What’s new: On June 3, DMAS published the Medicaid Bulletin with implementation guidance on the VHCA-VCAL legislation modifying the LTSS screening process to remove all hospital discharges to skilled care from the requirement for the hospital screening team to conduct the LTSS screening. 

For context, when a patient in the hospital was known to Medicaid (i.e., already enrolled in acute care coverage, application pending, etc.), the hospital was required to conduct the LTSS screening, even if the patient was being discharged to the nursing facility for skilled care.

• Under the new legislation, a hospital patient discharged to skilled care does not require a hospital screening team to conduct the LTSS screening unless the patient requests the screening, or the individual is being discharged directly to a nursing facility for long term care LTSS services.

More details: Should the skilled patient in the nursing facility subsequently indicate a potential need for LTSS, the approved nursing facility screening team would be responsible for conducting the screening at that time. 

• The legislation allows that screening to take place within three business days of the initiation of LTSS to receive Medicaid reimbursement from that service initiation date; any screening after three business days is still allowed, but Medicaid payment would only start from the screening date forward in that scenario.
• DMAS is aware that the system currently requires that a screening be completed before the “Level II” status can be entered into the DMAS system to trigger Medicaid coverage of the coinsurance for the Dual eligible recipient. The agency is working on addressing that issue within the system but did not want to hold up the implementation of the larger change in the LTSS process while figuring out a solution.   

Importantly, the legislation also removed an existing inadvertent barrier for Medicaid certified-only nursing facilities to establishing screening teams. While not addressed in the bulletin, we have been informed by DMAS that the issue has been addressed and staff from these facilities can now sign up and take the required training course to establish the screening teams.

• If you run into any problems with that, please email Nicole Braxton at DMAS directly.

Another component of the guidance: The Bulletin also addresses the ability for a nursing facility team to screen certain individuals from the community through collaboration with the community-based team when the individual has expressed a desire for nursing facility placement and the community-based team is unable to screen expeditiously. The bulletin sets out several documentation requirements for that process. 

Don’t forget PASRR: In all circumstances, skilled or LTSS, the federally mandated PASRR must still be completed prior to admission.

• With the removal of the majority of hospital screenings for discharges to nursing facilities, this would place the onus for the PASRR on the nursing facility to complete prior to admission.

Questions: DMAS has the screeningassistance@dmas.virginia.gov mailbox for questions and concerns. For VHCA-VCAL, you can always contact April Payne or Steve Ford.