If you are a patient in a hospital or a loved one of a patient in the hospital and you or your loved one are going to be discharged to a Medicaid certified nursing facility, here is a look at some of the factors that a hospital discharge planner needs to address for you regarding your discharge. Besides getting approval from some of the insurances (which is crazy enough in itself). Let’s take a look at some other basic aspects; (All of the following points assume you were residing at home prior to your hospitalization)
· First of all, A PAS (Preadmission Screening) requirement is needed.
This can be one of two things;
1. If the intended length stay in the NF is expected to be less than 30 days, then a 7000 7000 form can be completed.
2. If the expected length of stay in the NF is going to be greater than 30 days, then a PASRR screen (3622) 3622 will need to be completed.
· The next consideration is what will be the payment source when you arrive at the NF.
· 1. If the payment on day one of your admission to the NF is going to be anything other than Medicaid (including private pay, private insurance like Blue Cross/Blue Shield, Anthem, etc; a Medicaid HMO or a Hospice benefit) than only one of the two PAS requirements described above are required.
· 2. If your payment source will be Medicaid on day one of your admission to the NF (You will also need one of the PAS requirements described above depending on your intended length of stay in the NF), and you will also need a LOC (Level of Care). In order to qualify for a LOC, then you will basically need to meet criteria of;
· a. Requiring assistance with two ADL’s (Activities of Daily Living) such as bathing, grooming, dressing, etc.
· b. Requiring 24 hour supervision due to a cognitive impairment like dementia.
c. Requiring a skilled service such as Physical Therapy/Occupational Therapy or an IV treatment.
The Preadmission Review department is responsible for issuing the PAS Result and LOC. In Ohio, the Area Agencies on Aging have a contract with both the Ohio Dept of Aging (ODA) and Ohio Dept of Jobs and Family Services to perform the Preadmission Review process for all individuals seeking admission to Medicaid certified nursing facilities. Preadmission review also issues LOC’s (levels of care) for NF residents converting to Medicaid vendor payment, and LOC’s for NF residents transferring from one Medicaid certified NF to another. There are 12 Preadmission Review departments in Ohio. Each site covers a certain territory of specific counties in OH. You can view them at Area Agency. Each site has its own specific hours (generally 9AM -5PM or 8:30AM -4:30PM, etc- Monday thru Friday). However, there are after hours coverage hours on the weekend. You can view a schedule of after hour coverage at Extended Preadmission Review Hours.
My next article will cover aspects of the PASSPORT Home Care Program.