Medicaid Bulletins on LTSS Screening
On June 10, 2022, DMAS posted two new Medicaid Bulletins related to the Medicaid Long Term Services and Supports (LTSS) Screening process. We urge you to read the memos in their entirety and pay careful attention to the details about the screening process.
The first bulletin establishes a 90-day catch-up period running until September 8, 2022 for nursing facilities (NFs) to conduct an LTSS Screening for any individual residing in a nursing facility without an LTSS Screening. The second bulletin addresses required training for the physicians, physician assistants, and nurse practitioners who review and authorize or deny Medicaid LTSS Screenings.
VHCA-VCAL will host Lunch & Learn webinars in July to review the LTSS Screening process for nursing facilities and answer any member questions. Details about the webinars are provided at the end of this message.
Bulletin: Medicaid Long Term Services and Supports Screening in Nursing Facilities, Screening Restoration after COVID-19 Flexibilities
The first Medicaid Bulletin provides clarification and guidance related to required Medicaid LTSS Screenings in nursing facilities. It addresses the Code of Virginia 32.1-330 requirement that all persons requesting or applying for Medicaid LTSS be screened prior to the initiation of services and the 12VAC30-60-308 requirement for NFs to review the completed LTSS screening forms to ensure that applicable NF admission criteria have been met, documented, and submitted via the DMAS electronic screening record system prior to admission.
During the COVID-19 public health emergency some individuals were admitted to nursing facilities directly from a hospital without an LTSS Screening per the governor’s Executive Orders (EOs 58, 84, and 16). We are also aware that the various waiver periods caused confusion that may have resulted in individuals that should have been screened regardless to be admitted without the screening. To ensure that individuals are held harmless going forward, DMAS will allow 90 days from the date of the bulletin for a facility to conduct an LTSS Screening for any individual residing in a nursing facility without an LTSS Screening. The 90-day period will run through September 8, 2022.
As a reminder, changes to the LTSS Screening went into effect on January 1, 2021. These changes allow skilled nursing facilities (SNFs) staff to conduct LTSS Screenings for non-Medicaid members admitted to SNFs who have a change in financial status and require intermediate care facility level of care. All SNFs and NFs should have appropriate staff trained to complete the LTSS Screening when required for an individual who resides in a nursing facility. The training was outlined in an October 20, 2020 Medicaid Bulletin.
DMAS is requesting that all individuals admitted to an NF during the COVID-19 public health emergency without a screening, even those that were covered by the waiver, be screened. It is important that a screening be documented in the electronic record as the electronic Medicaid LTSS Screening (eMLS) system connects to several other Virginia Medicaid systems, which are linked together to verify screening dates and expedite enrollment and payment. The intention is to assure the individual and facility are not harmed in any way in the future because a screening cannot be found. VHCA-VCAL has received significant feedback from members regarding the delays in obtaining screenings conducted prior to the current date, which frequently impedes admissions to NFs.
Important Notes from April Payne and Steve Ford
DMAS is allowing this catch-up period in response to the confusion caused by the various beginning and ending dates for the COVID flexibilities (and the fact that a few flexibilities had an additional effective period after the initial ended). Our understanding is that during the catch-up period, corrections can be made to address the situation going forward to allow for payment. It will not allow for retroactive payment to the admission date or level of care change.
Facilities should take advantage of the clean-up period to review records for ALL current residents to ensure that individuals who needed to be screened prior to admission were fully screened and determined functionally eligible (and have the documentation thereof), or the facility will face non-payment.
After September 8, 2022, there will be no remedy if a NF admits a patient who was required to have been screened prior to admission without that screening having been completed. In more direct terms, this would mean the individual would not be eligible for Medicaid payment for NF care and have no path toward eligibility. Therefore, the NF would not get paid for the care provided.
VHCA-VCAL does want to work with DMAS to address situations that are beyond the control of the facility, but anything we are able to achieve will likely have a substantial period of non-payment. There is also no certainty that the agency would agree to such a solution, which would mean permanent non-payment for that individual. We therefore want to strongly emphasize the importance of having a process in place to verify LTSS Screenings are being conducted as needed.
With the legislation we advocated for in 2020, VHCA-VCAL worked very hard to shift the screening workload of the hospitals with the creation of the NF screening teams in certain circumstances. This was intended to increase efficiency for NFs, but the rules around the three types of screening teams and the screening requirements remain and must be followed. Failure to do so risks not only losing payment, but also the efficiency gained with the circumstances in which the NF can conduct the screening.
Bulletin: Medicaid Long Term Services and Supports Screening (LTSS) Training for Physicians
The second Medicaid Bulletin issued June 10 provides additional guidance specifying that as of August 1, 2022, physicians (including nurse practitioners and physician assistants) who have responsibility for reviewing and providing final authorization or denial of Medicaid LTSS Screenings will be required to have completed the Medicaid LTSS Screening Training and enter their unique certification number when approving screenings.
The screenings will not process in the eMLS system without the certification number. Remember, a screening not fully processed is incomplete and will result in non-payment for NF services.
Completion of the training is required every three years and physicians will receive emailed notifications prior to the expiration date.
