Current through Register Vol. 41, No. 3, September 23, 2024
A. LTSS
screenings for adults living in the community. LTSS screenings for adults who
are residing in the community and who are not hospital inpatients shall be
completed and submitted by the CBT to eMLS. If the individual, or any of the
other persons permitted to make such requests, requests an LTSS screening, the
CBT shall be required to perform the requested LTSS screening. Every individual
who applies for or requests LTSS shall have the opportunity to choose the
setting and provider of services, and have this choice documented.
1. Requests for LTSS screenings shall be
accepted from either an individual, the individual's representative, an adult
protective service worker, the individual's physician, or an MCO care
coordinator having an interest in the individual. The CBT in the jurisdiction
where the individual resides shall conduct such LTSS screening. For the LTSS
screening to be scheduled by the CBT, the individual shall either agree to
participate or, if refusing, shall be under order of a court of appropriate
jurisdiction to have an LTSS screening. Medicaid payment for services cannot be
considered without agreement of the individual or the individual's
representative to participate in the LTSS screening.
a. The LDSS or LHD in receipt of the request
for an LTSS screening shall contact the individual or the individual's
representative within seven days of the request date for screening to schedule
an LTSS screening with the individual and any other persons whom the individual
selects to attend the screening.
b.
When the CBT has not scheduled an LTSS screening to occur within 21 days of the
request date for screening, and the LTSS screening is not anticipated to be
complete within 30 days of the request date for screening due to the screening
entity's inability to conduct the LTSS screening, the LDSS and LHD shall, no
later than seven days after the request date for screening, notify DARS and VDH
staff designated for technical assistance.
2. Referrals for LTSS screenings may also be
accepted by LDSS or LHD from an interested person having knowledge of an
individual who may need LTSS. When the LDSS or LHD receives such a referral,
the LDSS or LHD shall obtain sufficient information from the referral source to
initiate contact with the individual or the individual's representative to
discuss the LTSS screening process. Within seven days of the referral date, the
LDSS or LHD shall contact the individual or the individual's representative to
determine if the individual is interested in receiving LTSS and would
participate in the LTSS screening. If the LDSS or LHD is unable to contact the
individual or the individual's representative, the LDSS or LHD shall document
the attempt to contact the individual or the individual's representative using
the method adopted by the CBT.
a. After
contact with the individual or the individual's representative, or if the LDSS
or LHD is unable to contact the individual or the individual's representative,
the LDSS or LHD shall advise the referring interested person that contact or
attempt to contact has been made in response to the referral for an LTSS
screening.
b. Information about the
results of the contact shall only be shared by the LDSS or LHD with the
interested person who made the referral when the LDSS or LHD has the
individual's written consent or the written consent of the individual's legal
representative who has such authority on behalf of the individual.
B. LTSS screenings for
children living in the community. LTSS screenings for children who are residing
in the community and who are not hospital inpatients shall be completed and
submitted via eMLS. If the individual or parent or guardian, or any of the
other persons permitted to make such requests, requests an LTSS screening, the
DMAS community screening designee shall perform the requested LTSS screening.
Every individual who applies for or requests LTSS shall have the opportunity to
choose the setting and provider of services and have this choice documented.
1. A child who is residing in the community
and is not an inpatient shall receive an LTSS screening from a DMAS community
screening designee. The DMAS community screening designee may receive requests
for LTSS screenings directly. Any requests for LTSS screenings for a child
received by the CBT shall be forwarded directly to the DMAS designee. For the
LTSS screening to be scheduled by the DMAS community screening designee, the
child shall either agree to participate or, if refusing, shall be under order
of a court of appropriate jurisdiction to have an LTSS screening. Medicaid
payment for services cannot be considered without agreement of the individual
or the individual's representative to participate in the LTSS
screening.
2. The request for LTSS
screening of a child residing in the community shall be accepted from the
parent, legal guardian, the entity having legal custody of that child, an
emancipated child, a physician, an MCO care coordinator, or a child protective
service worker having an interest in the child.
3. Referrals for LTSS screenings may also be
accepted from an interested person having knowledge of a child who may need
LTSS. The process, timing, and limitations on the sharing of the results for
referrals for LTSS screenings for children shall be the same as that set out
for adults in subdivision A 2 of this section.
C. LTSS screenings in hospitals for adults
and children who are inpatients. LTSS screenings in hospitals shall be
completed when an adult or child who is an inpatient is discharged directly to
an NF or may need LTSS in the community upon discharge or when the individual,
MCO, or representative requests an LTSS screening. Medicaid payment for
services cannot be considered without agreement of the individual or the
individual's representative to participate in the LTSS screening. Every
individual who applies for or requests LTSS shall have the opportunity to
choose the setting and provider of services and have this choice documented.
1. As a part of the discharge planning
process, the hospital LTSS screening team shall complete a face-to-face LTSS
screening when:
a. The individual's physician,
in collaboration with the individual or the individual's representative if
there is one, makes a request of the hospital team. If the individual is a
child, the LTSS screening shall be completed when the individual's physician,
in collaboration with the child's parent, legal guardian, the entity having
legal custody of the child, the emancipated child, adult protective services
worker, child protective services worker, or MCO care coordinator makes a
request of the hospital LTSS screening team; or
b. The individual, the individual's
representative if there is one, parent, legal guardian, entity having legal
custody, emancipated child, adult protective services worker, child protective
services worker, or MCO care coordinator requests a consultation with hospital
case management.
2. When
there is a request, such individual shall receive an LTSS screening conducted
by the hospital LTSS screening team regardless of if the individual is eligible
for Medicaid or is anticipated to become eligible for Medicaid within six
months after admission to an NF.
3.
The hospital LTSS screening team shall exclude all institutionally induced
dependencies from the face-to-face LTSS screening documentation.
D. LTSS screenings for individuals
needing LTSS after a skilled or rehabilitation nursing facility services
admission. LTSS screenings for individuals who need LTSS after receiving
skilled or rehabilitation nursing facility services that are not covered by the
Commonwealth's program of medical assistance services after discharge from an
acute care hospital shall be completed and submitted via eMLS by NF LTSS
screening teams. Medicaid payment for services cannot be considered without
agreement of the individual or the individual's representative to participate
in the LTSS screening. Every individual who applies for or requests LTSS shall
have the opportunity to choose the setting and provider of services and have
this choice documented.
1. Requests for LTSS
screening shall be accepted from either an individual, the individual's
representative, the individual's physician, the NF LTSS screening team, or an
MCO care coordinator having an interest in the individual. The nursing facility
LTSS screening team shall contact the individual or the individual's
representative prior to enrollment in LTSS to schedule an LTSS screening with
the individual and any other persons whom the individual selects to attend the
LTSS screening.
2. Nursing facility
LTSS screening teams must include at least one registered nurse and physician
but may include a social worker or other members of the interdisciplinary team.
The authorization or denial for Medicaid LTSS (DMAS-96 form) must be signed and
attested to by the nursing facility LTSS screener and a physician.
E. LTSS screenings shall be
submitted via eMLS within 30 days of the screening request.
Statutory Authority: §
32.1-325 of the Code of
Virginia; 42 USC §
1396 et
seq.
