Preadmission Screeners Frequently Asked Questions
Training Materials:
VISSTA web site
Pre- Admission Screening Manual
UAI Manual
DMAS-96
UAI Electronic Payment Service Materials:
Overwiew
Specifications
Electronic UAI FAQ
Answers to Frequently Asked Questions:
Posted February 7, 2008:
QUESTION:Is the local DSS responsible for completing a preadmission screening on a private pay nursing home patient, who has applied and appears to be eligible for Medicaid. A screening was not completed when patient entered the facility.
RESPONSE:If this person is moving from one nursing facility to another, then no, you do not need to do a pre-admission screening. DMAS would consider this a nursing facility to nursing facility transfer.
If the person is moving from the nursing facility to the community and will be receiving waiver services, then yes, a screening would need to be done.Posted November 5, 2007:
QUESTION:If someone is in a Nursing Home and they have a MR/MH diagnoses and are clearly a Mental Health case who does the screening for Assisted Living placement? (DSS or local mental health agency)
RESPONSE:If the person no longer meets the criteria for nursing facility placement and assisted living placement is appropriate to meet their needs, then the screener of last resort is the local department of social services. The MH diagnosis does not really impact the assisted living program for the purposes of pre-admission screening. The screening team should complete the screening and if appropriate make a referral for MH services to the local community services board if the person has not already been referred to them. I would check to see if the nursing facility has already reached out to the CSB. This should all be part of the discharge plan for this individual.Posted November 5, 2007:
QUESTION:On the D-Mas 96, section II, if the individual currently has Medicaid, how should the question "if no, has individual formally applied for Medicaid" be answered, if at all? I had a screening sent back several months ago because that question was left blank (since it says "if no" and the answer to the first question was yes), but the PHN tells me that she has had screenings sent back because it was answered (with a 1, to indicate "yes") and was told that it should be left blank if the individual already has medicaid. Which is correct?
RESPONSE:Data entry of the form requires an answer in both questions. If you have had a screening returned for failing to answer that is why. We suggest that you respond in the 1st question as "yes" then you should respond to the 2nd question as "yes". If you respond to the 1st question as "no", then you will need to respond to the 2nd question as either "yes" or "no" depending on the situation.Posted November 5, 2007:
QUESTION:If an individual applies for medicaid in anticipation of receiving personal care, and the eligibility worker completes the application before the results of the EDCD screening is received, does the PC screening have to be redone, or is there a time frame in which the original screening is still acceptable?
RESPONSE:Eligibility determination for financial coverage in Medicaid and pre-admission screening are two different things. Determination for financial eligibility often takes place at the same time as the determination to see if someone meets the established criteria for waiver services, but they don't have to take place at the same time. The pre-admission screening is an independent process from financial determination. In this example, you would not have to complete a new/update to the pre-admission screening you have complete simply because the eligibility was determined prior to your completion.Posted February 8, 2006:
QUESTION: Is there a time limit on when a PAS screening must be scheduled following receipt of the referral?
RESPONSE: DMAS does not have an established time frame. We suggest that screenings be completed within 30 days of referral, but leave the actual time frames up to the screening teams. We unable to know what scheduling issues a screening team has which is why we don't have a set time frame.Posted February 8, 2006:
QUESTION: A client who was screened and is currently receiving personal care services has requested PERS. Where do we find a list of providers which can provide service on the Eastern Shore?
RESPONSE: You may find a list of providers on the DMAS website (www.dmas.virginia.gov)
by using the provider search function.Posted February 8, 2006:
QUESTION: RE: DMAS 96 section Il-"Is Individual Currently Medicaid Eligible" If client has applied for Medicaid and told by DSS that they should be (or are) eligible, but have not received an award letter and number, should we check 1 or 2.
RESPONSE: You would check #2 - for the first question and then answer Yes for the follow up question.Posted February 8, 2006:
QUESTION: 93 year old lady who lives by herself and has Medicaid. She has been screened and approved for E&D Wavier services but does not want the service. She only wants Medicaid to pay for a "Lifeline" device. No provider will request this as they are not providing services. Is there a way for her to receive this device without a provider under Medicaid?
RESPONSE: The service that the individual is requesting is only available through the EDCD waiver. As you know this service is not a stand alone service, so it must be authorized with one of the other services offered under the EDCD waiver. If the individual wishes to receive this service, they will have to accept one of the other services as well. This service is not offered through any other Medicaid program. She must use a Medicaid authorized provider for this or any other service.Posted February 8, 2006:
QUESTION: Would a local screening team enter a nursing facility to screen for CBC if the resident had been admitted to the facility under circumstances that did not warrant a pre-admission screening?
RESPONSE: Yes, the local team may enter the nursing facility to complete the screening for waiver placement. They may not authorize nursing facility placement, but can authorize waiver placement.Posted February 8, 2006:
QUESTION: Recently I had a personal care services patient who wanted nursing home placement. I was told we no longer have to update screenings and that the PCS screening would be sent with the patient to the nursing home. Is that true.
RESPONSE: Yes, because the nursing facility is the alternate institutional placement for individuals in the EDCD waiver, the screening is valid for both levels of care. This was a change that DMAS instituted a couple of years ago.Posted February 8, 2006:
QUESTION: If a patient is alert and oriented and refuses to give permission for the discharge planner to initiated the pre-admission screening process and refuses to apply for Medicaid and understands health condition can the d/c planner proceed without patients consent (UAI wouldn't be complete without patient's cooperation).
RESPONSE: If the patient is alert and oriented, it is their right to refuse placement or even the completion of the required documents. Without consent the documents would not be complete and service authorization (such as nursing facility placement) could not take place. It would be better to have the consent since the screening really is not valid without it.Individuals are not required to complete a Medicaid application for financial assistance as part of the pre-admission screening process. This often happens at the same time, but it is not required. You can complete the pre-admission screening and the individual may never apply for financial assistance through Medicaid.
The second part of this question would be if the patient had a safe plan with family and refused to apply for Medicaid or for the d/c planner to do the UAI is the d/c planner still responsible for seeing that the UAI is done if the situation changes and the patient enters a nursing home from home. (This could be for nursing home or personal care)
RESPONSE: Discharge planners are not required to complete pre-admission screening documents once the individual has been discharged. It is the individual's right to refuse placement and to refuse to apply for Medicaid coverage. The individual needs to understand that Medicaid will not be able to assist until the required documents are in place which may result in the local screening team coming into the home to complete the documents.Posted February 8, 2006:
QUESTION: Can the d/c/ planner complete this screening if pt is competent and refuses and understands safety/ health risk while she is in the hospital?
RESPONSE: Again, if the individual is refusing to participate in the screening process, that is their right. We can not force placement or services on any individuals. If you feel that there is a health, safety, or welfare issue, you are mandated to make an APS referral.QUESTION: We have a resident at our nursing home who is on Medicare and is skilled. She has applied for Medicaid but has no screening. Who screens? We told by a county Health Department that they cannot come to a nursing home to screen. When this resident was admitted to our facility she was admitted from home after a hospital stay.
ANSWER: Once an individual enters a nursing facility, the pre-admission screening requirements become null and void (if the person was not screened prior to admission). I would direct your attention to the Nursing Facility Manual, Chapter VI, pages 32-34 which address what you, as a nursing facility provider, need to complete in order to obtain authorization to bill for services. The pre-admission screening team is not permitted to enter your facility to complete a nursing facility pre-admission screening.Posted before February 9, 2006
QUESTION: Is a DMAS 95 required for all screenings?
RESPONSE: The DMAS-95 Level I is required for all nursing facility admissions. If, after the completion of this form, it is determined that a condition of mental illness, mental retardation or a related condition is present, a Level II referral must be made to DDM, the contractor who is assigned to completed this task. The Level II screening must be complete prior to admission to the nursing facility. The 101A is required for all waiver placements when a person has a diagnosis of mental illness, mental retardation or a related condition. Waiver placements means those individuals who will receive services under the Elderly or Disabled with Consumer Directed Services Waiver. After the completion of this form when it has been determined that a condition of mental illness, mental retardation or a related condition is present, a 101B referral must be made to the local community services board who is assigned to complete this task. The 101B screening must be completed prior to admission to the waiver.Posted before February 9, 2006
QUESTION: Is the patient pay amount still required on the DMAS 97 for E&D Waiver?
REPONSE: The patient pay amount (if known at the time of the screening) should be included on the DMAS-97 Plan of Care. If the screener does not know the actual amount at the time of the screening, they should mark the form accordingly.Posted before February 9, 2006
QUESTION: A client was originally screened in Dec. 2003 and Personal Care services began. In July 2004, PC stopped. In April 2005, the client went into a Nursing home. The PC agency is refusing to update the DMAS 96, even though less than a year had transpired between the end of services and the date of NH admission. Who is responsible for the 96 update or new screening?
RESPONSE: Personal care agencies are never permitted to update the DMAS-96 information. This was done at sometime during the past, but it is no longer permitted. Because this recipient was without any services from July 2004 to April 2005, it would be the local department of social services/local health departments responsibility to complete a new screening. However, since this individual has already been admitted to a nursing facility, a screening can not be completed. Once an individual enters a nursing facility, the pre-admission screening requirements become null and void (if the person was not screened prior to admission). I would direct your attention to the Nursing Facility Manual, Chapter VI, pages 32-34 which address what you, as a nursing facility provider, need to complete in order to obtain authorization to bill for services. The pre-admission screening team is not permitted to enter your facility to complete a nursing facility pre-admission screening.Posted before February 9, 2006
QUESTION: What if a request is made by the nursing home for a patient who they received from the hospital into the nursing home for a short stay (less than 6 months) or for Rehab and the family decides they can no longer care for the patient and wants them to stay in Long-term care. Do we update the UAI and re-file a DMAS 96 for continuing more than 6 months or does the same apply by the question ask earlier and the pre-admission screening team not go into the NH months?
RESPONSE: It is not necessary to update the DMAS-96 form in order to change the length of stay question from less than 6 months to more than 6 months. The nursing facility needs to have their physician write an order which states "resident required long term placement as opposed to temporary placement when originally screened". This order would then be placed on the resident's chart and a copy of the order is sent to the eligibility worker for their records in case the spousal allowance needs to changed. This process also works in reverse, meaning that if the person was screened for long term placement but only needs temporary placement, the nursing facility physician can write an order to that fact. Pre-admission screening teams are not permitted to enter nursing facilities to perform screenings or update screenings for individuals who are receiving nursing facility services.Posted before February 9, 2006
QUESTION: Can an individual enter a Veterans NH (intermediate care facility), from the community, and be screened by using only the form VA FORM 10-1204? Or would this individual need to be pre-screened using the UAI? Of course the VA facility is seeking Medicaid payment.
RESPONSE: Veteran Administration admissions are exempt from the Pre-Admission Screening process. DMAS accepts the discharge information from the VA (form 10-1204) in lieu of the normal pre-admission screening documents. This is addressed in the Pre-Admission Screening Manual in Chapter V, page 5.Posted before February 9, 2006
QUESTION: Regarding the DMAS-101 and DMAS-95 - if there is not a diagnosis of MR or MI does that mean that this form is NOT completed and submitted with the screening package?
RESPONSE: The DMAS-95 Level I is always completed for nursing facility placements whether or not a diagnosis of mental illness, mental retardation or a related condition is present. This is a federal requirement for placement in a nursing facility. If the condition is present you would complete the DMAS-95 Level II for a referral to the current contractor, DDM for completion of the Level II portion of the screening. The Level II portion must take place prior to placement in the nursing facility.As far as placement in a home and community based care waiver, such as the EDCD waiver, the DMAS 101A is completed if there is a diagnosis of mental illness, mental retardation or a related condition. It is not a federal requirement for completion at this point and time. We would suggest that you complete this form if one of the above diagnoses are present. If the condition is present you would, of course, complete the referral for the 101B portion of the screening. The referral would go to the appropriate community services board in your area. The 101B portion must take place prior to accessing services through the waiver.
Posted before February 9, 2006
QUESTION: Since the form states "yes" or "no" and "referring" or "not referring" for a Level II, and why, I always thought it needed to be completed to indicate there isn't such a diagnosis as well as if there is.
RESPONSE: You are correct in your statements regarding the purpose of the questions and the appropriateness for completion.Posted before February 9, 2006
QUESTION: Now that we are receiving more requests for EDCD Waivers for small children I have a concern about the home health providers. Due to the fact that the providers have traditionally provided services only for adults, they do not do a CANIS check on their employees. If DMAS is providing a list of providers to the parents of small children, and a home health care employee has a history of founded abuse complaints, DMAS could have a huge liability issue. Now that EDCD waivers include small children, will the providers be compelled to do a CANIS check on all future and current employees?
RESPONSE: The agency must obtain a criminal history check from the State Police. If a minor receives consumer-direction personal care or respite care, the employee must be screened through the Protective Services Registry at DSS.Posted before February 9, 2006
QUESTION: I went out on a preadmission screening on a lady who is currently in an assisted living facility. Her MD requested she be evaluated for a nursing facility. She has the diagnoses of dimentia and schizophrenia. She has no POA. She meets the NF criteria. She refused to sign any forms or agreements including the 97 and consent to exchange information. I realize she needs to have a level 2 done. She lost her medicaid because she would not sign the application. Social services is considering options such as guardianship but that will be a long time coming if they pursue it. Can I proceed with requesting a level 2 in the absence of her signatures and any action by DSS. Thank you.
RESPONSE: Yes, you may proceed in the absence of a signature provided this person has not been judged incompetent. I would suggest that you document that she is refusing to sign the documents and the reason for her refusal.Posted before February 9, 2006
QUESTION: If a resident is in an ALF and is admitted to the hospital and upon discharge is going home and will need CBC, isn't it the responsibility of the discharge planner at the hospital to complete the screening?
RESPONSE: Yes, it is the responsibility of the hospital to screen the individual for home and community based waiver services prior to discharge.Posted before February 9, 2006
QUESTION: Is a preadmision screening needed for a hospice client to received the EDCD Waiver.
RESPONSE: Yes, it is required for Hospice patients who are also going to access services through the EDCD waiver. It is not required for nursing facility placements, but is required for waiver placements.Posted before February 9, 2006
QUESTION: For doing an update- (I do my screenings on computer) and am going to go back on the original screening put the date and update any new findings.. Do I need to get family to re-sign the 97 (they stopped PC in 3/05 because pt. moved with another family member- she's back with the original member and they want to restart PC with the same agency) or do I just need to get the update written and get a new 96 signed and send the updated page and 96 to the Agency?
RESPONSE: As far as updates go, the only thing that has to be updated is the UAI itself and the letter that you attach addressing the updates. You should not be updating the DMAS-96 or DMAS-97 forms.Posted before February 9, 2006
QUESTION: Under the ED/CD waiver does a personal attendant have to be age 18 and over?
RESPONSE: Yes, the personal attendant must be 18 years of age or older for any consumer directed service for any waiver.Posted before February 9, 2006
QUESTION: I did a PC Screening (E&D waiver) on 9/04 for a young child who is completely dependent in all IADLs and ADLs. Mom used personal care for a while, but hasn't for the past 3 months. Now, she wants to place the child in a nursing home, and there is no question she'll be eligible (severely brain damaged, almost vegetative). Should we (DSS and Health Dept) be the ones to update the screening for NH placement, or should it be the old PC provider?
RESPONSE: Personal Care Agencies are no longer permitted to update the pre-admission screening documents. If an update is required, it would be the responsibility of the pre-admission screening team who completed the original assessment to perform that update. The update can be in the form of a telephone update.Posted March 21, 2006
QUESTION: I understand there is UAI training conducted by VISSTA that details the "mobility" piece on the UAI. However, that piece can be crucial as to whether or not someone passes a screening. There are multiple opinions on this issue in my office despite the fact that all of us have been trained on the UAI. My question: mobility - does this apply to if someone needs human assistance to be put into a wheelchair before they wheel themselves independently? Or is that process of putting someone in a wheelchair part of transfer? If someone places a person in the wheelchair and then that person can self-propel out of their apartment and go downstairs in the elevator and get their mail and then come back up to their apartment without human help are "mechanical help" only in mobility if they need someone to be with them when they go to the doctor - i.e. outside their apartment building? Does a person who does this receive a big D in mobility or not?
RESPONSE: Assisting someone to reach a wheelchair is part of the transferring ADL function. It is related to their mobility, but it falls under transfer for the actual assistance. Mobility really address whether or not a person is 'confined' and 'confined' in this context is how a person moves about, meaning whether they are confined to the indoors or they can move about outside as well as indoors.
Given you information above, I would say that this person is Dependent in Mobility and falls under the category of Mechanical and Human Help.Posted March 27, 2006
QUESTION: What are the guidelines for screening someone who has not started the Medicaid application process even if it appears that the person has income or resources that would prevent them from qualifying?
RESPONSE: Financial eligibility has no impact on pre-admission screening to determine if someone meets criteria for a service. They are independent processes and should be treated as such. Providers may not require a person to determine financial eligibility for Medicaid coverage prior to a screening being completed.Posted April 7, 2006
QUESTION: Can someone get personal care from a Medicaid personal care agency and a personal attendant under the CD facilitator program? Who sets the total # of hours? Thank you.
RESPONSE: Yes, a person may receive both agency directed and consumer directed services at the same time. It is the responsibility of the service facilitator for consumer directed services to coordinate the number of hours used by the recipient. A recipient can choose the number of hours they want to use with each service, but they can not go over the allotted number of hours given.Posted April 11, 2006
QUESTION: Is there a recommended time frame for a screening to be done after the referral is received?
RESPONSE: DMAS does not have an established time frame for the completion. Our target goal has always been within 30 days of the referral.Posted April 20, 2006
QUESTION: I am with a hospice agency and I have been told that if someone leaves their home to go into LTC and they already have hospice in place they do not need a pre-screening completed. I need something in writing station this the case for proof to a facility. Thanks!
RESPONSE: When a person enters a LTC facility under their Hospice benefits, they are exempt from the pre-admission screening processing because they are Hospice patients. However, if that person has revoked their Hospice benefits, then they would need to have the pre-admission screening completed prior to entering the LTC facility.Posted April 25, 2006
QUESTION: Because of this agency's proximity to the state of Tennessee, we often have clients who request nursing home placement in that state. Those nursing homes do not require a completed pre-admission screen, but they do require that the Level II referral be completed. Who is responsible for the referral to the Dual Diagnosis Provider for the Level II when the screening team has not completed the UAI Assessment?
RESPONSE: The Department of Medical Assistance Services (DMAS) does not have reciprocating agreements with other states for the completion of pre-admission screening documents which includes the Level II screening for MI/MR/RC. DDM would not be responsible for the referrals for individuals who are seeking placement outside the state of Virginia for nursing facility services. The individual would need to seek guidance from the admitting state regarding their policies for admission and completion of these documents. Since DDM is a Virginia specific provider, our documents may not work for out of state placement.
NOTE: DMAS can not make payments for out of state placements when the service is offered in the state of Virginia. All out of state placements where DMAS is the payor require prior approval from DMAS before placement is made. If DMAS is not going to be the payor (meaning the person will be seeking Medicaid coverage through the other state), then DMAS does not need to approve this placement.)
Posted August 2, 2006
QUESTION: Regarding the DMAS 101a/DMAS 95 question 4a, If an individual has spina bifida (or any related condition) and is obviously of high intelligence (that is, there is not MR), do we mark yes or no?
RESPONSE: If they have any type of related condition, you must mark YES and then complete the questions.
QUESTION: What is the process to complete a screening for respite for skilled LPN services? We have done the screening and gotten the respite plan of care signed. There is no authorization on the DMAS 96 for respite. EDCD services would not be helpful for the trach dependent child. What is the next step?
RESPONSE: We no longer authorize services, we authorize waivers. If respite is what they need and they meet the criteria for EDCD, then you must authorize EDCD. We have gotten away from authorizing services a while back. That is one reason why we changed the DMAS-96 to authorize the waiver and not individual services.
Posted August 29, 2006
QUESTION: In order to qualify for the Alzheimers AL waiver, the individual has to already be receiving AG. The Alzheimers waiver screening must be conducted by the PAST, while the AG screening can be conducted by a DSS social worker alone. Does the screening therefore need to be conducted twice, first by the social worker for the AG, and then by the PAST for the waiver? Or would the appropriate thing be to involve the PAST in the initial AG screening, and then use the same screening for both?
RESPONSE: You could do it either way. It makes more sense for time purposes to do them together. It really is up to the screening teams to decide how they want to do them.