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OBRA SCREENING for people with MI diagnosis

Meeting Federal Requirements for Nursing Facility Admission of People with DD Diagnosis John Fillbrandt Age-Disabilities Odyssey June 20, 2011. OBRA SCREENING for people with MI diagnosis. See Bulletin 10-53-02. Long-Term Care Consultation LTCC. Bulletin 11-25-02. OBRA.

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OBRA SCREENING for people with MI 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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