Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-10 - LONG TERM CARE › Section 560-X-10-.16 - Preadmission Screening And Resident Review

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Prior to admission, all individuals
			 seeking admission into a nursing facility must be screened for suspected mental
			 illness (MI), intellectual disability (ID), or a related condition (RC) to
			 determine if the individual's care and treatment needs can most appropriately
			 be met in the nursing facility or in some other setting.
(2) A Level I screening document (LTC-14)
			 must be completed in its entirety and submitted to OBRA PASRR Office for a
			 Level I Determination prior to admission. The Level I Screening can be
			 completed by anyone who has access to the medical records excluding family
			 members.
(3) The nursing facility
			 is responsible for ensuring that the applicant is not admitted into the nursing
			 facility without a Level I Screening, Level I Determination and Level II
			 Determination, if applicable, from the Department of Mental Health. The nursing
			 facility is responsible for ensuring that the Level I Determination is signed
			 and dated by the RN indicating that the Level I Screening is accurate based on
			 the available medical records.
(4)
			 The Department of Mental Health is responsible for conducting a Level II
			 Evaluation on all applicants and residents with a suspected diagnosis of
			 MI/ID/RC to determine the individual's need for mental health specialized
			 services and medical eligibility. For all residents with a primary or secondary
			 diagnosis of MI/ID, the Department of Mental Health will make the determination
			 of appropriate placement in a nursing facility, based on the results of the
			 Level II Screening and the application of Medicaid medical criteria.
(5) If the nursing facility fails to obtain
			 the Level I screening, Level I Determination and Level II Determination, if
			 applicable, made by the Department of Mental Health prior to admitting the
			 resident into their facility, the Alabama Medicaid Agency will recoup all
			 Medicaid payments for nursing facility services from the date of the resident's
			 admission and continuing until the Level I Determination or Level II
			 Determination, if applicable, is received.
(6) If a resident is discharged into the
			 community for more than 30 days, a new Level I Screening, Level I
			 Determination, and Level II Determination, if applicable, is required before
			 admission.
(7) If the nursing
			 facility's interdisciplinary team identifies a significant change in the
			 condition of a resident with a diagnosis of MI/ID/RC, an updated Level I
			 Screening must be completed and submitted to the Department of Mental Health's
			 PASRR Office within 14 days of the resident's status change to receive an
			 updated Level II Determination to establish continued eligibility. If the
			 nursing facility fails to update the Level I Screening for a significant change
			 in a resident's condition, the Alabama Medicaid Agency may recoup all Medicaid
			 payments for nursing facility services from 14 days of the resident's change in
			 condition and continuing until the updated Level II Determination is
			 received.
Rule
				  560-X-10-.14, Preadmission
				  Screening and Resident Review, was renumbered to Rule 560-X-10-.16, as per
				  certification filed August 11, 2003; effective September 15,
				  2003.
Author:
Samantha McLeod, Administrator, LTC
				  Program Management Unit
Statutory Authority:
State Plan; Title XIX,
				  Social Security Act; 42
				  C.F.R. §
											435.911.