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.