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Elizabeth M. Whitehorn, Director

Provider Notice Issued 04/04/2017

Pre-Admission Screening Process for Long Term Care Admissions

 

Date:  April 4, 2017                                                    

 

To:      Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), and Nursing Facilities eligible to be licensed as Specialized Mental Health Rehabilitation Facilities (SMHRF)

 

Re:     Pre-Admission Screening Process for Long Term Care Admissions

_______________________________________________      _______________________

 

The purpose of this notice is to provide information regarding the Pre-admission Screening process for Long Term Care (LTC) admissions. Prior to admission to a LTC facility, individuals are required to be screened to determine if institutional placement or home and community-based services are appropriate and allowable via two separate screening processes. First, individuals must meet the level of care functional eligibility need for institutional or community-based services. Secondly, there must be an assessment, as part of the federally required Pre-admission Screening and Resident Review (PASRR) process, to identify individuals with a Serious Mental Illness (SMI) and/or Intellectual/Developmental Disability (I/DD).

 

Level of Care Functional Eligibility

Functional eligibility determinations for a nursing facility level of care are primarily conducted in hospitals by Care Coordination Units (CCUs) contracted by the Department on Aging (DoA), and in the community by both the CCUs and the Department of Human Services (DHS) Division of Rehabilitation Services (DRS). CCUs and DRS staff will screen individuals using the Determination of Need (DON) assessment tool.

In addition, DHS Mental Health PASRR agents conduct nursing facility level of care determinations for referrals from hospital psychiatric units and/or community mental health centers using a separate assessment tool. Finally, Independent Service Coordination (DDISC) entities contracted with DHS Division of Developmental Disabilities conduct level of care determinations for persons seeking admission to a nursing facility, and for all persons seeking Developmental Disability (DD) services that are funded through Medicaid.

 

PASRR Process

The federally required Pre-admission Screening and Resident Review (PASRR) process is intended to help ensure individuals are not inappropriately placed in nursing facilities. The PASRR assessment must be completed prior to admission to the nursing facility and requires that all applicants:

 

  • Be evaluated for serious mental illness (SMI) and/or Intellectual/Developmental Disability (I/DD).
  • Be offered the most appropriate setting for their needs.
  • Receive services they need in those settings.

 

The PASRR process requires that all applicants to Medicaid-certified nursing facilities be given a preliminary assessment to determine whether they have a suspicion of SMI or I/DD. This assessment is called an "OBRA Level I screen." Individuals identified as having a suspicion of SMI or I/DD are referred to the appropriate MH PASRR agent or DD ISC to determine if an in depth evaluation needs to be completed which is called "Level II" PASRR. The completion of the Level II evaluation provide a determination of need, determination of appropriate setting, and a set of recommendations for services to inform the individual's plan of care.

 

Changes to DoA CCU Screening Process

For individuals seeking admission to a LTC facility, the DoA CCUs conduct the majority of the Level I screens. Hospital discharge planning staff can also conduct an OBRA Level I screen. As noted above, the CCUs conduct Determination of Need (DON) assessments to determine whether the individual requires the level of services provided by a LTC facility.

 

On August 19, 2016 Public Act 99-0857.pdf was enacted into law. In response to this Public Act, the DoA implemented changes to the policy and procedures that affect the CCU screenings described above. The following changes became effective January 1, 2017:

  • CCUs must complete the screening within one day of the request.
  • CCUs are responsible for transmitting the screening results to the Long Term Care provider.
  • CCUs are available seven (7) days a week during regular business hours in order to accommodate and complete screening requests.
  • DoA will collect data in collaboration with HFS to be used to identify and resolve areas of non-compliance, to improve policy and procedures, and fulfill reporting requirements.

 

Need for Screens after Discharge from Hospital

If the screening has been completed, the CCU will transmit the results to the LTC provider. If the screening results were not previously transmitted to the LTC provider and did not accompany the individual from the hospital, the providers are instructed to contact the CCU in the geographic area of the LTC provider to complete the screen and transmit the results to the provider. If the LTC provider is unable to obtain the results from the CCU, the provider should contact the DoA via email at Aging.OCCS@illinois.gov for assistance. The DoA will check their system to verify completion of the screening and will contact the appropriate CCU to either transmit the results to the LTC provider or complete the screening if necessary.

 

Agency Collaboration

Hospitals, LTC facilities, CCUs, MH PASRR agents and DD ISCs all play a role in the pre-admission screening process and are encouraged to collaborate to provide information to each other in the most expedient means possible. Hospital discharge planners must contact the CCU to perform screening assessments at least 24 hours in advance of a pending discharge to a LTC facility; however, this should be considered a minimum timeline. CCUs, MH PASRR agents and DD ICSs are being instructed to request information on the discharge planning approach and criteria in their local hospitals and note opportunities for earlier identification of LTC referrals. LTC providers should also coordinate with hospital discharge planners, CCUs, MH PASRR agents and DD ISCs to assure that the required screenings are completed prior to admitting new individuals.

 

Approval for Medicaid Reimbursement

Pursuant to federal PASRR regulations, authorization for Medicaid payment to the LTC provider for covered services is not allowable until the pre-admission screening has been completed. In individual circumstances, the DHS Division of Mental Health (DMH) can approve PASRR level 2 post-screens, but the PASRR screening requirements are not affected by Public Act 99-0857 (pdf). State statutes require that all persons age 18 or older seeking admission to a nursing facility must be screened to determine the need for nursing facility services prior to being admitted, regardless of income, assets or funding source. Therefore, the State will continue to reject claims for reimbursement of LTC services provided prior to the completion of the required screenings.

 

DoA, DHS and HFS conducted a webinar on the pre-admission screening process on February 14th. Questions that were received as a result of the webinar are answered and can be found here (pdf).    

 

If you have questions, contact the Bureau of Long Term Care toll free at 844-528-8444.

                                         

 

 

Felicia F. Norwood

Director