Screening

Overview

The Code of Virginia §32.1-330 requires that all individuals requesting the Commonwealth Coordinated Care Plus (CCC Plus) waiver, Program of All-inclusive Care for the Elderly (PACE) or Medicaid support for long-term services and supports (LTSS) in a nursing facility be screened to determine the level of care needed and their eligibility for LTSS. Persons who are determined to meet LTSS criteria via the screening are authorized for enrollment for LTSS and individuals are provided a choice of settings and providers for services.

LTSS eligibility criteria is based on:

the degree of support needed to perform activities of daily living (ADLs) and physical health status;
whether the individual has ongoing medical or nursing needs;
and whether the individual is “at risk” for nursing facility admission or hospitalization within 30 days of the screening in the absence of the provision of services and supports (42CFR§441.302).

Screening is conducted by community-based teams including staff from local departments of social services and health, hospital staff at discharge, and skilled nursing facility staff (regulatory rules apply) when a screening has not already been conducted.

DMAS supports the LTSS screening process by:

Maintaining an automated screening submission and payment system. In collaboration with state partners DMAS created the electronic Medicaid LTSS Screening (eMLS) system. eMLS enables screeners to obtain immediate screening results upon submission of screening information and print or download copies of the Medicaid LTSS Screening packet. The eMLS User Guide and online training is found at CRMS Training Resources | MES (virginia.gov).
Utilizing data dashboards to enhance technical assistance to screeners. eMLS dashboards enable DMAS to follow timeliness of screenings, monitor locations where screenings occur and track LTSS choices made by individuals authorized for LTSS.
Implementing a training and certification course in cooperation with VCU. Registration for training modules is found at Medicaid Long-Term Services and Supports (LTSS) Screening Training (vcu.edu); and
Providing ongoing technical assistance to screeners and stakeholders.

In addition, DMAS is responsible for the oversight of the federally required Pre-Admission Screening and Resident Review (PASRR) process for persons who may be living with mental illness, intellectual disability or related conditions and are applying for nursing facility care. Activities include:

Assuring compliance with the Social Security Act and Code of Federal Regulations for PASRR;
Collaborating with DBHDS for the provision of evaluation and determination of need for specialty services within a nursing facility; and
Collection of data and monitoring of Level I screening, Level II evaluations and determinations, and resident reviews.

Attention all Authorized Screeners for DMAS Medicaid Long Term Services and Supports (LTSS)

The Department of Medical Assistance Services (DMAS) and Virginia Commonwealth University, Partnership for People with Disabilities are pleased to provide on-line, modular training related to the Medicaid Long-Term Services and Supports (LTSS) Screening process. This training is being offered to enable Screeners to meet Virginia regulation provisions regarding the LTSS Screening process and to meet training requirements as stated in 12VAC30-60-310. Successful completion of this training results in a 3-year LTSS Screening Certification. Recertification is required every three years.

Screeners and guests should allow approximately five hours for the full training. Physicians taking only Module 5 should allow at least 20-30 minutes. You do not need to complete the training in one session and are free to leave the training site and return as many times as you would like.

Information regarding the training may be found in the link provided below. We encourage you to review this information carefully prior to registering for the training.

Once the training is completed and you are certified, you are STRONGLY encouraged to bookmark the training site and regularly return to it for answers to questions which may arise as you complete LTSS Screenings.

Screening Connections for LTSS

Information and Resources

PASRR: PreAdmission Screening and Resident Review

All persons, regardless of payment status or reason for admission to a nursing facility (NF), must be screened for Mental Illness (MI), Intellectual Disability (ID) and Related Conditions (RC). This screening is called a Level I Screening. Medicaid members receive a Level I Screening during the Medicaid LTSS Screening process for NF enrollment.

If the nursing facility is processing admission of a non-Medicaid member, or anyone who does not have a Medicaid LTSS Screening which includes the Level I Screening, the NF must complete or arrange for the completion of the Level I Screening (the form below may be used). If the individual is determined to need an evaluation for MI, ID or RC, the NF is responsible for follow-through of the Level II process as described in the Medicaid LTSS Screening Manual, Chapter IV. Both the Level I Screening and, if needed, Level II evaluation and determination for specialty services must be completed prior to any admission to a NF.

PASRR Level I MI, ID or RC State Form for Non-Medicaid NF admissions to nursing facility

If the PASRR Level I Screening so indicates, the individual must be referred to Maximus for a Level II Evaluation and Determination, prior to NF admission. Please use the FAX Cover Form, link provided below:

PASRR FAX Cover Form for Submission of Level II Screenings to MAXIMUS

ALL persons who have a Level II evaluation and determination must be tracked to assure appropriate care is provided. Please use the following form to return needed information to Maximus:

Virginia Resident PASRR Tracking Form

Demographic Corrections for eMLS

LTSS Screeners must assure that all demographic information is correct on the Medicaid LTSS Screening. If you make errors and the screening is submitted OR the demographic information autofills with incorrect information, you must use the following form and directions to resolve the problem:

DMAS LTSS Screening Change to Member Information Request Form

Once you are notified that the corrections have been made you must return to eMLS and VOID/Delete the screening and then reenter the entire screening again so that the correct demographic information can autofill.

Screening Manual

Screeners may visit the Virginia Medicaid Enterprise System (MES) website to access the Screening Manual.