Virginia Hospital & Healthcare Association, on behalf of its hospital and health system members, submits this comment to express concern with the interpretation and application of these emergency regulations for completion of pre-admission screenings in hospitals.  In particular, there is concern that the determination of when hospitals are required to complete the UAI’s for patients that may need Medicaid-funded LTSS has been expanded throughout this regulatory process.  

Va. Code 32.1-330 requires pre-admission screening of individuals who at the time of application for admission to a nursing facility are eligible for medical assistance or will become eligible within six months following admission.  The corresponding regulations should be carefully drafted and interpreted to ensure that hospitals and community-based agencies are not unnecessarily performing screenings under circumstances where the individual is not or will not become eligible within six months.  Indeed, the regulations require that “individuals shall be screened if they are eligible for Medicaid or are anticipated to become eligible for Medicaid reimbursement of their NF care within six months of nursing facility placement.”  12VAC30-60-302.E.  This suggests that there are instances where an individual shall not be required to be screened (i.e., when not eligible for Medicaid or not expected to become eligible within six months).  In practice, however, it is unclear how the screening requirement is to be interpreted where Medicaid eligibility is not apparent in all circumstances, which may result in the performance of screenings in the hospital setting when it is either not appropriate or not required.  Unnecessary or inappropriate performance of screenings should be eliminated to ensure the most efficient use of limited resources.

Furthermore, Va. Code 32.1-330 limits hospital responsibility for completing screenings to inpatients.  The definition of “inpatient” included in the emergency regulations at 12VAC30-60-301 is limited to individuals for whom a physician has issued an order for admission to the hospital, which would exclude hospital outpatient, observation, or emergency department patients.  Notwithstanding this limitation in the regulations, hospitals continue to receive requests to perform screenings for patients who do not fit into this definition.

Careful drafting and interpretation of these emergency regulations will help to ensure that individuals who are or are anticipated to become eligible to receive Medicaid-funded LTSS receive the required screening promptly in the most appropriate setting.  Thank you for this opportunity to comment.  Any questions or requests for additional information can be directed to Brent Rawlings, Vice President & General Counsel, brawlings@vhha.com (804)-965-1228.

Please accept these comments to the Emergency/NOIRA stage for the pre-admission screening regulations on behalf of the Virginia Health Care Association-Virginia Center for Assisted Living (VHCA-VCAL), our members’ 30,000 employees, and the 29,000 residents served in our over 280 nursing centers and assisted living facilities. VHCA-VCAL is proud of our role as the Commonwealth’s largest association representing long term care. Our strength, effectiveness, and integrity are significantly enhanced by the diversity of our membership, which includes proprietary, non-profit, and government-operated facilities dedicated to providing the highest quality of care.

Our only comment on the draft regulations is to seek clarification to the new 12VAC30-60-315 language.  This new section provides for community based and nursing facility service providers to conduct ongoing determinations that individuals meet functional needs for Medicaid LTSS.  However, this section also specifies that individuals enrolled in MCOs responsible for the provision of LTSS also conduct such evaluations.  For community providers (DMAS 99 LOC) and nursing facilities (MDS), there are parameters provided to guide these evaluations; for MCO, there are no such parameters other than “qualified MCO staff”.  

Further, as the Commonwealth moves to managed long term services and supports (MLTSS) in the near future, a high percentage (if not all) individuals qualified for LTSS in the community or in a nursing facility will also be enrolled in a MCO; there is no delineation of dual responsibility and hierarchy of the determination of ongoing need.  As written, both the provider and the MCO are responsible for the assessment.  Where there is disagreement, it is not clear which assessment prevails.  This needs to be corrected prior to the launch of MLTSS, and we believe should be delegated to the clinical expertise of the providers who see the patient on a daily basis.

Thank you for the opportunity to comment.  Please direct any questions to Steve Ford, SVP, Policy and Reimbursement, at steve.ford@vhca.org  or (804) 212-1695.