Ala. Admin. Code r. 560-X-10-.16

Current through Register Vol. 42, No. 9, June 28, 2024

Section 560-X-10-.16 - Preadmission Screening And Resident Review

(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.

Ala. Admin. Code r. 560-X-10-.16

Rule effective October 1, 1982. Amended: Effective February 8, 1984; October 9, 1985; December 12, 1988. Emergency rule: Effective January 1, 1989. Amended: Effective April 14, 1989. Emergency rule: Effective June 1, 1989; October 1, 1990. Amended: Effective February 13, 1991. Amended: Filed August 11, 2003; effective September 15, 2003. Amended: Filed November 18, 2009; effective December 23, 2009.

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.