ࡱ> odnqhijklmnopqrstuvwxyz{|}~   m bjbjVV <<`###KKK___8<L_3D^}f$'CCCCCCC1FHHCK;w";;C##C;L#KC;CR>T|A*C_L?CD03D?II<|A|AVIKA;;;;;;;CC]f;;;3D;;;;I;;;;;;;;; :  H12- 007 Procedure January 13, 2012 TO: Home and Community Services (HCS) Division Regional Administrators Area Agency on Aging (AAA) Directors Division of Developmental Disabilities (DDD) Regional AdministratorsFROM:Bill Moss, Director, Home and Community Services Division Linda Rolfe, Director, Division of Developmental DisabilitiesSUBJECT: Revised Long-term Care Manual Nursing Facility Case Management and Relocation Chapter, now Chapter 10Purpose:To notify staff that the Nursing Facility Case Management and Relocation Chapter 10 has been revised.Background:Chapter 10 of the Long-term Care Manual had its last major revision in 2009. Whats new, changed, or ClarifiedThe revised, draft Chapter 10 updates information and fixes some broken links. Staff had the opportunity to comment on this chapter in October of 2011. ACTION:Effective immediately, begin using this chapter, attached below or by going online to:  HYPERLINK "http://adsaweb.dshs.wa.gov/docufind/LTCManual/NFCare/" http://adsaweb.dshs.wa.gov/docufind/LTCManual/NFCare/Related REFERENCES: ATTACHMENT(S): Nursing Facility Case Management and Relocation Chapter:  EMBED Word.Document.8 \s  Chapter Revision Sheet:  EMBED Word.Document.8 \s  CONTACT(S):Liz Prince, Program Manager Debbie Blackner, Program Manager (360) 725-2561 (360) 725-2557  HYPERLINK "mailto:prince@dshs.wa.gov" prince@dshs.wa.gov  HYPERLINK "mailto:Debbie.blackner@dshs.wa.gov" Debbie.blackner@dshs.wa.gov      PAGE 2    012367YbyĻ|r^NA4Ahh^,CJ^JaJhhEnUCJ^JaJhhEnU5CJ\^JaJ'hhEnU5B*CJ\^JaJphh hpA5^J h 5^J hV75^J hpA5^JhhEnU^JhhEnU5\^JhC!5\^Jhh}Q5\^JhpA5\^JhI5\^JhQhEnU5CJ\^JaJhQhEnU5CJ\aJ(jhQhEnUCJUaJmHnHu     238{  !$If $If$a$gdfr$a$yz| & d e n o v x / 2 ûó旉|rh^Th\CJ^JaJh>cCJ^JaJhO{CJ^JaJhICJ^JaJhh2JCJ^JaJhhEnU;CJ^JaJ!hhEnU5;CJ\^JaJhhEnU^JaJh>c^JaJhI^JaJhh}Q^JaJhl^JaJhhEnU5CJ\^JaJhhEnUCJ^JaJhh}QCJ^JaJ& d e o SJ $Ifgd>cJkdm$$IfH0=-% o&4e4 Ha  !0$*$If $IfJkd$$IfH0=-% o&4e4 Ha E F R RI $Ifgd>cJkdG$$IfH0=-% o&4e4 Ha !$Ifgdfr $IfJkd$$IfH0=-% o&4e4 Ha2 3 C D E F Q R Y Z \ y z  [ \ {m\N@h&B*CJ^JaJphhfrB*CJ^JaJph!hIhB*CJ^JaJphhV7B*CJ^JaJphh AB*CJ^JaJphh>cB*CJ^JaJphh&B*CJ^JaJphhC!B*CJ^JaJphhhEnU;CJ^JaJ!hhEnU5;CJ\^JaJhhEnUCJ^JaJhh CJ^JaJhfrCJ^JaJhV7CJ^JaJ \ ] ^ f RJkd!$$IfH0=-% o&4e4 Ha !$Ifgd>c $IfJkd$$IfH0=-% o&4e4 Ha\ ] f   7 8 9 : B N O P Q R d ʼʯʯʼubXK@h>c5CJ^JaJhh CJ^JaJh CJ^JaJ$hhEnU56CJ\]^JaJ!hhEnU5;CJ\^JaJhhEnUCJ^JaJhN hb>CJ^JaJh{hb>0JCJ^JaJhb>hb>CJ^JaJjhb>CJU^JaJhb>CJ^JaJhfrCJ^JaJhhEnU5CJ\^JaJ!h&hfrB*CJ^JaJphf 9 : C O P Q R d NJkd$$IfH0=-% o&4e4 Ha$If $IfJkd$$IfH0=-% o&4e4 Ha $Ifgdb>d  , u [}}} !$Ifgdl $IfOkd$$IfH0=-% o&4e4 Hayt? 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^ ݏ?om $ w,tK K:G2JW(R9ݮcCPl(I@BG\CVF > nem!D <1F@}U6R' iXe2S삄 .-rn.];#\v+ַ1y%X^%;Eu84)z{K=Rc/s7fHQ(̟zp0gU,W0ѴRvv ofiy!ݳN 6qsޝC?7.9S5awƪhR?`k +^j^yOHʵ?$/]o$R=Ŝ# J4F> R6 P)Rcv?&e{򃬠#MY!yvTAP0ή z $f(}U[{W&;~s>L.O Fܻĭ\,t_^}bgϱ 9sv"͝|maCX3mT3cXEe-rc^Kw(8鹵Ʈ.ó|s91"P]a0r0?l y_dӱhW"|c]*"H'>7i#h%d^zBB359(^M |ҬoC.swtmNϯA TZ5a0Լa HyNP{`ut D.2B-8lGSyW]b ڙs ֝vJV_Ժ\wzuKuVe*1H-\&sy \e[f]a%T58{ӫ-q.TE.h$89Tr,Wwi4d `CPCW8bYVp>(dЋTQ?Wֹ]ަ2Y7-J HU / .F;^FFO}蕇 b18Wdf: ˅:CB5.,c͝+Zf|84T{te\=;u?H>O;k(8p町9͑W'' dh鑫'sNR^,^k~0mݲ bk< ɼbXsapYkU}DB^z-/+@ۦy%>[]9DrًxLJ>v폈cNpסvR̚WȌՍK])[HcfX5Q &@k?rz_Rc)sOq~ax (҅&][ pQ[twn/ew>Єu|R3BџKRsgZ$iԴ?pP%b(J-3+9AHjtN7S0T'RN&Qqvިi5>iG/+r|A\CO[D㏖N+KZN7 +;9zoap6ɋ j9}>s`E B5op;W#2t3uDt~`9(?t=H1d,2FSt)ڱk?ס_wZtM}q*֢a!q(M(5vŭE\Ri`]#Pqԩtv(F[*7vca\G^Ix5hZ0(G7^vʉi, g 2 JPbQ3||7z䉨Rb?1uA?p͚g;ǪxͿQt]?dz"fr*!#T``mf Ryn1XLd cJp7|.Qdp19wW;#8dx,x;V ՊB t6c?8ؕ16IrS484OO3AGC+ߧ endstream endobj 97 0 obj [ 250 0 0 0 0 0 0 0 0 0 0 0 250 0 250 278 0 0 0 0 0 0 0 0 0 0 278 0 0 0 0 0 0 722 667 0 722 0 0 0 722 333 0 0 0 0 0 0 0 0 0 556 0 0 0 944 0 0 0 0 0 0 0 0 0 444 500 444 500 444 333 500 500 278 0 500 278 778 500 500 500 0 333 389 278 500 500 722 0 500 444] endobj 98 0 obj <] /Filter/FlateDecode/Length 241>> stream x5INajfvYP@ \cutڕ[.~֢TZT=}_Yx"ـ/HߋLMd.r"(bnC`Ѕ d1< B0000 d! 0 S0 30XX<,CVe(A UX5؀l@ pppЄs8NѷE5!͋x{0! endstream endobj xref 0 99 0000000017 65535 f 0000000017 00000 n 0000000125 00000 n 0000000181 00000 n 0000000476 00000 n 0000003893 00000 n 0000004070 00000 n 0000004313 00000 n 0000004492 00000 n 0000004741 00000 n 0000004914 00000 n 0000005159 00000 n 0000005328 00000 n 0000005568 00000 n 0000005743 00000 n 0000005982 00000 n 0000008998 00000 n 0000000018 65535 f 0000000019 65535 f 0000000020 65535 f 0000000021 65535 f 0000000022 65535 f 0000000023 65535 f 0000000024 65535 f 0000000025 65535 f 0000000026 65535 f 0000000027 65535 f 0000000028 65535 f 0000000029 65535 f 0000000030 65535 f 0000000031 65535 f 0000000032 65535 f 0000000033 65535 f 0000000034 65535 f 0000000035 65535 f 0000000036 65535 f 0000000037 65535 f 0000000038 65535 f 0000000039 65535 f 0000000040 65535 f 0000000041 65535 f 0000000042 65535 f 0000000043 65535 f 0000000044 65535 f 0000000045 65535 f 0000000046 65535 f 0000000047 65535 f 0000000048 65535 f 0000000049 65535 f 0000000050 65535 f 0000000051 65535 f 0000000052 65535 f 0000000053 65535 f 0000000054 65535 f 0000000055 65535 f 0000000056 65535 f 0000000057 65535 f 0000000058 65535 f 0000000059 65535 f 0000000060 65535 f 0000000061 65535 f 0000000062 65535 f 0000000063 65535 f 0000000064 65535 f 0000000065 65535 f 0000000066 65535 f 0000000067 65535 f 0000000068 65535 f 0000000069 65535 f 0000000070 65535 f 0000000071 65535 f 0000000072 65535 f 0000000073 65535 f 0000000074 65535 f 0000000075 65535 f 0000000076 65535 f 0000000077 65535 f 0000000078 65535 f 0000000079 65535 f 0000000080 65535 f 0000000081 65535 f 0000000082 65535 f 0000000083 65535 f 0000000084 65535 f 0000000085 65535 f 0000000086 65535 f 0000000087 65535 f 0000000088 65535 f 0000000089 65535 f 0000000090 65535 f 0000000000 65535 f 0000010292 00000 n 0000010474 00000 n 0000010501 00000 n 0000010758 00000 n 0000027785 00000 n 0000028086 00000 n 0000051847 00000 n 0000052122 00000 n trailer <] >> startxref 52564 %%EOF xref 0 0 trailer <] /Prev 52564/XRefStm 52122>> startxref 54701 %%EOFWordDocument  rSummaryInformation(DocumentSummaryInformation8C @_1385894973 FйCйC       !"#$%&'()*+,-./0123456789:;<=>?@ADEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcfghijklopqrstuvwxyz{|}~ 5bjbjVV r<<,)NNtHM| l5$+:+++, 9<LFA,,AA++>E>E>EA++>EA>E>E0+`ZB0HC 00pd=,>>Ef?@d=d=d=>Ed=d=d=AAAAd=d=d=d=d=d=d=d=d=N W: Nursing Facility Case Management and Relocation Section Summary HYPERLINK \l "_Nursing_Facility_Case"Nursing Facility Case Management and Relocation Purpose, History, and Philosophy HYPERLINK \l "_The_Role_of"The Role of the Nursing Facility Social Worker HYPERLINK \l "_The_Role_of_1"The Role of the Quality Assurance Nurse (QAN) HYPERLINK \l "_Providing_Nursing_Facility"Providing Nursing Facility Case Management and Relocation Activities HYPERLINK \l "_Placement:_From_the_1"Placement: From the Community Setting (HCS/AAA/DDD Responsibilities) HYPERLINK \l "_Frequently_Asked_Questions"FAQs on PASRR  What is Pre-Admission Screening & Resident Review? HYPERLINK \l "_Providing_Nursing_Facility_Case_Man"Clients that Do Not Meet Nursing Facility Level of Care HYPERLINK \l "_Determining_and_Documenting"Determining and Documenting Discharge Potential HYPERLINK \l "_Monitoring_Discharge_Potential_1"Monitoring Discharge Potential HYPERLINK \l "_Case_Transfer_Protocol_1"Case Transfer Protocol for Institutional (Hospital, Nursing Facility, or ICF-MR) Settings HYPERLINK \l "_Discharge_Resources"Discharge Resources HYPERLINK \l "_Medical_Institution_Income"Housing Maintenance Allowance(HMA-formerly MIIE) HYPERLINK \l "_Community_Transition_Services_(CTS)"Community Transition Services (CTS) HYPERLINK \l "_Residential_Care_Dischare"Residential Care Discharge Allowance (RCDA) HYPERLINK \l "_Assistive_Technology"Assistive Technology (AT) HYPERLINK \l "_Client_Intervention_Services"Client Intervention Services & Independent Living Consultation HYPERLINK \l "_Social/Therapeutic_Leave"Social/Therapeutic Leave HYPERLINK \l "_Roads_to_Community"Roads to Community Living HYPERLINK \l "_Report_Abuse,_Neglect,_1"Reporting Abuse, Neglect, or Exploitation HYPERLINK \l "_Out_of_State"Out of State Nursing Facility Placements HYPERLINK \l "_Admission_of_DDD_1"Admission of DDD Clients and Children HYPERLINK \l "_Alien_Emergency_Medical"Alien Emergency Medical HYPERLINK \l "_Home_&_Community"Home & Community Services Private Health Insurance and Good Cause Determinations HYPERLINK \l "_Work_Performance_Relocation"Work Performance Standards Resources HYPERLINK \l "_DDD_PASRR_Level"List of PASRR Contractors HYPERLINK \l "_Rules_and_Policy_1"Rules and Policy  Read more about rules and policies on this subject. HYPERLINK \l "_SAMPLE_LETTER:"Sample Letter for Nursing Facility Level of Care Notification Ask an Expert: The Program Manager for Nursing Facility Case Management and Relocation is Debbie Blackner. She can be contacted at (360) 725-2557 or emailed at HYPERLINK "mailto:debbie.blackner@dshs.wa.gov"debbie.blackner@dshs.wa.gov . Nursing Facility Case Management and Relocation Purpose, History and Philosophy Purpose The purpose of this chapter is to ensure that: Nursing facility clients who have discharge potential or the desire to move to another setting are assisted by the Nursing Facility Case Manager (NFCM) in assessing barriers to relocation. This may include: Assuring residents have information about community long-term care options; Assuring the desire and potential for discharge are identified as well as barriers to relocation; Working with the client, his/her family, NF staff, and others to remove or address the barriers to discharge (discharge planning); Assessing, care planning, authorizing services, and making referrals and coordinating care with other community and informal resources; Authorizing and arranging discharge resources; Individuals (Medicaid and Non-Medicaid), identified as likely to have a developmental disability and/or mental illness, are assessed for their need for Specialized Services per PASRR process. Medicaid clients are determined/confirmed to meet nursing facility eligibility. Philosophy of Nursing Facility Case Management The State of Washington is among the nations leaders in rebalancing institutional and community-based long-term care services. The Washington State legislature recognized the desire of most people to maintain as much independence as possible in lesser cost settings and as a result passed legislation directing the department to expand the options available to long-term care clients beyond nursing facility care (HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.39"Chapter 74.39 RCW, HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.39A"Chapter 74.39A RCW, and HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.41"Chapter 70.41 RCW). This legislation also directed that the department provide discharge planning for individuals to assist them in moving to the least restrictive setting of their choice. ADSA continues to work actively with clients from the point of admission to a nursing facility to achieve the clients discharge goals and potential. This includes meeting face-to-face with clients early in their admission and working with families and staff at the facility to advocate that therapies, treatments and teaching is provided in a timely fashion. The goal is for clients to receive services in the least restrictive, most appropriate setting that meets the clients care needs while honoring client choice and preference. ADSA embraces the notion that clients with very high care needs can be cared for and supported in a variety of settings through the implementation of waivers and state plan services that provide alternatives to nursing facility care. ADSAs mission has been, and continues to be, to provide an array of long-term care options from which clients and their families can choose. The Role of the Nursing Facility Social Worker The discharge planning responsibilities of nursing facility staff are governed by HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-97-032"WAC 388-97-032, HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-97-042"WAC 388-97-042, HYPERLINK "http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr483_main_02.tpl"42 CFR 483.12, and HYPERLINK "http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr483_main_02.tpl"42 CFR 483.20. HYPERLINK "http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr483_main_02.tpl"42 CFR 483.12 requires when a residents health improves sufficiently, the resident can be discharged with appropriate notice. Facilities are required to provide sufficient preparation to the resident to ensure safe and orderly transfer. HYPERLINK "http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr483_main_02.tpl"42 CFR 483.20 requires that the facility conduct initial and periodic comprehensive assessments (there are timeframes established in the federal rule). The assessment must include the services needed to attain the residents highest physical, mental and psychosocial well-being as required under HYPERLINK "http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr483_main_02.tpl"42 CFR 483.25. The care plan must include a summary of the residents stay and final status, and a post discharge plan of care. The nursing facility staff should work collaboratively with the NFCM to provide and ensure a smooth discharge plan. The Role of the Residential Care Services Quality Assurance Nurse (QAN) The role of the QAN complements the work of the NFCM. While NFCMs work with individual clients, QANs are primarily focused on working with the facility and facility systems to ensure certain outcomes for clients. This includes rehabilitative, teaching and care activities that have a goal of improving the clients level of functioning so that discharge is possible. While looking at facility systems and protocols, the QANs sample a number of individual residents to determine if negative outcomes for that resident represent problems with facility systems. Federal nursing facility regulations require nursing facility staff to evaluate for discharge potential each time a comprehensive assessment is completed for a resident. In Washington State, this means that each resident of a nursing facility is assessed for discharge potential on at least a quarterly basis. When the QANs do discharge protocols, they review individual residents to determine: If the facility has identified discharge potential; If a residents preference and wishes regarding discharge have been addressed by the facility; Whether the resident has been accurately assessed; That the individual residents strengths and weaknesses have been identified; That a plan has been created so that the residents abilities can improve if discharge potential exists; That community referrals have been established; That potential risks to the discharge have been identified and a plan to address those risks has been created; That a comprehensive post discharge plan of care has been established if a resident is being discharged. The NFCM should communicate concerns about discharge activities as they relate to specific clients according to locally established procedures. When the QAN completes his/her reviews, this will aid him/her when focusing on a particular facility. Providing Nursing Facility Case Management and Relocation Activities HCS provides nursing facility case management by working with HCS/AAA/DDD staff, the client, family members/informal supports, nursing facility staff, the clients physician, and community providers to assist clients in accessing services in the community. Nursing facility case managers (NFCMs) are responsible for discharge planning and case management for: Dual eligible clients. Medicare clients who also have Medicaid as a secondary payment source. Medicaid applicants/recipients who need nursing facility payment to cover the cost of their care. Private pay clients, when requested and as time allows. A NFCM should not wait for communication from the nursing facility informing them that a client is ready for discharge. Instead, the NFCM should be actively involved with the client at the earliest possible time to work with the client, family, the NF, and community providers to remove/address barriers to discharge. Note: For more information on case transfer timeframes for when an in-home client enters an institutional setting, see the Case Transfer section of LTC Manual, Chapter 5. NFCMs: Are familiar with the nursing facility administrator, the Director of Nursing, the social worker(s) and the discharge planner(s) in their assigned facilities. Conduct a face-to-face visit for each newly admitted Medicaid and dual eligible client within 10 calendar days to begin to dialog about community options and the steps/potential/desire for discharge; Monitor and document all work towards the discharge goals of identified clients in CARE. Provide information to the facility staff and clients of what services ADSA has available. Tips: Obtain a copy of the nursing facility census on a weekly basis to confirm the number of newly admitted/discharged Medicaid only and dual eligible (Medicaid/Medicare) clients. Bring ADSA informational pamphlets to nursing facilities as resource materials for clients and families. Attend applicable client care conferences with nursing facility staff to keep apprised of discharge potential and progress towards discharge goals. Placement: From the Community Setting (HCS/AAA/DDD Responsibilities) Before placing a client in a nursing facility from a community setting: Make sure the client meets nursing facility level of care (NFLOC) per the CARE assessment. All waiver clients and MPC clients who are functionally eligible for an HCS waiver are eligible for admission to a nursing facility and do not need to be assessed before admission. MPC and Chore clients who are not functionally eligible for an HCS or DDD waiver must be assessed before admission to determine nursing facility level of care for Medicaid to fund their stay. For Medicaid recipients/applicants (clients who are receiving Medicaid, but not home and community programs) an initial assessment must be completed to determine NFLOC. Document in the SER the reason for placement in the nursing facility and complete the NFLOC screen in CARE (unless other arrangements have been made) and note on the CARE NFCM screen possible barriers to returning to the community or the least restrictive care setting. This information will be used by the NFCM to begin discharge planning efforts. Document a discussion with the client/representative of attempts to explore other options available to the client and/or the clients representative. Note: If eligible, clients may choose nursing facility care regardless of the alternatives available, but the placement worker must explain and offer all options and document the discussion in the SER. Assist the client in finding a facility by using the NH Directory if necessary. Medicaid-certified nursing facilities may not discriminate against Medicaid clients per HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-97-0040"WAC 388-97-0040. Do not admit clients to a facility that has a Stop Placement. Residential Care Services Division (RCS) may issue a Stop Placement when a nursing facility is in violation of its contract. Do not admit new clients until the Stop Placement has been rescinded by RCS. The RCS district manager may approve readmission for clients on a case-by-case basis while a stop placement is in effect. Ensure that a HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_300.pdf"PASRR Level I Screening Form is completed. The PASRR form is a federal requirement for all persons entering a nursing facility. This form is used to determine whether the client needs additional services because of mental health issues or developmental disability and is used to determine if the facility is the appropriate place to meet those extra needs. For more information, read the HYPERLINK \l "_Frequently_Asked_Questions"PASRR FAQs. Obtain HCS management approval for placement per local policy and authorize placement. Document receipt of approval in the SER. To begin payment and document nursing facility eligibility, send the HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_443.pdf"DSHS 14-443 form to financial and: Include the name of the facility; Check the Yes box indicating that the client meets the NFLOC; Check the box indicating whether the client is likely to meet/exceed 30 days in the facility; and Include the date of admit. Note: Did you know there is an NFCM automated tickler that will generate 30 days after a client is determined yes for NFLOC and yes for Expected Discharge within 30 days? Send a copy of the CARE Assessment Details to the nursing facility upon request. The service summary does not need to be signed for placement purposes. Ensure the nursing facility received a copy of the HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_300.pdf"Level I Pre-Admission Identification Screen, 14-300 Form (PASRR) and include the Level II PASRR Specialized Services evaluation, if applicable. Close all SSPS authorizations effective the day prior to the admission. Send the client a Planned Action Notice. Transfer/assign the case to the NFCM per local transfer policy, when applicable. Do not inactivate the client in CARE, regardless of discharge potential upon admit; the NFCM will need to determine and monitor discharge potential. Note: For more information on case transfer timeframes for when an in-home client enters an institutional setting, see the HYPERLINK "http://adsaweb.dshs.wa.gov/docufind/CoreServices/"Case Transfer section of LTC Manual, Chapter 5, Case Management. Note: The Veterans Affairs Registered Nurses (VARN) determines eligibility for all state Veterans home placements. PRE-ADMISSION SCREENING & RESIDENT REVIEW (PASRR) Frequently Asked Questions What is PASRR? The Pre-Admission Screening & Resident Review (PASRR) process is used to determine: Whether a client has a serious mental illness or developmental disability, and requires nursing facility care; Does not require in-patient hospitalization, and/or; Needs specialized services. Who should be screened under PASRR? Anyone seeking nursing facility placement, whether funded by Medicaid or a non-Medicaid source, must be screened prior to admission to a Medicaid-certified nursing facility. Who completes the Level I Pre-Admission Identification Screen for People Coming From a Hospital? The referral source (e.g. physician, hospital staff, etc.) completes the HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_300.pdf"Level I Pre-Admission Identification Screen, DSHS 14-300 prior to admission to the nursing facility. This form can be downloaded from the DSHS website HYPERLINK "http://www.dshs.wa.gov" \o "http://www.dshs.wa.gov/"www.dshs.wa.gov. Is a CARE assessment needed for a client who meets the PASRR level I screen? HCS completes Brief assessments prior to admit for all individuals, regardless of payment source, who have a positive PASRR and require Level 2 evaluation. If the client is case managed by DDD (MPC or waiver services), the HCS and DDD worker will communicate and review the current CARE assessment in order for HCS to verify the client meets NFLOC. The DDD case manager will document that the client meets NFLOC prior to admit. Who completes the Level I Pre-Admission Identification screen for people coming from their own homes or from a residential setting? A referring physician should complete the form. For Medicaid funded clients, HCS, AAA, or the DDD ensure that the screens are complete for current clients being placed in a NF. If the individual meets the criteria for one of the Advanced Categorical Determinations (Section II of the Level I form), a physician must sign the form. DDD completes the screens for DDD clients who are being admitted to a nursing facility directly from home. Are there exceptions to a Level I being completed? Level I Pre-Admission Identification Screens are not required for the applicants who are: Transferring from one NF to another NF; or Being readmitted to the same NF following hospitalization, but only if a Level One Pre-Admission ID Screen has been previously completed and is still applicable to the individuals status. What happens if someone meets the PASRR criteria for PASRR Level II? If someone meets PASRR Level II criteria: The referral source will contact DDD or the MH contractor for an evaluation. (See list attached.) Prior to admission to the nursing facility, DDD or the MH contractor will perform a Level II evaluation to verify the diagnosis and determine whether the person needs specialized services. If the person has both a developmental disability and serious mental illness the primary diagnosis will determine who conducts the evaluation. It is the nursing facilitys responsibility to ensure that potential residents have a completed PASRR Level I screening and, if necessary, a Level II evaluation prior to admission into the facility. Are there exceptions to a Level II Evaluation being completed? You are not required to refer someone for a Level II evaluation if he/she: Requires NF care for less than 30 days, and: Services are for medical reasons, following treatment in an acute care hospital or for respite purposes, as certified by the attending physician; and He/she is not a danger to self or others. Has an explicit terminal prognosis where life expectancy is less than six (6) months, as certified by a physician. Has a severe medical condition that prevents him/her from participating in Specialized Services (e.g. ALS, COPD, ventilator dependent, CHF). Has documented evidence of a primary diagnosis of dementia (as defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); or Has a primary diagnosis of delirium as defined in the latest edition of the DSM. Note: The physician must approve and sign for any of the above Advanced Categorical Determinations. What are Specialized Services? Specialized services are provided in combination with services provided by the nursing facility and are provided or contracted by the state (HYPERLINK "http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr483_main_02.tpl"42 CFR 483.120). Specialized services are services that: For individuals diagnosed with mental illness, result in the continuous and aggressive implementation of an individualized plan of care. For individuals diagnosed with mental retardation, result in treatment which meets the requirements of HYPERLINK "http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=2e75c13a0a382bce9dbfcd5d3c8c6373&rgn=div8&view=text&node=42:5.0.1.1.2.9.7.6&idno=42"42 CFR 483.440. What if a Nursing Facility finds that a persons condition has changed after admission? The NF should promptly refer residents to DDD or the local MH evaluator who: Already have a mental illness or developmental disability and show a significant change in condition. Develop a mental illness and may need a Level II evaluation. No longer meet the criteria for an advanced categorical determination. Note: Level II evaluations must be completed if a person remains in the nursing facility longer than 30 days, if the medical condition improves and allows for participation in mental health services, or if the persons delirium resolves whenever other Level I criteria are sufficient to qualify for a Level II evaluation. What if there is not a PASRR contracted evaluator in my area or if I have questions about a PASRR contracted evaluator? The Division of Behavioral Health and Recovery (DBHR) is responsible for contracting with all Level II PASRR contractors who conduct evaluations related to mental illness. For questions about DBHR contracted PASRR evaluators, please contact HYPERLINK "mailto:Kara.panek@dshs.wa.gov"Kara Panek at 360-725-1400 or HYPERLINK "mailto:Hank.balderrama@dshs.wa.gov"Hank Balderrama at DBHR at 360-725-1736. The Division of Developmental Disabilities (DDD) is responsible for conducting Level II evaluations related to mental retardation. For questions about the DDD evaluators, please contact your local DDD MPC Coordinator. What if I have other questions about this process? For other questions about PASRR, please refer to your regional HCS or DDD office or your local Residential Care Services (RCS) field manager. Clients that do not meet Nursing Facility Level of Care (NFLOC) If the client does not meet nursing facility eligibility at admission to the nursing facility, or at any time subsequent to admission: The facility must initiate transfer/discharge of a resident who does not require nursing facility care (HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-97-0100"WAC 388-97-0100), The facility must send a 30-day notice to the client, the clients surrogate decision maker and, if appropriate, a family member or the clients representative. The notice must include the reason for denial and their right to a fair hearing, per HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.42.450"RCW 74.42.450. ADSAs policy is to authorize payment for 30 days or until the client is discharged, whichever is earlier. Client must meet financial eligibility in order for the facility to be paid. Payment will be made from state funds to the nursing facility on an HYPERLINK "http://adsaweb/documents/BlankA191A.xls"A19-Invoice Voucher using the following process: The nursing facility must complete an HYPERLINK "http://adsaweb/documents/BlankA191A.xls"A-19 and HYPERLINK "http://www.irs.gov/pub/irs-pdf/fw9.pdf"W-9 Form when the client is discharged from the facility and send the forms to the NFCM. Following all HYPERLINK "http://adsaweb/hcs/documents/ISForms/A-19%20instructions.doc"A-19 instructions, the A-19 and W-9 forms are reviewed, signed and returned to the nursing facility by the authorizing HCS office. Upon return of the approved A-19 and W-9, the nursing facility will send them to: NFCM Program Manager DSHS, Aging and Disabilities Services Administration PO Box 45600 Olympia, WA 98504-5600 The NFCM must send the client a Planned Action Notice per normal procedures based on the NFLOC/Assessment that determined the client does not meet nursing facility level of care (see the HYPERLINK "http://adsaweb/CA/CMIS/SITroom/"CARE Online Resources). Continue to work with the client on discharge planning options and document all efforts. If the case manager observes that a facility has a pattern of admitting clients who do not meet NFLOC, notify the QAN, the chain of command and call the Complaint Resolution Unit (CRU) hotline with specific concerns. Determining and Documenting Discharge Potential In the absence of a local agreement, for home and community-based clients who are admitted from the hospital, Medicaid-funded clients, or for residents who apply for Medicaid, within the first 10 calendar days of admission/application date, the NFCM, must: Complete the NFCM screen in CARE. Identify discharge potential: Significant: The client is interested and has minimal or no barriers or barriers can be easily overcome. Moderate: The client is interested, but has barriers that will take some time to resolve. Limited: The client is/isnt interested, but has barriers that can be overcome. None: The client is unable to overcome the barriers to discharge. (e.g. specific medical issues that cannot be met in the settings that the client is willing to consider with services available informally, in the community and under home and community-based services); OR the client cannot express interest because of severe cognitive limitations; OR the client refuses all discharge options. Tip: The clients wishes should be the primary influence regarding discharge plans; family desires should be considered in discharge planning, but should not be the sole source. Document the clients preferred discharge setting. Explain and consider authorizing HYPERLINK \l "_Medical_Institution_Income_Exemptio"Housing Maintenance Allowance (formerly Medical Institutional Income Exemption (MIIE) for clients likely to return to their own home within 6 months. Ensure nursing facility eligibility by determining/confirming that: The clients existing CARE assessment indicates nursing facility eligibility that will serve as criteria for functional eligibility. For Medicaid applicants (applying for Medicaid funding), recipients (medical only), and clients who are MPC eligible, determine if the client meets NFLOC criteria. HYPERLINK \l "_Providing_Nursing_Facility_Case_Man"Click here for clients who do not meet NFLOC. Document the clients barriers to discharge including any concerns the client may have, the plan/action item to overcome the barrier, and goal for each identified barrier. Continue to update this tab throughout the clients nursing facility stay as new barriers arise and other pertinent information becomes available or the barrier is resolved. Note: Unless other local agreements have been made, for cases that are being retained by AAA/DDD, the NFLOC tab in CARE must be completed by the AAA case manager or NFCM, and in coordination with DDD, when necessary. Note: If the client is discharged from the facility within the first 10 calendar days of admission and the social worker was unable to determine NFLOC, a face-to-face interview is not necessary. The NFCM may use other means to determine that the client meets nursing facility eligibility such as the clients medical chart, nursing assistant notes, and staff interviews. Send the HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_443.pdf"14-443 to financial (unless already sent by RCCM/AAA/DDD) and complete the Nursing Facility Placement section by checking/filling in the appropriate boxes including: The date of the request for assessment; If the client is functionally eligible or if the level of impairment does not meet nursing facility eligibility; Date of admit; Name of the facility; If the client is likely to meet/exceed 30 days. This determination is the NFCMs good faith belief that the client will be residing in the facility for less or more than 30 days based on the information they have available. Financial uses this information to determine which program rules to apply for the facility stay and to complete the award letter which allows the facility to be paid; and Date of discharge, if applicable. Complete this box if the client has already discharged from the facility at the time you determine NFLOC. Also, include the setting the client discharged to and which program was used, if services were authorized. HYPERLINK \l "_How_is_the"Click here for more information on how the payment begin date is determined. Note: Did you know there is an NFCM automated tickler that will generate 30 days after a client is determined yes for NFLOC and yes for Expected Discharge within 30 days? Note: If it was anticipated the client would not exceed 30 days and does, the NFCM must inform the financial worker using the HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_443.pdf"DSHS form #14-443. Monitor, as appropriate, and document progress towards discharge in the SER. Coordinate with nursing facility staff and other case managers. Do not rely on nursing facility staff to call when the client is ready to discharge. The work of a NFCM begins when the client is admitted to the nursing facility. Attend care conferences as needed. Work with the AAA, DDD and/or other HCS staff regarding clients who are returning home within 30 days. Record actual date of discharge on the NFLOC screen in CARE within 7 days of discharge. This is important for accurate tracking of all NF discharges. Enter the discharge information on the RCL SharePoint site on the Core Discharge form. Note: If a client on an HCS waiver was placed into the nursing home from the hospital, there is no need to have them sign an Acknowledgment of Services form. Exception: For any clients applying for Disability Lifeline, determine nursing facility eligibility, using the Brief assessment, within 5 working days of admit/application. Note: For more information on case transfer timeframes for when an in-home client enters an institutional setting, see the Case Transfer section of LTC Manual, Chapter 5. How is the Payment Begin Date Determined? For Medicaid Recipients: To ensure timely hospital discharge of Medicaid-eligible persons, Medicaid payment begins on the date of the request for an assessment or the date of admission to the NF (including swing beds), whichever is later. Nursing facilities must request assessments before or on the same day of admit to be guaranteed payment (this includes weekends). For Medicaid Applicants: NFs must request assessments for Medicare/private-pay NF residents converting to Medicaid as soon as it is determined that the resident will likely need Medicaid funding. Medicaid payment will being on the date: The financial application for NF care was received; or Nursing facility placement; or When the client is functionally and financially eligible. Payment can begin no more than three months prior to the first day of the month in which the financial application is received. Monitoring Discharge Potential The NFCM will: Continue to monitor discharge potential and work with the client, nursing facility staff, and family to help relocate the client to a community based setting. Establish ticklers in the Case Management Information System (CMIS) application for visiting the client/family members and for completing tasks to eliminate/address barriers to relocation. Visit the client and inform the client and/or family/representative, as appropriate, of case management services. Offer support to the client, the family and/or representative by addressing concerns regarding care in the nursing facility or other quality of life issues. Monitor progress towards discharge goals and encourage progress towards the highest level of functioning possible. If it is not feasible for the client to return to their own home, talk to the client, their family/representative, and/or his/her case manager about other living situations such as adult family homes or boarding homes. In coordination with the nursing facility staff, contact AFHs and BHs to determine if they have openings and discuss the clients care needs to learn if they would be interested in coming to meet the client or have the client visit the home. Encourage the teaching of clients so that they are able to address their own care needs, such as self-medication programs, nutritional programs, or home evaluations. Document progress towards discharge in the SER and update applicable screens in CARE. No Discharge Potential For clients who have been determined to have no discharge potential, offer ongoing support to the client, family and/or representative by addressing concerns regarding care in the nursing facility or other quality of life issues and continue to support all efforts towards reducing or eliminating discharge barriers. If the client has not made any progress towards discharge after 6 months, re-evaluate discharge potential and barriers to discharge. If the clients discharge potential has changed, update the CARE NFCM screen including barriers to discharge, the plan/action items to address the barrier, and goals for each identified barrier. Provide ongoing case management and relocation services, if applicable. If the client continues to have no discharge potential, inactivate the client in CARE using the No Discharge Potential code. Note: Did you know there is an NFCM automated tickler that will generate 6 months after a client is determined yes for NFLOC and Limited or None for Discharge Potential? Note: For DDD clients, move the LTC assessment to history and remove yourself from the CARE team on the Overview screen. Do not inactivate the client in CARE. Ready for Discharge When there is discharge potential and the client chooses placement in a less restrictive setting, perform an assessment (initial, significant change, or reapply) and develop an individualized plan that reflects client choice and their specific care needs. If appropriate, authorize discharge resources, such as Community Transition Services, Residential Care Discharge Allowance, Assistive Technology, or Client Intervention Services and Independent Living Consultation (APS clients only). For DDD clients, contact the DDD case manager to initiate the completion of a DDD assessment and to coordinate any discharge resources that may be needed. Case Transfer Protocol for Institutional (Hospital, Nursing Facility, or ICF-MR) Settings The intent of this case transfer policy is to encourage coordinated discharge/treatment planning in the best interest of the client. The AAA Case Manager (or DDD Case Resource Manager) should collaborate with HCS Social Worker to determine if and when a case transfer is appropriate for a client who intends to return to an in-home setting. In that regard, either AAA and/or HSC staff may: Assess client in NF or hospital Determine NFLOC in the NFCM screen of CARE Attend care conferences at the hospital, NF, or ICF-MRS Access discharge resources for clients Review charts and/or files Request Housing Maintenance Allowance (HMA) (formerly Medical Institution Income Exemption - MIIE) Timeline Benchmarks Client may remain with AAA/DDD for 30 days from initial admit to NF regardless of subsequent changes in institutional setting (hospital, SNF, ICF-MR). Client may be kept longer if return to in-home setting is imminent. If a hospital stay goes beyond 30 days, AAA CM may coordinate with HCS SW regarding possibility of transfer to HCS. If client does not intend to return to in-home setting, AAA/DDD may transfer client to HCS immediately. HYPERLINK "http://adsaweb/docufind/LTCManual/CaseManagement/"See Case Management Section of the Long-Term Care Manual. Discharge Resources Housing Maintenance Allowance (HMA) (formerly Medical Institution Income Exemption - MIIE) Housing Maintenance Allowance: The HMA is income, up to 100% of the Federal Poverty Level, that the client can keep in order to maintain his/her residence during his/her NF or institutional stay. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-513-1380"WAC 388-513-1380 Who is eligible?A single client applying for HMA must be: A Medicaid recipient. Certified by a physician that he or she will likely be institutionalized in a NF or Medical Institution for no more than six (6) months. A married client may be eligible if both members of the couple are residing in a NF or receiving Housing Maintenance Allowance and one of them is likely to return to their place of residence within six (6) months. A married client whose spouse is not institutionalized is not eligible for the HMA. What is covered under the HMA?The client is allowed to keep monthly income up to 100% of the federal poverty level to maintain his/her residence for things such as rent, mortgage, property taxes/insurance, telephone (basic land-line), and basic utilities. The HMA does not include recreational or diversional items such as cable or internet connections. How do I authorize HMA?Consult with the financial worker to determine the first month that an HMA could be authorized. Verify the cost to maintain the residence using things such as canceled checks, bills or receipts. Request written verification from the client's physician that the client is likely to return home within six months using the HMA letter HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_456.pdf"DSHS form 14-456. Place the itemized documentation and the completed HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_456.pdf"DSHS form 14-456 from the physician in the clients file. List the monthly expenses and calculate the exemption on the HYPERLINK "http://asd.dshs.wa.gov/FormsMan/FormPicker.aspx"DSHS form 14-443 (HCS/AAA staff) or on HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/word/15_345.doc"DSHS Form 15-345 (DDD staff) and send it to the financial worker. List detail of the action in the CARE SER under Activity Code NFCM. Note: If the AAA/DDD worker retains case management of the case, the completion of the HMA is his/her responsibility. When do I authorize this service and for how long?The HMA begins on the first of the month (as stated on the HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_456.pdf"DSHS 14-456) and ends when the client is discharged from the facility or at the end of six (6) months, if the client is not discharged. HMA should not be requested for a month in which the client does not have participation (i.e. the first month of admission or when Medicare is the only payment source). For non-SSI clients, circumstances must be reviewed after 90 days and financial must be informed of the need for an extension or termination of HMA. If it is determined that the client no longer has discharge potential, terminate the HMA and notify financial. If a client is discharged to home and later re-admitted, you may reauthorize the HMA. What if it is a Temporarily Institutionalized SSI Recipient?SSI only income: Upon NF admission, the clients SSI income is exempted; therefore, these clients are not eligible for a HMA. SSI/SSA (or some other income): Authorize the HMA taking into consideration the clients SSI income for the first 3 months. SSI income would need to be subtracted from the total need, since this income is available to the client for the first 3 months. If the client continues to need NF care following the first 3 months and has additional income such as SSA, pension, retirement, etc., authorize an income exemption for 3 additional months. Are ETRs allowed for HMA?If the client has only SSI income and requires NF care following the first 3 months of institutional care, a local ETR for a Residential Care Discharge Allowance (RCDA) can be authorized to maintain the clients residence. However, this ETR can only be authorized for 3 additional months. No ETRs are allowed for HMA s longer than 6 months. No ETRs are allowed for amounts over the federal poverty level per month.  Community Transition Services (CTS) Community Transition Services (CTS): CTS is money used to purchase one-time, set-up expenses necessary to help relocate clients discharging from any congregate setting (both institutional and non-institutional) settings to a less restrictive setting. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-106-0305"WAC 388-106-0305 Who is eligible for CTS?HCS/AAA clients who are receiving Medicaid long-term services who: Are discharging from a congregate setting to a more independent/less restrictive setting; and Will be receiving HCS waiver services (COPES, MNRW, MNIW) upon discharge. CTS funds must be considered before you use RCDA state funds.What is covered under CTS?Services or items necessary to establish the residence are covered which may include such items as medical equipment, set-up fees/deposits for service access (telephone, electricity, heating), security deposits (that do not include payment for rent), essential furnishings, health and safety assurances (pest eradication, one-time cleaning) and basic items essential for living outside the institutional setting. CTS can be used to purchase items that are covered under the waiver such as environmental modifications, while the client is located in the nursing home. What is not covered under CTS?Federal rules require that services do not include rent, recreational or diversional items such as television, cable or DVD players. CTS does not pay for items or services paid for by Medicaid or other programs and resources. For eligible clients, the RCDA can be used in combination with CTS for items/services not covered under CTS. How much can I spend?The amount that can be used for CTS is $816. Note: If both CTS and RCDA funds are being authorized the combined costs cannot exceed $816 without an ETR. Do I need a provider contract?A contract/agreement is required for all CTS providers. Check to see if the provider has an existing contract (e.g. specialized medical equipment or home modifications). If there is not an existing contract and the provider will have unsupervised access to the client and/or their belongings, pursue a Client Service Contract before authorizing services. This contract can be obtained by accessing the ACD website. Providers must also meet all other obligations associated with the contracting process such as background checks and insurance requirements when applicable. For items/services being purchased from a provider who does not have an existing contract and does not have unsupervised access to the client and/or their belongings, use the HYPERLINK \l "_Sample_of_Provider"Provider Agreement. Payment will be done through the A-19 process with the contractors separate invoice attached. How do I authorize CTS?Perform a CARE assessment to determine/document the need and plan of care for the CTS; Move the assessment to Current. The CTS provider may be used as the paid provider; Document the extent of services provided and the cost in the CARE SER, for NF discharges use Activity Code NFCM; Complete the HYPERLINK "http://adsaweb/docufind/ltcmanual/nfcare/documents/housing%20modification%20property%20release%20statement%20form.doc"Housing Modification Property Release Statement for all environmental modification authorizations if the client has a rental agreement. Authorize a one-time payment up to $816 using the appropriate HYPERLINK "http://dshsapoly8817pd/sspsmenu/Default.aspx"SSPS code(s): (a) 5230, 5430, or 5530 for service payments (b) 5231, 5431, or 5531 for item payments Place the verification for costs in the client record; Send the client a Planned Action Notice. Note: All CTS payments must go directly to the provider. When do I authorize this service?This is a one-time payment only (no ongoing services/items), to be used to help clients establish a residence. Only if the client has needs beyond what is covered under CTS, can RCDA also be used. CTS funds can be accessed up to 30 days after discharge if the item/service is needed for a successful discharge and no other resource is available. You may use CTS each time the eligible client is discharged. Are ETRs allowed for CTS?Yes, all CTS funds that exceed $816 must have a local office ETR approval. Residential Care Discharge Allowance (RCDA) Residential Care Discharge Allowance (RCDA): RCDA is money used to help clients relocate from institutional and other residential settings to a less restrictive setting. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-106-0950"WAC 388-106-0950; HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-106-0955"388-106-0955Who is eligible for RCDA?HCS/AAA clients who are receiving long-term care services and are being discharged from a nursing facility, hospital, or any residential setting to a less restrictive setting. DDD clients who are being discharged from NFs only.What is covered under RCDA?Costs necessary to establish the residence are covered, which may include such items as rent, damage deposits, utilities, telephone, or the purchase of necessary equipment including handrails, ramps, assistive devices/furniture, bedding, household goods/supplies. The RCDA may also be used to fund trial visits in less restrictive settings. What is not covered under RCDA?The RCDA does not pay for items or services paid for by other state programs, and/or Community Transition Services under state waivers. RCDA does not include recreational or diversional items such as television, cable, or VCR/DVD players. When do I need a provider contract?A contract/agreement is required for all RCDA providers if they will have unsupervised contact with the client and/or the clients belongings. Check to see if the provider has an existing contract (e.g., specialized medical equipment or home modifications). If there is not an existing contract and the provider will have unsupervised access to the client and/or the clients belongings, pursue a Client Services Contract before authorizing services. This contract can be obtained by accessing the ACD website Providers must also meet all other obligations associated with the contracting process such as background checks and insurance requirements when applicable. For items being purchased from a provider who does not have an existing contract and does not have unsupervised access to the client and/or the clients belongings, use the HYPERLINK "file:///C:\\Documents%20and%20Settings\\Benned\\Local%20Settings\\Temporary%20Internet%20Files\\Content.Outlook\\Resources\\Provider%20Agreement%20Form.doc"Provider Agreement. Payment can be done through the A-19 process with the contractors separate invoice attached. How do I authorize RCDA?You must: For clients discharging with long-term care services, perform a CARE assessment to determine/document the need and plan of care for the RCDA. If the client will not be discharging with long-term care services, document the client need and reason for the allowance in the SER; Complete the HYPERLINK "file:///C:\\Documents%20and%20Settings\\Benned\\Local%20Settings\\Temporary%20Internet%20Files\\Content.Outlook\\Resources\\Housing%20Modification%20Property%20Release%20Statement%20Form.doc"Housing Modification Property Release Statement for all environmental modification authorizations if the client has a rental agreement. Document the cost in the CARE SER under Activity Code NFCM; and Authorize a one-time payment of up to $816 using SSPS code 4642 for items or 4645 for services; and Place the verification for costs in the client record; Send the client a Planned Action Notice. Note: The HCS social worker must coordinate and authorize all RCDAs for all DDD clients.When do I authorize this service?This is a one-time, set-up payment only, to be used to help clients establish a residence in a community setting. RCDA funds can be accessed up to 30 days after discharge if the item/service is needed for a successful discharge and no other resource is available. You may use the RCDA each time the eligible client is discharged.Are ETRs allowed for the RCDA?Yes, all RCDAs that exceed $816 must have a local office ETR approval. Assistive Technology Assistive Technology (AT): AT Project funds may be used to purchase assistive devices and services, which have no other funding source. The AT project is designed to: Increase a persons functional independence; Maximize a persons health and safety; Increase the likelihood that adults in institutional settings will transition to their own homes and communities.Who is eligible for AT?The Assistive Technology (AT) Project provides financial assistance for assistive technology services and devices for adults who are eligible for: Core long-term care services (Medicaid-funded); Adult Protective Services; Division of Developmental Disabilities (DDD) services; or Older Americans Act programs. These adults live at home, in community residential programs, in nursing homes or in other settings.What is covered under AT?Assistive Technology Devices - any item, piece of equipment, or product system, whether acquired commercially off-the-shelf, modified or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities. AT devices include but are not limited to: environmental control devices, communication devices and HYPERLINK "http://hrsa.dshs.wa.gov/download/BillingInstructions/Durable_Medical_Equipment_BI_Asof12312007.pdf"Durable Medical Equipment (DME). Assistive Technology Services - services that assist persons with disabilities to select, acquire, or use assistive technology devices. AT services include, but are not limited to: Occupational Therapy (OT) and Physical Therapy (PT) evaluations, short-term training and eye examinations. Durable Medical Equipment (DME) - equipment which can withstand repeated use and which is used to serve a medical purpose when supplied to individuals with an illness, injury or disability. DME includes but is not limited to: wheelchairs, walkers, specialty beds, and mattresses. Non-Durable Medical Equipment - supplies that are used once or more than once but are time-limited, such as incontinence supplies or catheter bags. Minor Home Modification enables the individual to function independently and safely in their own home. Examples include but are not limited to: ramps, widening of doorways and bathroom modifications. AT funding can purchase specialized medical equipment and supplies if the equipment is denied by the funding source or not a covered service under the state plan. What is not covered under AT?Devices or services that are not directly related to increasing the individuals ability to access their homes and communities. Examples of non-covered items include but are not limited to: televisions, washer/dryers, and wall-to-wall carpeting or anything for cosmetic reasons. How much can I spend?Funds for this project are limited per fiscal year. Individuals can be put on a waiting list until funds become available. When do I need a provider contract?There is no requirement to have a contract for items purchased for the client or evaluations/training that are incidental to the purchase. How do I authorize AT?For clients discharging with long-term care services, perform a CARE assessment to determine/document the need based on input from the person with the disability for specific assistive devices and services. If the client will not be discharging with long-term care services, document the clients need for the specific devices/services in the SER; Document the assistive technology device in the appropriate equipment tables of the CARE tool; Use the appropriate comment box in CARE to document specific information pertaining to the device or service, i.e. Communication screen, Environment screen, or equipment table within the ADL screen. The documentation in the comment box will automatically roll into the Assessment Details. If needed, obtain information from collateral contacts such as therapists, doctors, or nurses. CARE documentation must include how the service/device will add to the clients health, safety, and increase functional independence so that the client can live in his/her own home or the least restrictive environment; Document that all other funding sources have been explored before submitting the final request to the AT program manager at headquarters. Follow procedures in HYPERLINK "http://adsaweb.dshs.wa.gov/docufind/CoreServices/"Assistive Technology Chapter (Chapter 16) of the Long-Term Care Manual.  Send the client a Planned Action Notice. Upon headquarters approval, ordering and payment will be authorized through an A-19 Invoice Voucher form and will be processed by the fiscal staff at headquarters. The case manager/social worker must supply the following information to the HYPERLINK "mailto:McDonPM@dshs.wa.gov"AT program manager: The ETR form; and The vendor identification and cost information.When do I authorize this service?This is a one-time payment only, to be used to help ADSA clients who have no other funding source for assistive technology.Are ETRs allowed for the AT?All AT services need ETR approval from headquarters. Upon depletion of project funds, subsequent requests may be denied.Client Intervention Services (CIS) and Independent Living Consultation (ILC) Client Intervention Services (CIS) and Independent Living Consultation (ILC): These funds are available for specific, short-term, client intervention services needs, not available through Medicaid or waiver services. Who is eligible for Client Intervention Services or Independent Living Consultation?HCS/AAA clients who are receiving the following Medicaid, long-term services: COPES, MNIW, MNRW; Chore recipients; Medicaid Personal Care recipients; APS Medicaid or non-Medicaid recipients; Medicaid Nursing Facility clientsWhat is covered under CIS or ILC?Client Intervention Services includes: Certified public accountants (CPA) to aid in the investigation of financial exploitation Capacity evaluations when it is difficult to determine if a person is at significant risk of personal or financial harm because of diminished capacity. If you need to request a capacity evaluation, do so prior to any court involvement Home environment evaluations One-time home hazardous cleanup Care planning for a specific client in a residential setting Medical consultation not available through Medicaid or waiver services Subsidized housing or housing options evaluation Nursing rehabilitation evaluation Physical or occupation therapy evaluation Independent Living Consultation includes: Interviewing skills training (e.g., train an individual who is having difficulty keeping a provider on how to interview, hire and fire and effective supervision of personal assistant services); Mobility Training (e.g., maneuvering techniquesin inaccessible areas and accessing public transportation); Money management training and/or referring to protective payee services; Training an individual on how to identify abusive situations and the tools used to assist an individual in avoiding and/or addressing those situations; Peer support to an individual to enable him/her to manage his/her healthcare needs and to assist in acceptance of the disability (e.g., connect the individual with local resources and assist in establishing the person to become independent in the community); Provide housing assistance (e.g., help in the application process for a variety of housing options, including home ownership); Assistive Technology evaluation (e.g., identifying potential barriers in housing, transportation, communication and durable medical equipment needs).What is not covered under CIS or ILC?Psychotherapy or counseling; Ongoing adult family home (AFH), boarding home (BH), or in-home provider training. Training and consultation to residential providers must involve a specific clients special needs (e.g. inappropriate behaviors) and must include a face-to-face interaction with the client; With the exception of Adult Protective Service recipients, persons not receiving MPC, CHORE, or waiver services in an AFH, BH, or in-home setting. How much can I spend?Due to limited funding, HCS staff must obtain Regional Administrator or appropriate designee approval. For AAA staff, up to $2,500 is available to each AAA per fiscal year. This funding is provided on a first-come basis; each AAA is not guaranteed $2,500 each year. Negotiate the scope of the service and payment rate with the potential contractor (see payment schedules). Stress that the funding for such services is limited. For independent living contractors, negotiate an hourly rate up to $80 per hour. For psychiatrist and psychologist contractors, use the appropriate HYPERLINK "http://adsaweb/hcs/documents/ISForms/Intervention%20Services%20Procedure.doc"services payment schedule. For all other contractors, negotiate a rate per hour from $60 to $100 for all intervention services contracts. Travel: Reimburse travel time at the hourly rate, or event rate for a psychiatric contract, for every 30 minute unit after the first 30 minutes of travel time, up to a maximum of three hours. Allowable travel time is portal to portal: Portal to portal is defined as: The distance traveled by the contractor from the contractors residence or office, whichever is closer, to the address of an appointment (appointment is defined as scheduled time with a person receiving intervention services); The distance from the address of an appointment to another appointment; The distance from an appointment to the contractors residence or office, whichever is closer. Travel time is not reimbursed for travel to non-relevant destinations, such as restaurants. Calculate travel time from the contractors residence or office to the clients location (to whom intervention or independent living services are being provided), whichever is closer. The contractor must specify travel time on the A-19 (example for a psychologist: Total travel time = 30 minutes (after the first 30 min.) = one 30 minute unit X $24.43 (1/4 the psychologist rate) = $24.43 for travel time). If the contractor travels to multiple clients in a given area, the contractor can bill travel only once. The contractor cannot submit a separate travel billing for each client. When do I need a provider contract?All CIS and ILC services must be under contract. Follow HYPERLINK "http://adsaweb/hcs/documents/ISForms/Intervention%20Services%20Procedure.doc"contracting procedures.How do I authorize CIS or ILC?Document in the client file, or CARE, the reason for the service and that all other resources have been explored. Make sure a valid contract exists, complete an HYPERLINK "http://adsaweb/hcs/documents/ISForms/Authorization%20Form.docx"authorization for Intervention Services form, obtain appropriate signatures and send it to the contractor. Payment will be done through the A-19 process with the contractors separate invoice attached. Once you have authorized the service, send the client a Planned Action Notice that you will find in CARE (see the HYPERLINK "http://adsaweb/CA/CMIS/SITroom/"CARE Online Resources).When do I authorize this service?For HCS staff You must receive approval from your Regional Administrator or appropriate designee. For AAA staff You must receive approval from your AAA Director or appropriate designee.Are ETRs allowed for the CIS or ILC?The ETR process is not allowed for CIS or ILC services. Are there other CIS/ILC forms available?Yes, click HYPERLINK "http://adsaweb/hcs/interventionForms.htm"here for more information. Social/Therapeutic Leave Social/Therapeutic Leave: The Department will pay the nursing facility for a Medicaid residents social/therapeutic leave up to 18 days per calendar year. See HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-97-0160"WAC 388-97-0160.What is covered under Social/Therapeutic Leave?Social/Therapeutic leave gives NF residents an opportunity to participate in: Social/ Therapeutic activities outside the NF and beyond the care of the NF staff. Trial visits to less restrictive settings. Social/Therapeutic leave must not be used for medical care leave in another medical institution. How is the NF paid?The department reimburses NFs for up to 18 days (24 hr. periods) per calendar year for each Medicaid resident's social/therapeutic leave. Social workers track the number of days spent per year and report those to the financial worker.How do I know if an ETR is needed?NFs and/or the resident can request additional Social/Therapeutic leave from the department in excess of 18 days per year. Note: NFs are required to notify the department of social/therapeutic leave in excess of 18 days per year.Are ETRs allowed for Social/Therapeutic Leave?Requests for ETRs for social/therapeutic leave exceeding 18 days per calendar year may be approved with a local office ETR. ETR should be submitted via the electronic ETR process in CARE. ETRs that promote resident independence are appropriate. Any requests for over 18 days of leave must be approved prior to the client taking the leave. If an ETR for leave exceeding 18 days per calendar year is approved or denied you must: Notify the HCS Financial Worker using a Social Service/Financial Services HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_443.pdf"DSHS 14-443 form; Document approval/denial in the SER; and Send the client a Planned Action Notice (HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/word/05_246.doc"DSHS Form 05-246). Note: Frequent or excessive social/therapeutic leave may indicate the resident has potential for NF discharge.  Roads to Community Living is a statewide, demonstration project funded by the Money Follows the Person grant. The purpose of the RCL demonstration project is to investigate what services and supports will successfully help people with complex, long-term care needs transition from institutional to community settings. For clients meeting eligibility criteria, additional transition services are available both while the client is in the nursing facility and for one year after they have moved to the community. See the HYPERLINK "http://adsaweb/docufind/LTCManual/roads"RCL section of the LTC Manual for more information regarding eligibility and services offered.  Roads to Community Living (RCL) Report Abuse, Neglect, Exploitation and/or Abandonment 1-800-562-6078 As an employee of DSHS, you are a mandatory reporter: Call and report any issues of abuse, neglect, exploitation, and abandonment of any nursing facility resident. This report will remain confidential within the limits provided by law. For additional information regarding abuse, neglect, self-neglect, exploitation or abandonment, see the HYPERLINK "http://adsaweb.dshs.wa.gov/docufind/LTCManual/APS/"APS Chapter of the LTC Manual. Out of State Nursing Facility Placements Clients placed in recognized bordering city nursing facilities for stays of 30 days or less, who intend to return to Washington, may receive coverage, if eligible. HYPERLINK "http://apps.leg.wa.gov/wac/default.aspx?cite=182-501-0180"WAC 182-501-0175 lists the bordering cities as: Coeur dAlene, Moscow, Sandpoint, Priest River, and Lewiston, Idaho; Portland, The Dalles, Hermiston, Hood River, Rainier, Milton-Freewater, and Astoria, Oregon. Follow the procedures listed in the HYPERLINK \l "_Placement:_From_the"Placement: From the Community Setting (HCS/AAA/DDD Responsibilities) section of this chapter. If the stay extends beyond 30 days, the client must do one of the following: Move to a Washington State nursing facility; Apply for benefits from the bordering state; or Supply the NFCM with information to demonstrate that there is a definite discharge date planned within the subsequent 60 days (e.g. a statement from the clients physician stating that the client needs an additional 20 days of rehabilitation after the first 30 days expires.) If a Washington State client applies for Medicaid from the bordering state and is determined not to be eligible, the NFCM must assist the client in moving back to Washington within 30 days. Continue payment authorization until the move is complete. Document your efforts in a SER. Rates for out-of-state nursing facility placements must be coordinated with the Home and Community Rates Manager, Lyle Baker, by email to HYPERLINK "mailto:Lyle.Baker@dshs.wa.gov"Lyle.Baker@dshs.wa.gov. Clients who are placed in out-of-state nursing facilities for emergency purposes may also receive coverage for their short stay per HYPERLINK "http://apps.leg.wa.gov/wac/default.aspx?cite=182-501-0180"WAC 182-502-0120. The NFCM must determine if the client meets nursing facility eligibility based on information available and notify financial. Note: Children residing in the Providence Child Center are exempt from these requirements. Admission of DDD clients and Children From home/residential settings The Nursing Facility Case Manager must: Work with the DDD or Childrens Administration (CA) case manager to determine if nursing facility care is the most appropriate service for the client; If a DDD or CA assessment has been completed, the NFCM may use this information to complete the NFLOC; If there is no DDD or CA assessment, the NFCM must complete the NFLOC in CARE; Review and authorize the placement, if appropriate; and If requested, participate in inter-disciplinary team staffings or provide consultation to the DDD or CA case manager. From the hospital The Nursing Facility Case Manager must: Determine NF eligibility within the first 10 calendar days of admission and inform financial per the HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_443.pdf"DSHS 14-443 form. If requested, participate in inter-disciplinary team staffings or provide consultation to the DDD or CA case manager. DDD/CA retains case management responsibility for reassessment and discharge planning in coordination with the NFCM. Note: Children residing in the Providence Child Center are exempt from these requirements. Note: All clients entering the nursing facility must have a PASRR Level 1 screening completed prior to admission to the facility. If a Level II evaluation is necessary, see list of HYPERLINK \l "_DDD_PASRR_Level"Level II Contractors. State Funded Long-Term Care for Non Citizens Federal guidelines limit medical care for non citizens to those services that are necessary to treat an emergency medical condition. Effective 11/1/2009, the need for nursing facility care was no longer considered an emergency medical condition and federal funds were no longer available. As a result of these changes, the state legislature gave limited funding for a state funded long-term care program to cover services that were being authorized prior to 11/1/2009. Effective 5/14/2011, the legislature directed ADSA to move individuals being served in the state funded program to a residential setting, if appropriate. HYPERLINK "http://www.dshs.wa.gov/manuals/eaz/sections/MedicalAssistance/EA_AlienMedical.shtml" \l "388-438-0125"WAC 388-438-0125 describes the state funded long-term care program. This program has limited slots for coverage based on legislative funding. New admissions into nursing facilities or residential settings under the state-funded long-term care program must be pre-approved by David Armes, Financial Policy Manager at ADSA headquarters via email, HYPERLINK "mailto:armesjd@dshs.wa.gov"armesjd@dshs.wa.gov. Further detail may be found at: HYPERLINK "http://www.dshs.wa.gov/manuals/eaz/sections/MedicalAssistance/EA_AlienMedical.shtml"Medical Assistance EAZ manual. Home & Community Services Private Health Insurance and Good Cause Determinations Medicaid clients are required to cooperate in the identification and use of third party liability (insurance carriers) that may be responsible for paying for nursing facility care and other long-term care services. Clients may object to the options offered by their private insurance for a variety of reasons, including the location of the facility. The Department is allowed to exempt the client from cooperation if we have determined that there is good cause for the exemption. If a client has third party liability (TPL) and resides in a facility that is a non-participating/non-network/non-contracted provider of the plan, the following process will occur: The nursing facility will contact the insurance carrier to determine if they will pay a non-participating/non-network/non-contracted provider, or can decide to become a participating/network/contracted provider if possible. In coordination with HCS, the nursing facility can determine if a client could be exempted from using their TPL if there is no DSHS participating/network/contracted nursing facility within 25 miles or 45 minutes from the clients current residence. If there is a DSHS participating/network/contracted nursing facility within 25 miles or 45 minutes of the clients current residence, the NFCM will talk with the client and/or the clients representative about the possibility of moving to a facility that is in the insurance carriers network. The department will determine if good cause exists. To determine good cause, the NFCM will evaluate the reasons why the client does not want to transfer to a participating network provider. Good cause can include a variety of reasons such as location, physical or emotional harm, or that a move to a different NF will cause transfer trauma. If the client is deceased, no longer a resident at the facility, or no longer has the insurance, a local exception to policy to HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=182-501-0200"WAC 182-501-0200 may be submitted. The Regional Administrator, or their designee, will make the final decision regarding good cause determinations. The NFCM will document in SER if good cause is approved or denied and inform HRSA-Coordination of Benefits Unit (nursing home desk) of the outcome. To contact the nursing home desk call the following number and extension based on the clients last name: 1-800-562-6136 A G extension 51936 H Z extension 51164 Note: The Veterans Affairs Registered Nurses (VARN) or other designee of the Washington Department of Veterans Affairs shall complete all good cause determinations for all state Veterans home placements. Work Performance Relocation Standards Nursing Facility Case Managers perform a wide variety of activities relating to NF admission and discharge. One measurement of work performance standards relates specifically to relocation. Relocation for this purpose is defined as a discharge in which one of the following is true: Without significant efforts of the NFCM, the discharge would not have occurred, or would have not have occurred now; there must be SER notes documenting the work; OR A face to face assessment resulting in a discharge has been completed, regardless of whether it is moved to current or history, or whether the client leaves with services. The expectation is that NFCMs will complete an average of 5 relocations per month which meet these criteria. The Regional Administrator may identify circumstances beyond the control of an employee that could affect his or her ability to meet the standard. Resources DDD PASRR Level II Contractors If a client needs a Level II evaluation for a developmental disability, contact the MPC Coordinator in the office that coincides with the county where the client lives. Regional DDD OfficeCountiesPhoneFAXRegion 1 Headquarters W. 1611 Indiana Spokane, WA 99205-4221 Adams, Asotin, Benton, Chelan, Columbia, Douglas, Ferry, Franklin, Garfield, Grant, Kittitas, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, Walla Walla, Yakima(509) 329-2900 800-462-0624 (509) 568-3037Region 1 Yakima Office 3700 Fruitvale Blvd, Suite 200 PO Box 12500 Yakima, WA 98909-2500(509) 225-4620 800-822-7840 (509) 574-5607Region 2 Headquarters 1700 E. Cherry St, Suite 200 Seattle, WA 98122-4695King, Snohomish, Skagit, San Juan, and Whatcom(206) 568-5700 800-314-3296 (206) 720-3334 Region 2 Everett Office 840 N. Broadway Building A, Suite 100 Everett, WA 98201-1288(425) 339-4833 800-788-2053 (425) 339-4856Region 3 Headquarters 1305 Tacoma Ave S, Ste 300 Tacoma, WA 98405Clallam, Clark, Cowlitz, Grays Harbor, Jefferson, Kitsap, Lewis, Mason, Pacific, Pierce, Skamania, Thurston, Wahkiakum(253) 404-6500 800-248-0949 (253) 593-2052Region 3 Olympia Office Point Plaza East, Bldg 2 6860 Capitol Blvd SE PO Box 45315 Olympia, WA 98501(360) 725-4250 800-339-8227 (360) 586-6502 Mental Health PASRR Level II Contractors If a client needs a Level II PASRR evaluation for mental health, contact the contractor who offers the service in the county where the client lives. CountyCompanyPASRR MH ContractorPhoneFAXBenton/FranklinLourdes CounselingHesla, Courtney(509) 943-9104 ext 7286 (509) 943-7244Chelan-DouglasIndependentGreene, Stephen (509)881-1214(509) 662-7827Clallam/Jefferson/LewisIndependentBonnet, Vaughn(303) 909-0973(360) 830 4424 ClarkColumbia River CMHCCarter, Jamie(360) 281-3078 (360) 828-5075 CowlitzGero Medical Psychological ServicesSoper, Ellen(360) 574-9565(360) 574-9565Grays HarborBehavioral Health ResourcesHerman, Ed(360) 532-8629 ext 217(360) 943-2659King/ WhatcomIndependentJones, Sandy(425)361-8262(425) 338-1470KitsapIndependentAronson, Peggy(360) 779-3125(360) 602-0324Kittitas/Klickitat/YakimaCentral WA CMHCWebert, Cheryl(509) 576-4922(509) 576-4902PierceGood Samaritan BH CareJensen, Julie(253) 697-8574(253) 770-1365Island, San Juan, Skagit, SnohomishCompass HealthMetcalf, Steve(425) 349-7309(425) 849-8430Adams, Asotin, Columbia, Garfield, Grant, Lincoln, Okanogan, Spokane, Walla Walla, WhitmanIndependentDavis, Michael(509) 532-1600(509) 533-1966StevensIndependentAmbergey, Jo Nell(509) 675-0642(509) 738-2561Mason/ThurstonProvidence St. PeterBeall, Sue(360) 493-7809(360) 493-7562 Rules and Policy HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.42.055"RCW 74.42.055Discrimination against Medicaid recipients prohibited.HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.42.056"RCW 74.42.056Department assessment of Medicaid eligible individuals Requirements. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-97-247"WAC 388-97Nursing Homes; Resident Rights, Care and Related ServicesHYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0700"WAC 388-106-0350What are nursing facility care services?HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0700"WAC 388-106-0355Am I eligible for nursing facility care services?HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0700"WAC 388-106-0360How do I pay for nursing facility care services SAMPLE LETTER: Date: To: Subject: Nursing Facility Level of Care Determination This notification is to inform you that _____________ who resides at your facility does not meet nursing facility level of care per WAC 388-106-0355, and therefore, is not eligible for Medicaid payment to your nursing facility. The Quality Assurance Nurse at DSHS Residential Care Services has been notified and you are now required per RCW 74.42.450 to send the client a 30 day notice. This determination was based on a thorough review of the clients nursing facility chart containing physicians orders, Minimum Data Set data, nursing notes, social service notes, therapy records and a face to face interview with the client and/or their representative. If you have any questions, please feel free to contact me directly. 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