Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services
chapter
Standards Established and Methods Used to Assure High Quality Care [12 VAC 30 ‑ 60]
Action 2015 Long Term Services and Supports Screening Changes
Stage Proposed
Comment Period Ends 11/3/2017
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10/27/17  9:19 am
Commenter: Jeannine Uzel, Director of Public Health Nursing, VDH

Virginia Department of Health comments on proposed regulations
 

The Virginia Department of Health (VDH) recognizes that a family’s decision to request long-term care services is a complex and very difficult decision to make.  Therefore, we appreciate the opportunity to provide comment on the proposed regulatory changes to 12VAC30-60-300.

The majority of our changes include suggestions for clarifying recommendations so they are clearly interpreted by the hospital and community based teams, as well as for the families who are participating in this process.  Substantive recommendations include:

  • Adjust the definition of the members of the Community Based Team (CBT) to align with the appropriation act, which excludes the physician from the process.
  • Strengthen regulatory guidance to reinforce that screenings must be conducted for any individual who requests one, which includes all individuals who may need Long Term Services and Supports (LTSS), regardless of payer source.
  • Encourage flexibility to be able to update or make changes to the UAI as evidence based practice changes and recommendations occur.
  • Develop training that is applicable and appropriate for screening teams.

We hope that consideration of these suggestions will result in a process that provides individuals and their families who are seeking long term care a clear and equitable process.

Section

Comment

12VAC30-60-301

Physician is added to the list of individuals in the definition of CBT; however, the appropriation act states that the team consists of a social worker and a licensed healthcare professional. Recommend removing physician from the team.

12VAC30-60-301

Face to face is defined, but not used elsewhere in the regulation content. There is no reason to define it if the term is not used.  The addition of a telehealth option would be beneficial for remote areas that are difficult to access.

12VAC30-60-301

 ePAS is not used for assisted living facility assessments; therefore, the screening process outlined in these proposed regulations does not apply. There are separate regulations that address assessments in assisted living facilities. It may be confusing to screeners if this language remains. Additional confusion with the statement, “LTSS means a variety of services that help individuals with health OR personal care needs”.  For service authorization, the individual must have health AND personal care (functional) needs.

12 VAC30-60-301                     

MCO should be able to refer for a screening, and should not be listed as a requester.  Individuals should still have the right to refuse a screening.

12VAC30-60-301

The definition of MCO is incomplete as it is missing the term “managed care organization” which should be listed prior to “or MCO.”

12VAC30-60-301

“primary account holder” is defined but not used elsewhere in the regulation content. There is no reason to define it if the term is not used.

12VAC30-60-301

Including nursing facility in the definition of “residence” is problematic.  Recommend strengthening the regulatory guidance to conduct screenings on any individual who requests one, including all individuals who may need LTSS regardless of payer source.

12VAC30-60-301

Language regarding the UAI limits the flexibility of DMAS to make changes to the UAI.  Recommend changing language to , “UAI or other DMAS approved assessment tool”.

12VAC30-60-302D

This language conflicts with 12VAC30-60-304, C2 that directs hospitals to screen an individual regardless of the payer source. If this language remains, it gives all screening teams the option to evaluate the individual’s financial status prior to conducting a screening, and to screen out individuals who may not be eligible for Medicaid in 6 months.

12VAC30-60-302E 2 & 3

The first sentence indicates that veteran and military hospitals staff shall not be required to perform screenings, and the individual shall be referred upon discharge to the CBT.  The next sentence implies that discharging the individual to a NF does not require a screening. Referring to the community based teams to screen for home and community based services after discharge may delay services.  Recommend veteran and military hospitals be permitted to screen for community based care prior to discharge using VA form 10-1204 (or its successor), “Referral for Community Nursing Home Care".

DBHDS should be permitted to conduct screenings for nursing facility placement or waiver services to avoid a service gap.

12VAC30-60-303A2

Is DMAS certain that ePAS will successfully process a screening that meets the criteria in 303 A2?

12VAC30-60-304A1

Recommend adding language that requires the MCO to consult with the individual or the individual’s representative prior to making a screening request or, as noted above, use language that indicates MCOs may refer for screenings.  Individuals should be afforded the opportunity to decline the screening.

12VAC30-60-304A1b

The DMAS designee for children’s screenings has been identified but the designee for screenings over 30 days has not.

12VAC30-60-304B1

Recommend that the language reflect that the request should be made directly to the DMAS designee.  This will reduce any potential delay between the request for the screening and performance of the screening.

12VAC30-60-304C

C seems to be in conflict with C1a and C1b.  C identifies who can request a screening (inpatient or rep) and then C1a and C1b stipulate additional persons who many request a screening.

12VAC30-60-304C1a & b

This guidance allows only the individual or the individual’s representative to make a request for a screening. Recommend including language to include child protective services workers and adult protective services workers who may need to request a screening for an individual who is in an unsafe situation.

12VAC30-60-3042

Consider using the following language: “The hospital team shall conduct a screening on the individual, regardless of the individual’s primary payer source for LTSS or whether or not the individual has been determined financially eligible for Medicaid.” This section contradicts 12 VAC30-60-302 D  that  states 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 the NF placement.

12VAC30-60-305

The term “eligibility” is used throughout this section. Unclear if this is referring to functional or financial eligibility for Medicaid LTSS.

12VAC30-60-306

Is there a need to spell out “Uniform Assessment Instrument” here since it was defined in the definition section?   The DMAS 95 is only completed for NF placement, not HCBS.  Recommend indicating this in the section.

12VAC30-60-308

Please consider adding language that screening documents not processed via ePAS shall not be accepted by providers. This may help stop the practice of some screening entities completing the UAI form by hand outside of the ePAS system.

12VAC30-60-310

Agree with initial training with an 80% pass rate but are concerned that 8 hours of training will be a burden for community based and hospital teams.  Would recommend a shorter update every 3 years but would not recommend repeating the initial training.  Recommend that DMAS track compliance with the online training.

12VAC30-60-313

The term “criteria” is used throughout this section. Unclear if this is referring to functional or financial criteria for Medicaid LTSS.