Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-003 - Procedures for Determination of Medical Need for Nursing Home Services

Current through Register Vol. 49, No. 6, June, 2024
I.
MEDICAL NEED ASSESSMENTS
Each Medicaid certified Nursing Facility will evaluate each
				nursing home applicant's need for nursing home services using the Form DMS-703.
				A thorough and complete evaluation must be conducted to ensure that individuals
				who do not require nursing home services are not admitted to nursing
				facilities.
For Medicaid eligible recipients, the Office of Long Term Care
				cannot guarantee Medicaid reimbursement for any applicant admitted prior to
				approval by the Office of Long Term Care Medical Needs Determination section.
				No applicant with diagnoses or other indicators of mental illness, mental
				retardation, or developmental disabilities may be admitted to nursing home care
				prior to evaluation and approval by the Office of Long Term Care.
A.
Nursing Facility Procedures
			 for Medical Need Assessments
1.
			 Complete the Form DHS-703 for each applicant. Be sure to mark the appropriate
			 box for application, ensure that all areas are completed and that the
			 applicant's degree of incapacity is reflected accurately. Use the Nurse's
			 Comments section on page 3 to provide other information related to the
			 individual's need for nursing home care.
2. Complete Form DMS-787 (Pre-Admission
			 Screening for Mental Illness/Mental Retardation, Level I Identification Screen)
			 for all applicants. If the completed form indicates that the individual has a
			 diagnosis or other indicators of mental illness, mental retardation, or
			 developmental disability, follow the procedures outlined under Section II
			 below.
3. If the completed Form
			 DMS-787 indicates the presence of MI/MR/DD, complete the Pre-Admission
			 Screening Annual Resident Review Client Consent form, Section III, with the
			 applicant and/or his/her guardian or legal representative. Attach the signed,
			 dated and witnessed consent form to the DMS-703.
4. If the individual has a diagnosis of
			 dementia (including Alzheimer's Disease or other related disorders), complete
			 form DMS-780 (Dementia Diagnosis Substantiation). Attach the signed and dated
			 form to the DHS-703. Refer to the section on Dementia below.
5. If the individual
does not
			 have
a diagnosis or other indicators of mental illness and/or
			 mental retardation/developmental disability, forward copies of the DHS-703 and
			 the DMS-787, and if applicable, the DMS-780, to:
Medical Need Determination
PO Box 8059, Slot S406
Little Rock, AR 72203
501-682-6973 (Telephone)
501-683-5306 (FAX)
Keep a copy of all forms for the facility's
				files.
Whenever possible, the application packet should be submitted
				to OLTC prior to the individual's admission to the Nursing Facility. Otherwise,
				the packet must be submitted within 48 hours of the individual's admission to
				the facility.
For private pay (Medicare, VA contract, private insurance,
				etc.) applicants who are applying for Medicaid coverage, the facility must
				submit the packet as soon as facility staff is made aware that the application
				will be made.
6. If the
			 individual
does have
a diagnosis or other indicators
			 of mental illness and/or mental retardation/developmental disability follow
			 procedures outlined in Section II.
7. Send a copy of the EMS-702,
Notice of Admission, Discharge, or Transfer from Nursing Home
to the local County DHS office and to the Medical Need
			 Determination Unit at the address in Section 1(A)(5), above.
8. Ensure that an individual acting on behalf
			 of the applicant applies or has applied for nursing home care at the DHS County
			 Office.