| Action | 2015 Long Term Services and Supports Screening Changes |
| Stage | Proposed |
| Comment Period | Ended on 11/3/2017 |
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4 comments
As a case manager/discharge planner I am finding patients with Medicaid only who are not able to function outside of an inpatient medical setting due to their complex medical needs and mobility dependencies are declined NHP as they are alert/oriented and have no behavior issues. The current guidelines usurp an entire Medicaid population from NHP with provision of 24 hour medical oversight needed to maintain the individuals health care needs.
Furthermore, if a patient does not meet criteria under the current guidelines he/she does not meet criteria for personal care aides in the community nor PACE program. Essentially the only option is for the patient to remain hospitalized which is an inappropriate disposition.
I respectfully request re-evaluation of the DMAS NHP guidelines to include patients who are alert/oriented with no behavior issues and are dependent for 2-4 ADLS and mobility, yet require 24 hour medical management due to complex medical needs which cannot be managed in a lesser level of care such as home with HHS, personal care aides, PACE program or ALF with HHS.
Respectfully Submitted,
Kathy Fowler
Kathy L. Fowler, B.S.W., M.S. OHRD, ACM
Clinical Social Work/Case Manager
UVA Transitional Care Hospital
#434-243-1229
.
I believe it would be very helpful for local screening teams as well as local SNF if the regulations were very explicit when discussing screening teams going into facilities to screen. Many times there is confusion from facilies as to whether local screening teams can/will come in and screen folks who were admitted either without a UAI initially or are no longer receiving Medicare benefits and are needing to move to a facility that will accept Medicaid as a funding sourse for LTC. Many facilities have a hard time understanding why screening teams cannot come in and screen folks who are going to remain in the facility. We have even had facilities locally who have told us residents were planning to go home with in home services in order to get our screening teams to come in. Then, after the screening is completed, we are advised the resident decided to remain in the facility!
The Virginia Department of Health (VDH) recognizes that a family’s decision to request long-term care services is a complex and very difficult decision to make. Therefore, we appreciate the opportunity to provide comment on the proposed regulatory changes to 12VAC30-60-300.
The majority of our changes include suggestions for clarifying recommendations so they are clearly interpreted by the hospital and community based teams, as well as for the families who are participating in this process. Substantive recommendations include:
We hope that consideration of these suggestions will result in a process that provides individuals and their families who are seeking long term care a clear and equitable process.
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Section |
Comment |
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12VAC30-60-301 |
Physician is added to the list of individuals in the definition of CBT; however, the appropriation act states that the team consists of a social worker and a licensed healthcare professional. Recommend removing physician from the team. |
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12VAC30-60-301 |
Face to face is defined, but not used elsewhere in the regulation content. There is no reason to define it if the term is not used. The addition of a telehealth option would be beneficial for remote areas that are difficult to access. |
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12VAC30-60-301 |
ePAS is not used for assisted living facility assessments; therefore, the screening process outlined in these proposed regulations does not apply. There are separate regulations that address assessments in assisted living facilities. It may be confusing to screeners if this language remains. Additional confusion with the statement, “LTSS means a variety of services that help individuals with health OR personal care needs”. For service authorization, the individual must have health AND personal care (functional) needs. |
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12 VAC30-60-301 |
MCO should be able to refer for a screening, and should not be listed as a requester. Individuals should still have the right to refuse a screening. |
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12VAC30-60-301 |
The definition of MCO is incomplete as it is missing the term “managed care organization” which should be listed prior to “or MCO.” |
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12VAC30-60-301 |
“primary account holder” is defined but not used elsewhere in the regulation content. There is no reason to define it if the term is not used. |
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12VAC30-60-301 |
Including nursing facility in the definition of “residence” is problematic. Recommend strengthening the regulatory guidance to conduct screenings on any individual who requests one, including all individuals who may need LTSS regardless of payer source. |
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12VAC30-60-301 |
Language regarding the UAI limits the flexibility of DMAS to make changes to the UAI. Recommend changing language to , “UAI or other DMAS approved assessment tool”. |
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12VAC30-60-302D |
This language conflicts with 12VAC30-60-304, C2 that directs hospitals to screen an individual regardless of the payer source. If this language remains, it gives all screening teams the option to evaluate the individual’s financial status prior to conducting a screening, and to screen out individuals who may not be eligible for Medicaid in 6 months. |
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12VAC30-60-302E 2 & 3 |
The first sentence indicates that veteran and military hospitals staff shall not be required to perform screenings, and the individual shall be referred upon discharge to the CBT. The next sentence implies that discharging the individual to a NF does not require a screening. Referring to the community based teams to screen for home and community based services after discharge may delay services. Recommend veteran and military hospitals be permitted to screen for community based care prior to discharge using VA form 10-1204 (or its successor), “Referral for Community Nursing Home Care". DBHDS should be permitted to conduct screenings for nursing facility placement or waiver services to avoid a service gap. |
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12VAC30-60-303A2 |
Is DMAS certain that ePAS will successfully process a screening that meets the criteria in 303 A2? |
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12VAC30-60-304A1 |
Recommend adding language that requires the MCO to consult with the individual or the individual’s representative prior to making a screening request or, as noted above, use language that indicates MCOs may refer for screenings. Individuals should be afforded the opportunity to decline the screening. |
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12VAC30-60-304A1b |
The DMAS designee for children’s screenings has been identified but the designee for screenings over 30 days has not. |
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12VAC30-60-304B1 |
Recommend that the language reflect that the request should be made directly to the DMAS designee. This will reduce any potential delay between the request for the screening and performance of the screening. |
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12VAC30-60-304C |
C seems to be in conflict with C1a and C1b. C identifies who can request a screening (inpatient or rep) and then C1a and C1b stipulate additional persons who many request a screening. |
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12VAC30-60-304C1a & b |
This guidance allows only the individual or the individual’s representative to make a request for a screening. Recommend including language to include child protective services workers and adult protective services workers who may need to request a screening for an individual who is in an unsafe situation. |
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12VAC30-60-3042 |
Consider using the following language: “The hospital team shall conduct a screening on the individual, regardless of the individual’s primary payer source for LTSS or whether or not the individual has been determined financially eligible for Medicaid.” This section contradicts 12 VAC30-60-302 D that states individuals shall be screened if they are eligible for Medicaid or are anticipated to become eligible for Medicaid reimbursement of their NF care within six months of the NF placement. |
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12VAC30-60-305 |
The term “eligibility” is used throughout this section. Unclear if this is referring to functional or financial eligibility for Medicaid LTSS. |
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12VAC30-60-306 |
Is there a need to spell out “Uniform Assessment Instrument” here since it was defined in the definition section? The DMAS 95 is only completed for NF placement, not HCBS. Recommend indicating this in the section. |
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12VAC30-60-308 |
Please consider adding language that screening documents not processed via ePAS shall not be accepted by providers. This may help stop the practice of some screening entities completing the UAI form by hand outside of the ePAS system. |
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12VAC30-60-310 |
Agree with initial training with an 80% pass rate but are concerned that 8 hours of training will be a burden for community based and hospital teams. Would recommend a shorter update every 3 years but would not recommend repeating the initial training. Recommend that DMAS track compliance with the online training. |
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12VAC30-60-313 |
The term “criteria” is used throughout this section. Unclear if this is referring to functional or financial criteria for Medicaid LTSS. |
To Whom It May Concern,
At Home Your Way/Moms In Motion would like to thank you in advance for your time as you review and consider the following comments in the final text of this regulation. We are providing comment on the proposed text changes to Long Term Services and Supports Screening. As services facilitation providers that have guided people with disabilities and their families through the screening process for long term services and supports for seven years we have noticed over the last two years that there have been trending changes in the number of people with disabilities who are approved. Among the trends, we are most concerned about the steep decline in approvals for children with varying disabilities but most significantly children with Autism that despite their age and disability are denied even when they meet the functional, financial and medical nursing criteria.
It is unclear where the discrepancies in screening lie and we are therefore supportive of the establishment of training requirements set forth in this proposed text. December 2018 is over a year away, we encourage review of denials by the Department of Medical Assistance Services (DMAS) to establish a foundation for needs assessment and planning to address the significant trends and make public data regarding the number of people who are referred to screening, request screening, are approved, denied, appeal, and their ages. Furthermore, we encourage training for screeners that includes both adult and child screening as the criteria for eligibility and processes differ greatly (12VAC30-60-310. Competency training and testing requirements). We have reviewed the November 22nd Medicaid Provider Manual Update/Revision regarding child screenings and believe that the 0-5 criteria considering the child and parent as a unit may further limit eligibility when screeners interpret the criteria without consideration of “other complex medical needs or equipment” to complete the Activity of Daily Living task. It has been our experience that various DMAS contracted screening locations vary greatly in interpretation of screening guiding documents and therefore the number of people approved or denied. The inconsistency of interpretation for long term services and supports presents a barrier to access for people with disabilities and their families.
Additionally, we often receive reports of over the phone denials of requests for screening and a lack of written notice when screening is denied leading to the absence of determination notice and right to appeal. The regulations do not indicate, nor should it be included, that screening should be conducted or eligibility determined over the phone.
Finally, we recommend that appropriated designees for adult referrals for screening include “an interested party having knowledge of an adult who may need LTSS” (12VAC30-60-304). This is similar to the designated referral entities for children wherein community members who have identified a need may initiate a referral. It would therefore support the health and safety of adults who are aging or impacted by disabilities in the community who may be isolated, declining in competence, passive in behavior, or simply unaware of available supports and services.
Sincerely,
Jessica “Flip” Grey, BSW
Compliance Analyst and Advocate
At Home Your Way/Moms In Motion