DMAS posted the updated Screening Manual for Medicaid-Funded Long-Term Services and Supports (LTSS) on October 29 to the Provider Manuals Portal. The updated manual reflects the changes that went into effect in January which allow for trained skilled nursing facilities (SNFs) staff to conduct LTSS Screenings for non-Medicaid members admitted to SNFs who have a change in financial status and require intermediate care facility level of care. Much of the updated manual remains the same with regards to requirements for when an LTSS Screening is required and the exemption reasons.

The following updates were made:

• Hospital Screening Teams are required to conduct a screening for all individuals who are Medicaid members, pending Medicaid members or persons likely to become financially eligible for Medicaid after admission to a nursing facility (NF). Hospitals shall not be required to initiate a screening for inpatients who are determined by the hospital team to be private pay individuals and are not anticipated to be financially eligible for Medicaid. However, anytime an inpatient or authorized representative requests a screening, a screening must be conducted.
• Community-Based Teams are not required to perform a screening for individuals who are private pay or are not anticipated to be financially eligible for Medicaid. However, anytime an individual living in the community who is not already receiving Medicaid LTSS requests a screening, a screening must be conducted.
• If a private pay individual (or person with 100 percent alternate forms of payment excluding Medicaid) is admitted for SNF services but later becomes Medicaid-eligible and needs LTSS, the NF will complete the Medicaid LTSS Screening per state guidelines. The NF LTSS screeners (including a registered nurse) and a NF physician must attest to their signature on the Medicaid LTSS authorization form regarding authorization or non-authorization for LTSS.
• If a private pay individual (or person with 100 percent alternate forms of payment excluding Medicaid) chooses a NF for services and is admitted directly to an NF for LTSS but later becomes Medicaid eligible, the NF will complete the Minimum Data Set (MDS) assessment per federal guidelines and a NF physician will certify whether the individual meets the NF level of care criteria.

As a reminder, these changes went into effect on January 1, 2021, and all SNFs and NFs should have appropriate staff trained to complete the LTSS Screening when required for an individual who resides in a nursing facility. The training was outlined in an October 20, 2020 Medicaid Bulletin.

Additional Resources

Update Regarding Mandatory Training for LTSS Screening
LTSS Screening Provider Manual
New Short Screening Responsibilities
Medicaid Portal Registration Users Guide
ePas Set Up and Resources
Web Portal Pre-Admission Screening Automation (ePAS) Users Guide
VCU-DMAS Launch Communication

How does this impact the Federal Preadmission Screening and Resident Review (PASRR)? 

Because the Preadmission Screening and Resident Review (PASRR) screening is coupled with the LTSS Screening for Virginia’s Medicaid program, the screening team responsible for conducting the PASRR screening prior to admission is determined by whether an individual being admitted to a nursing facility is required to have a LTSS Screening before admission.

If the hospital or community screening team conducts the LTSS screening, then that screener will conduct the PASRR screening, because it is part of the LTSS Screening. Those screeners are required to provide a copy of the of the screening to the nursing facility for review prior to admission.

• A hospital screening team would conduct a screening for individuals with any type of existing Medicaid membership or for any individual requesting a LTSS Screening while in a hospital regardless of payor type.

• A community screening team would conduct a screening for individuals in the community who have an existing Medicaid membership (including those individuals who have applied and are pending approval) or for any individual requesting a LTSS Screening while living in the community, regardless of payor type. 

If an LTSS Screening is not required, the NF screening teams are responsible for conducting the Level I screening and, if applicable, requesting and obtaining results from Ascend/Maximus for a Level II screening prior to admission to the nursing facility.