Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 81 - Certification › Section 19 CSR 30-81.030 - Evaluation and Assessment Measures for Title XIX Recipients and Applicants

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment adds the level-of-care
				  evaluation and assessment requirements back that were effective prior to
				  October 31, 2021, in order for those individuals who would have qualified for
				  Title XIX-funded services prior to October 31, 2021, to be eligible to receive
				  services funded through the American Rescue Plan Act. The amendment also
				  removes the words "an Intellectual Disability/" on the DHSS-DRL-110 (10-20)
				  form included herein in sections (2) and (3).
PURPOSE: This rule sets the requirements for the
				  periodic evaluation and assessments of residents in long-term care facilities
				  in relationship to evaluation and assessment processes, level of care needed by
				  individuals, and appropriate placement of individuals in order to receive this
				  care. The rule also includes the algorithm utilized for the department's Home
				  and Community Based Services program for its level-of-care determination. The
				  rule includes a second level-of-care determination to be utilized from October
				  31, 2021, until the funding from the American Rescue Plan Act (temporary
				  enhanced federal medical assistance percentage) has been
				  expended.
(1) For purposes of
				this rule only, the following definitions shall apply:
(A) Applicant-any resident or prospective
				resident of a certified long-term care facility who is seeking to receive
				inpatient Title XIX assistance;
(B)
				Certified long-term care facility-any long-term care facility which has been
				approved to participate in the inpatient program and receives Title XIX funding
				for eligible recipients;
(C) Initial
				assessment forms-the forms utilized to collect information necessary for a
				level-of-care determination pursuant to 19 CSR 30-81.030 and designated Forms
				DHSS-DRL-109 (10-20), Nursing Facility Level of Care Assessment and
				DHSS-DRL-110 (10-20), Level One Nursing Facility Pre-Admission Screening for
				Mental Illness/Intellectual Disability or Related Condition, included
				herein.
(D) Inpatient Title XIX
				assistance-Title XIX payments for intermediate or skilled nursing care in a
				certified long-term care facility;
(E) Level-of-care assessment-the
				determination of level-of-care need based on an assessed point count value for
				each category cited in subsection (4)(B) of this rule;
(F) Level-of-care determination-the decision
				whether an individual qualifies for long-term care facility care;
(G) Long-term care facility-a skilled nursing
				facility (SNF), an intermediate care facility (ICF), or a hospital which
				provides skilled nursing care or intermediate nursing care in a distinct part
				or swing bed under Chapter 197, RSMo;
(H) Pro re nata (PRN)-medication or treatment
				ordered by a physician to be administered as needed, but not regularly
				scheduled;
(I) Recipient-any
				resident in a certified long-term care facility who is receiving inpatient
				Title XIX assistance;
(J)
				Redetermination of level-of-care-the periodic assessment of the recipients'
				continued eligibility and need for continuation at the previously assigned
				level of care. Periodic assessment includes, but is not limited to, the
				following:
1. Assessment of new admissions to
				a long-term care facility;
2.
				Assessment of a change in mental and/or physical status for a resident who is
				being readmitted to a long-term care facility after transfer to an acute care
				facility, and the previous DA-124 A/B or C forms do not reflect the resident's
				current care needs; and
3.
				Assessment of DA-124 forms as requested by the Department of Social Services,
				Family Support Division;
(K) Reevaluation of level-of-care-the
				periodic assessment of the recipients' continued eligibility and need for
				continuation at the previously assigned level of care. Periodic assessment
				includes, but is not limited to, the following:
1. Assessment of new admissions to a
				long-term care facility;
2.
				Assessment of a change in mental and/or physical status for a resident who is
				being readmitted to a long-term care facility after transfer to an acute care
				facility, and the previous DHSS-DRL-109 (10-20), Nursing Facility Level of Care
				Assessment or DHSS-DRL-110 (10-20), Level One Nursing Facility Pre-Admission
				Screening for Mental Illness/Intellectual Disability or Related Condition forms
				do not reflect the resident's current care needs; and
3. Assessment of DHSS-DRL-109 (10-20),
				Nursing Facility Level of Care Assessment or DHSS-DRL-110 (10-20), Level One
				Nursing Facility Pre-Admission Screening for Mental Illness/Intellectual
				Disability or Related Condition forms as requested by Department of Social
				Services, Family Support Division;
(L) Resident-a person seventeen (17) years or older
				who by reason of aging, illness, disease, or physical or mental infirmity
				receives or requires care and services furnished by a long-term care facility
				and who resides in, is cared for, treated, or accommodated in such long-term
				care facility for a period exceeding twenty-four (24) consecutive hours;
				and
(M) The department-Department
				of Health and Senior Services.