Medicaid Screenings for Long-Term Services and Supports

Medicaid Screenings for Long-Term Services and Supports

In 1982, § 32.1-327.2 (re-codified at § 32.1-330) of the Code of Virginia was revised to require PAS for all individuals requesting LTSS to determine eligibility for Medicaid covered home and community-based services (HCBS) or institutional long-term care. Preadmission screening is the first level of authorization for Medicaid reimbursement for nursing facility level-of-care, HCBS Waivers or PACE.

Screening ensures that Medicaid-eligible individuals, and t hose who would become eligible for Medicaid with six months after admitted to nursing facilities meet the DMAS level of care criteria based on the degree of support required to perform activities of daily living (ADL). The screening also determines whether the individual has medical or skilled nursing needs. Medicaid LTSS uses institutional criteria to determine financial eligibility; this means that the threshold for receipt of LTSS is lower because the individual is “At risk” for institutional placement within 30 days or less in the absence of services (42CFR§441.302)

The Virginia General Assembly in the 2014 and 2015 Sessions developed legislation and budget language to strengthen the screening process. The requirements focused on reducing the time between a request for a screening and completion of that screening, development and implementation of tracking and monitoring of screenings and contracting for screenings for children.

A key strategy for meeting the legislative mandates was the development of an automated screening submission and claims process. DMAS, in collaboration with the Virginia Department of Health (VDH) and the Department for Aging and Rehabilitative Services (DARS), developed an electronic preadmission screening system called ePAS that eliminated the paper forms associated with the PAS process, including the UAI, and included an electronic claims submission process for Medicaid reimbursement to the screening entities. An ePAS User’s Guide and Tutorial can be found at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal Effective September 1, 2016, emergency regulations created the framework for defining and managing the screening process. Development of the final regulatory package is in process with anticipated completion by February 2018.

PAS Overview

December 2016Page 1