H05-024 – Policy/Procedure

March 15, 2005

TO: / Home and Community Services (HCS) Regional Administrators
FROM: / Penny Black, Director, Home and Community Services Division
SUBJECT: /
SIGNIFICANT CHANGE ASSESSMENT REQUIRED WHEN MEDICAL LEAVE EXCEEDS 20-DAY BED HOLD
Purpose: / To clarify when a significant change assessment must be completed for residential clients returning from a bed hold.
Background: /
  • Chapter 3, page 18 of the Long-Term Care (LTC) Manual states that when an HCS client is ready for discharge from a skilled nursing facility (SNF) to a community residential facility, HCS completes a significant change assessment for existing clients.
  • Following implementation of HCS centralized bed hold processing(MB H04-076), headquarters bed hold staff have routinely reauthorized services upon notification of a client’s return to a residential facility from a nursing home or hospital stay within the 20-day bed hold period and occasionally when leave has exceeded 20 days.

What’s new, changed, or
Clarified / Policy:
  • All current HCS clients on medical leave longer than 20 days must have a significant change assessment completed prior to the client’s discharge to a residential setting. Case managers are not to reauthorize client services when medical leave exceeds 20 days without completing a significant change assessment and assuring that all program eligibility requirements are met per Chapter 7. This will minimize duplication of payments and ensure continued client eligibility.
  • When notified by the provider within the 20-day bed hold period that care needs have changed or an assessment is requested, case managers will continue to complete a significant change assessment prior to the client’s returnto a residential setting.
  • The case manager is not required to perform a significant change assessment prior to a client’s discharge back to a residential setting if:
  • the medical leave is less than 20 days,
  • there is no reportedchange in the client’s condition, andno significant change assessment is requested, and
  • the client remains financially eligible per program requirements.

ACTION / Case Manager Procedures:
Case managers can monitor current bed hold expiration dates by selecting “Review/Amend Bed Hold Requests” on the Bed Hold Menu. (A new column will identify expiration dates of all pending bed holds.) Timely notification of client discharge and return remains critical in reducing overpayments related to bed holds. Please remind providers per WAC’s 388-76-675(3) (b) and 388-78A-2640(2) they are expected to notify case managers promptly of resident medical discharges and returns.
For bed holds greater than 20 days
  1. Complete a significant change assessment prior to the client’s return to a residential facility;
  2. Obtain required service summary signatures, verify financial eligibility, and reauthorize services upon confirmation of return. If client was admitted to an SNF, obtain the client’s signature on a new 14-225 Acknowledgement of Services form verifying the client’s choiceto return to waiver services;
  3. Notify financial services via DSHS 14-443 of the client’s return and daily rate, as well as name and admission date of the SNF, if applicable.
For bed holds less than 20 days
  1. If there is a reported significantchange in the client’s condition, complete a significant change assessment, obtain required service summary signatures and update the client’s bed hold request to alert headquarters staff that services can be reauthorized.
  2. Notify headquarters bed hold staff when a client in bed hold status has transferred to an SNF including date of admission and name of the SNF. Headquarters bed hold staff will forward information provided to the appropriate financial service worker. If notifying financial workers directly, case managers still must update the bed hold request to include the transfer information.
  3. If the client was admitted to an SNF, obtain the client’s signature on a new 14-225 Acknowledgement of Services form, verifying the client’s choice to return to waiver services.
HCS Headquarters Bed Hold Staff Procedures:
  1. Upon receiving bed hold requests, headquarters bed hold staff will continue to close waiver services, notify financial services of medical discharge and authorize all bed holds.
  2. Once headquarters bed hold staff are notified that a significant change assessment has moved to current and required signatures obtained, headquarters bed hold staff will terminate bed hold codes, reopen services, and send 14-443 for clients returning within the 20-day bed hold period.
  3. Headquarters bed hold staff will not reauthorize client services when the return occurs after the 20-day bed hold.
  4. To notify contracted residential providers and nursing homes of this policy change, a Dear Medicaid Contractor letter will be sent informing them clients on medical leave longer than 20 days must have an assessment before payment to community residential facilities can be resumed.
Effective immediately, case managers must follow the bed hold policies and procedures outlined above.
Related
REFERENCES: / RCW 18.20.290WAC 388-76-675
WAC 388-105-0045WAC 388-72A
MB H04-076MB 03-076
ATTACHMENT: / Dear Medicaid Contractor Letter

CONTACT(S): / David Yarbrough, HQ Bed Hold ProgramManager
(360) 725-2449

Judi Plesha, HQ Bed Hold Program Manager
(360) 725-3220

George Zimmerman, Residential Policy Manager
(360) 725-2534