PreAdmission Screening Process

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Pre-Admission Screening Process

• Specific Questions to Consider
• Melissa A. Fritzman
• Program Administration Supervisor II
• Division of Long-Term Care and Quality Assurance
• Department of Medical Assistance Services

Virginia Department of Medical Assistance
Services
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Specific Questions to Consider

• Does the individual have adequate supports to
  reside safely at home?
• If the answer is yes,
• If the individual has adequate support networks,
  consider eligibility for home and community based
  services. Such as
• EDCD Waiver OR
• HIV/AIDS Waiver

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Specific Questions to Consider

• Home service options are
• ) HIV/AIDS Waiver
• )Elderly or Disabled with Consumer Directed
  Services Waiver
• Developmentally Disabled Waiver
• )Mental Retardation Waiver
• )Program of All-Inclusive Care for the Elderly
  (PACE) (where sites are available)
• Primary service needs for the appropriate home
  and community based care services are described
  later.

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Specific Questions to Consider

• If the answer is no,
• If the individual does not have adequate
  caregiving support, consider facility-based
  service options based on the individuals level
  of care needs.

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Specific Questions to Consider

• Service options are
• 1)Assisted Living Facility Residential Living
  or Regular Assisted Living. Does the individual
  lack enough support to remain at home, but
  prefers the least restrictive facility setting?
  If yes, then authorization to the Residential or
  Regular Assisted Living program may be
  appropriate.

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Specific Questions to Consider

• Service options are
• 2)Nursing Facility As with the EDCD AND
  HIV/AIDS Waivers, requires both functional and
  medical/nursing needs. Specialized Care provided
  in a nursing facility may be appropriate for
  individuals with specialized medical needs such
  as ventilator care, comprehensive rehabilitation,
  or intravenous pain management or other
  specialized services.

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Specific Questions to Consider

• Does the individual require personal care?
• If an individual meets criteria for personal care
  services, explore which program is most
  appropriate to meet the care needs of the
  individual. Programs are geared to offer a
  package of services relevant to the needs of the
  specified population.

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Questions to consider in selecting the most
appropriate program

• Consumer-Directed Services Is the individual
  over the age of 18, without cognitive impairment,
  and interested in managing his/her own personal
  attendant? If no, then is there a responsible
  family member willing and able to direct and
  manage the personal attendant? If no, consumer
  directed services are not appropriate.

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Questions to consider in selecting the most
appropriate program

• Elderly or Disabled with Consumer Direction
  Waiver Is the individual elderly or disabled
  without conditions cited in the mental
  retardation waiver, AIDS waiver or technology
  assisted waiver? Is the individual interested in
  adult day health care? If yes, then
  authorization to the EDCD Waiver may be
  appropriate.

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Questions to consider in selecting the most
appropriate program

• AIDS/HIV Waiver Has the individual been
  diagnosed with symptomatic HIV or AIDS and has
  skilled needs that require home health or skilled
  nursing services? Is the individual experiencing
  debilitating medical and functional sysmptoms.
  If yes, then authorization to the HIV/AIDS Waiver
  may be appropriate.

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Questions to consider in selecting the most
appropriate program

• Developmental Disabilities Waiver Has the
  individual been diagnosed with a developmental
  disability (other than MR)? If yes, then
  authorization of the DD Waiver may be
  appropriate.

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Questions to consider in selecting the most
appropriate program

• PACE Is the individual
• over the age of 55?
• residing in a PACE service area?
• requiring some skilled or private duty nursing
  care?
• interested in attending adult day health care and
  receiving comprehensive services through and
  adult day health care center?
• If yes, then authorization to the PACE program
  may be appropriate.

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Questions to consider in selecting the most
appropriate program

• Mental Retardation Waiver Has the individual
  been diagnosed with mental retardation or a
  related conditon? Does the individual require
  specialized training to enhance skills, supported
  employment, therapeutic consultation, assistive
  technology, day support, residential support,
  personal care, private duty nursing, crisis
  stabilization or environmental modifications to
  provide optimal level of care?

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Questions to consider in selecting the most
appropriate program

• Mental Retardation Waiver (cont.)
• If yes, then authorization to the Mental
  Retardation Waiver may be appropriate.

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Questions to consider in selecting the most
appropriate program

• Technology-Assisted Waiver Does the individual
  depend on mechanical ventilators, prolonged
  intravenous administration of nutritional
  supplements, drugs, peritoneal dialysis,
  tracheostomy care or other specialized services?
  If yes, then authorization to the
  Technology-Assisted Waiver may be appropriate.

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Questions to consider in selecting the most
appropriate program

• If you answered YES to any of the above
  questions, consider the service referenced.
• When considering home-based services, it is
  essential that the screener carefully consider
  whether a safe and appropriate plan of care can
  be developed for each individual. Medicaid is
  prohibited from providing home care when it
  appears that an individual may not be safe in the
  home at all times.

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Questions to consider in selecting the most
appropriate program

• Medicaid is the payor of last resort, so
  Pre-Admission Screening Teams need to consider
  all other options prior to authorization of a
  Waiver Service or Nursing Home placement.
• Individual authorizations should be for the least
  restrictive environment to meet the individual
  recipients needs.

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Does the individual require private duty nursing
in the home?

• If the individual meets the criteria and requires
  private duty nursing, determine which program is
  most appropriate.

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Does the individual have special needs?

• In addition to the basic long term care services
  special needs services are available from various
  programs.
• Programs are geared to offer a package of
  services relevant to the needs of the specified
  population.

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When considering whether a safe plan of care can
be developed

• Will the individual be safe and have his or her
  care needs met when the waiver provider is not in
  the home?
• If the waiver plan of care cannot meet the
  individuals overall care needs, can a safe and
  adequate plan of care be developed to meet his or
  her remaining care and supervision needs?

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When considering whether a safe plan of care can
be developed

• If the individual has a diagnosis of dementia or
  has sufficient cognitive impairments, will
  adequate supervision be provided when waiver
  services are not in the home?
• In case of emergency, such as fire, will the
  individual have adequate support and resources to
  call for help or exit the residence safely?

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When considering whether a safe plan of care can
be developed

• If the individual requires skilled nursing care,
  are there formal/informal supports qualified to
  provide the necessary care?
• Does the individual live in an environment that
  ensures the individuals health and/or safety and
  is adapted to his or her functional needs (e.g.,
  grab bars in the bathroom where needed,
  wheelchair accessibility ramp, voltage and wiring
  to support necessary durable medical equipment)?

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When considering whether a safe plan of care can
be developed

• If the screener answers NO to any of the above
  questions, the individual may not be appropriate
  for home care from waiver program. The screener
  should assess whether the necessary supportive
  services are available through other community
  resources.
• NOTE If NO is the answer to 6 and the
  individual qualifies for the Mental Retardation
  Waiver or the Technology Assisted Waiver,
  environmental modifications may be available from
  the waiver program.

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When considering whether a safe plan of care can
be developed

• Does individuals caregiving situation require
  Respite Services?
• Respite provides routine or episodic relief to an
  unpaid live-in caregiver from the burden of
  caregiving.

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Respite can be considered in the following
programs

• HIV/AIDS Waiver
• Elderly or Disabled with Consumer Direction
  Waiver
• Mental Retardation Waiver
• Developmental Disabilities Waiver
• Program of All-Inclusive Care for the Elderly
  (PACE) (where active)
• Technology Assisted Waiver

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Contact information

• Pre-Admission Screeners list serve at
• http//www.dmas.virginia.gov/ltc-Pre_admin_screene
  rs.htm
• For questions, please contact the Facility and
  Home Based Service Unit at 804-225-4222 or by fax
  at 804-371-4986.
• Please visit the DMAS website at
• www.dmas.virginia.gov