. If the facility has questions regarding the case, the facility should be referred to the Provider Relations Unit in the Division of Medical Services.