On November 25, 2019, DMAS will publish an Exempt Action Final Regulation to elminate the hospital’s three-day exception post-discharge for providing the Medicaid long-term services and supports  (LTSS) screening to a nursing facility for an individual who is admitted to the nursing facility for skilled nursing services. This final exempt action will become effective December 25, 2019. VHCA-VCAL presented the agency with the concept for this change to improve the screening process and ensure members can meet their obligations under federal screening regulations.

VHCA-VCAL is appreciative of the agency’s willingness to work with the association since this summer to remove the three-day exception because it forced nursing facilities to be out compliance with federal law related to preadmission screening or forced them to deny services individuals are entitled to receive. 

Background

Federal law requires that individuals who are seeking nursing facility placement be screened prior to admission in order to determine if the facility placement is medically appropriate. For hospitals that are discharging Medicaid members to a nursing facility, Virginia regulations currently permit the hospitals up to three days after discharge to submit the required screening forms via the automated system. This has created a situation where Medicaid members are being discharged from hospitals and in need of nursing facility care, and facilities are prohibited from admitting them in the absence of the federally-required screening.

Hospitals complete an individual’s screening for Medicaid long-term services and supports by entering or uploading completed screening forms to the agency’s electronic screening portal (ePAS). The uploaded ePAS forms are the official screening record and provide the data that is required to determine that the individual has met the level of care required for nursing facility or for home and community based waiver services. The uploaded ePAS forms determine if the admitting facility is the appropriate setting for the individual, per federal requirements.

The hospital’s screening is not complete until it uploads the screening forms to ePAS. Until the hospital completes this last step, nursing facilities have no official screening to validate the individual’s admission or to comply with federal screening requirements to support Medicaid reimbursement. The Code of Federal Regulations requires preadmission screening be completed prior to new admissions to a nursing facility (42 CFR 483, Subpart C, §§ 483.100- 483.138). Any reimbursement that DMAS may pay a facility prior to the availability of the official ePAS document would be subject to retraction. DMAS would be subject to a retraction of the federal percentage of those same funds in a federal audit.

DMAS’s current regulations permit hospitals up to three days post-discharge to enter or upload the screening forms to ePAS. This three-day period creates a potential lag between an individual’s hospital discharge and his admission to a nursing facility, with possible gaps in needed services that could put the individual at risk of harm. It also puts at risk any reimbursement that nursing facilities earn by providing services to Medicaid members prior to the availability of the official ePAS screening form.

As noted, the member’s mental or intellectual capacities, functional abilities, medical nursing needs, risk of institutionalization, or the appropriateness of the member’s placement in a nursing facility cannot be determined until a screening is completed. The only alternative is to remove the three-day extension and ensure that hospitals complete the screenings by the time of the patient’s discharge. This final exempt action is designed to resolve this obstacle to medical care, to ensure the health and safety of Medicaid members and ensure that nursing facilities are able to fulfill their obligations under federal screening regulations.