*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2012 |
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23.05 - Long-Term Care Consultation (LTCC) |
Archived: June 1, 2016 (Previous Versions) |
The primary purpose of the Long-Term Care Consultation (LTCC) program is to prevent or delay nursing or certified boarding care facility placements. Long-Term Care Consultants also perform preadmission screening (PAS) of all individuals seeking admission to a long-term care facility, as required under state and federal laws.
Waiver Program or Alternative Care (AC) Service Eligibility.
In most cases, an LTCC refers to an in-person visit that determines the level of care a client needs by assessing his or her health and psychosocial needs.
The LTCC is also used to document that a person requires an institutional level of care for the purpose of meeting the eligibility requirement for MA payment of LTC services through the CAC, CADI, EW and BI programs.
By contrast, a Preadmission Screening (PAS), is a communication between the LTCC staff and another health care professional seeking to admit a client to a facility that is generally completed by telephone.
The LTCC assessment and the PAS processes are defined by the Aging and Adult Services Division of DHS.
Note: People requesting services through the Developmental Disability (DD) waiver must have a full team DD screening. The Full Team Developmental Disabilities (DD) Screening takes the place of the LTCC.
Make a referral to the county LTCC team when:
l a client files a request for MA payment of LTC services by completing a Minnesota Health Care Programs Application for Payment of Long-Term Care Services (DHS-3531), a Minnesota Health Care Programs Request for Payment of Long-Term Care Services (DHS-3543), or a request for MA payment of LTC services with ApplyMN; and
l a Lead Agency Case Manager/Worker Communication Form (DHS-5181) has not been received documenting that the client meets the institutional level of care requirement.
When making the referral:
l Contact the client or the client’s authorized representative to discuss the requirement that the client needs an institutional level of care and that an LTCC is required before MA can pay for LTC services.
l Follow the county procedures for making a referral to the LTCC team.
n Provide the necessary information to contact the client to offer an LTCC if a screening has not been completed.
n Request the DHS-5181 if a screening has been completed.
n Document the outcome of the referral in case notes.
Note: Also make a referral to the county LTCC team if there is any reason to suspect that the client may benefit from receiving home and community-based waiver services; for example, it is known that the person resides in a housing with services establishment (commonly known as assisted living).
Example:
Sally submits a Health Care Application (HCAPP) in June. Although Sally did not use the Minnesota Health Care Programs Application for Payment of Long-Term Care Services (DHS-3531), her date of birth indicates that she is 95 years old and her address is listed as that of an assisted living facility that serves people with memory loss.
Action:
Make a referral to the county LTCC team because Sally may benefit from home and community-based services.
The county LTCC team:
l determines whether the person needs a nursing facility or certified boarding care facility level of care by assessing the person's health and psychosocial needs.
l helps the person develop a community support plan if they choose home and community-based services.
l must inform people of available alternatives to institutionalization and recommend either a facility placement or community-based care.
l enters risk status on the LTC Screening Document subsystem in MMIS.
l documents that the person meets EW, CADI, CAC, BI, or AC service eligibility on the LTC Screening Document.
MA will not pay for EW, CAC, CADI, or BI services provided prior to the completion of the LTCC in-person assessment and program eligibility determination, as indicated on the LTC Screening Document in MMIS under the Assessment Result date. State-funded AC service payments are also effective as of the Assessment Result date.
Verify that MA applicants or enrollees either have had or are exempt from preadmission screening before admission. A Physician Certification (DHS-1503) that indicates a screening has been completed or that a screening is not required verifies the PAS requirement. Keep a copy of the completed DHS-1503 in the case file.
MA will not pay for nursing facility or certified boarding care services received before the Assessment Result date indicated on the LTC Screening Document.