Provider Notice issued 02/14/2025

The purpose of this notice is to ensure providers understand the screening and assessments required before a person can admit to the following long term care settings:

·         Nursing Facilities (NF) certified by Medicaid

·         Supportive Living Programs (SLP)

·         Specialized Mental Health Rehabilitation Facilities (SMHRF)

Healthcare and Family Services (HFS) has the means and authority to seek recoupment of NF, SLP, and SMHRF payments through the reconciliation of admission and screening/assessment dates, if it is discovered that services were provided before the completion of required preadmission processes.

Aditionally, the beginning date of payment is based upon the Medicaid eligibility date, requested admission date, date of the pre-admission screening, date the provider receives the required pre-admission screening results, and the date the transaction is electronically submitted. If the admission transaction is not submitted timely, the Department of Human Services (DHS) caseworker will use the date the provider entered the information in MEDI as the date of admission. State and Federal regulations regarding PASRR are located towards the end of this notice.

Preadmission Screening and Evaluations Required by Setting

All required screenings and/or evaluations are initiated via the primary PASRR system, AssessmentPro, which is available 24 hours a day.

Each preadmission process relies on information obtained directly from the individual or guardian and authorized representatives/caregivers. Cooperation with interview scheduling and the provision of supporting and required documentation is key to

ensuring the quickest turnaround regardless of where the individual is needing SLP or assistance in the community.

Preadmission Screening and Evaluation Purposes

PASRR

·         Level I PASRR screening identifies the presence of known or suspected Serious Mental Illness (SMI), Intellectual Disability (ID), and/or Developmental Disability (DD) in addition to if, and when, a Level II PASRR assessment is needed.

·         A Level II PASRR assessment, conducted by Maximus for those with SMI and the Division of Developmental Disabilities for those with ID/DD, determines NF setting appropriateness and any disability specific services the NF must provide if the person admits.

·         There are no exceptions to the Level I PASRR preadmission screening for NF applicants.

Determination of Need (DON)

·         Evaluates a person’s level of care needs and program eligibility, as conducted by the Department of Aging (DoA) in partnership with Community Care Units (CCUs).

·         Exceptions to this process are limited to individuals who are seeking admission from out of state or certain emergency situations as described in Title 89 IL Adm Code 140.642(c).

Supportive Living Program (SLP) Initial Screening and Assessment

·         The initial SLP screen determines if there are disability indicators and if so, a SLP assessment is conducted by Maximus for those with SMI or the Division of Developmental Disabilities for those with ID/DD.

·         A SLP assessment identifies any persistent needs and risks related to a SMI or ID/DD disability and the likely appropriateness of the SLP.

·         There are no exceptions to SLP initial screening for SLP applicants.

SMHRF Referrals and Assessment

·         The SMHRF referral determines the potential appropriateness of a SMHRF setting for an individual and, as appropriate, a SMHRF assessment will be performed by Maximus, to evaluate their global needs and strengths for mental health treatment.

·         There are no exceptions to submitting SMHRF referrals for potential SMHRF residents.

·         PASRR Screening requirements included in the Williams Consent Decree.

Regulations Related to Preadmission Screening and Assessment

Federal PASRR regulations are primarily found at: 42 CFR Subpart C §483.100 through 483.138, although particular attention to the following is also advised:

·         42 CFR Subpart B §483.20: Resident Assessments

·         42 CFR Subpart B: §483.65 Specialized Rehabilitative Services

·         42 CFR Subpart C §483.120: Specialized services

·         *42 CFR Subpart C §483.122 (b): FFP for NF Services

·         *42 CFR Subpart C § 483.130 (e): PASRR Determination Criteria

*State and federal regulations require completion of preadmission processes before payment for services can be made.

Illinois Nursing Home Care Act

·         (210 ILCS 45/2-201.5)

·         (210 ILCS 45/2-104.3)

·         (210 ILCS 45/3-202.2b)

Nursing Facilities Illinois Administrative Code

·         Title 89 140.11 and Title 89 140.12  - Provider Enrollment

·         Title 89 140.510 - Determination of Need for Group Care

·         Title 89 140.513 b) 4) – Notification of Admissions and Changes in Resident Status

·         Title 89 140.642  - Screening Assessment for Nursing Facility and Alternative Residential Settings and Service

·         Title 89 240.1010 - Choices for Care Pre and Post Screening and Informed Choice

Supportive Living Provider Illinois Administrative Code

·         Title 89 146.220 Resident Participant Requirements

Guidance on logic for recording screening dates in MEDI

All admission transactions must be submitted electronically within 120 days of the admission date or within 120 days of their receipt of the HFS 2536 Interagency Certification of Screening Results form or HFS 3864 Screening Verification form from the screening agent, if not received at admission. The requested admit date on the 1156/26 section of the admission transaction submission should be the date the LTC provider requests Medicaid to be the payor of the LTC services.

Please review the Implementation of New Policy for Systematic Processing of LTC Admissions (pptx)  and Provider Notice Issued 08/23/2021 for further instructions on entering screening information into MEDI.

See the flow chart below for applying timely submission 

Kelly Cunningham, Administrator
Division of Medical Programs