Screening

LTSS Screening

Overview

In 1982, § 32.1-327.2 (re-codified at § 32.1-330) of the Code of Virginia was revised to require preadmission screening (PAS) for all individuals requesting Medicaid Long-term Services and Supports (LTSS) which includes home and community-based services (HCBS) or institutional long-term care. Medicaid LTSS Screening is the first level of authorization for Medicaid reimbursement for nursing facility level-of-care, Commonwealth Coordinated Care Plus (CCC Plus) waiver, and Program for All-inclusive Care for the Elderly (PACE).

Screening ensures Medicaid-eligible individuals, and those who will become eligible for Medicaid within six months, meet the required level of care criteria. This criteria is based on the degree of support needed to perform activities of daily living (ADL); whether the individual has medical or skilled nursing needs; and is “at risk” for nursing facility admission within 30 days of the screening in the absence of services (42CFR§441.302). Screening is conducted by hospital staff at discharge and by community-based teams including staff from local departments of social services and health.

DMAS has strengthened the screening process by developing an automated screening submission and claims process. In collaboration with the Virginia Department of Health (VDH) and the Department for Aging and Rehabilitative Services (DARS), DMAS developed an electronic preadmission screening system called ePAS that eliminated paper forms associated with the PAS process, including the UAI, and included an electronic claims submission process for Medicaid reimbursement to the screening entities. The system enables DMAS to track the time between a request for a screening and completion of that screening as well as whether an individual chooses a nursing facility or community-based program for services.

Effective September 1, 2016, emergency regulations created the framework for defining and managing the screening process. Development of the final regulatory package is in process with anticipated completion by August 2018.

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.

Information regarding the training is provided below. We encourage you to review the introduction module prior to registering for the training as the module provides useful information regarding how to proceed in the registration process. Access the module.

Screeners and guests should allow approximately five hours for the full training. Physicians taking only Module 5 should allow at least 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’d like. Register as either a screener or a guest.

Additional instructions and contact information for DMAS Medicaid LTSS Training can be found here:

April 2019 Letter to all LTSS Screeners and Guests [pdf]

Notification of Availability of the Physician's Module and Instructions [pdf]

Inter-rater Reliability (IRR) Study

The Department of Medical Assistance Services (DMAS) has contracted with Maximus to improve the reliability of Medicaid eligibility screenings for long-term services and supports. There are two objectives in the enabling legislation:

Validation of the children's criteria as used in the Uniform Assessment Instrument, and
Design and implementation of an inter-rater reliability test for the screening process.

This study will determine the degree of consistency and reliability of long-term care screenings verifying consistent results across the Commonwealth, regardless of region or screener. No outcomes of screenings will be changed because of this study.

The Inter-rater Reliability (IRR) Study seeks to demonstrate the degree of consistency and reliability of long-term care assessments for children and adults, regardless of region or assessor and assurance that screeners are identifying the most integrated and appropriate settings, minimizing unnecessary institutional placements.

Read the IRR FAQ.

Find IRR resources.

Visit the Maximus website for additional IRR tools and resources.

Email VAIRR@maximus.com or contact the Help Desk phone support at 833-73 VAIRR (833-738-2477) for assistance.