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Frequently Asked Questions
Long Term Care FAQ's  

 
1.  When a patient is transferred to the hospital and then returns what admission date is used? Is the original admission date or the date the patient returned from the hospital to the NF?
     When a patient is transferred to the hospital and then returns the original admission date is used as long as the patient is not discharged due to the number of days in the hospital as long as the patient has not exceeded the inpatient day limit which is 15 days per admission or readmission. If the patient is discharged from the NF and readmitted, the new admit date is used.

2.  Where is the Plan of Care Form?
     It is now called a Prior Authorization Form and has and option under the HCBS menu.

3.  What is the actual approval/application process for MS Medicaid?
     At one time there was actually a hospice category of eligibility. That is no longer the case. Medicaid beneficiaries are just eligible for hospice services. The Medicaid Regional Offices process the applications for MS Medicaid.

4.  How do Hospice Lock-ins work, and how are they corrected?
     Lock-ins are initiated by the enrollment application. The hospice provider number must be entered in field 12 and if applicable the LTC provider number must be entered in field 14. The lock in can be verified by calling Xerox Provider and Beneficiary Support Call Center at 1-800-884-3222. If there is an error on the enrollment form, the form should be corrected and mailed to Xerox.

5.  What is the time frame for lock-ins?
     Providers should submit the enrollment form immediately as claims will deny until the lock-in segment is updated. The goal of Xerox is to update the lock-in segments within 5 business days of receipt.

6.  At what point can a benficiary be billed for hospice services?
     Section 3.09 and 3.10 of the Medicaid Policy addresses when a beneficiary can be billed.
Policy can be accessed on the provider drop down menu/provider specific information/"provider type"/Policy or on the Division of Medicaid website: www.medicaid.ms.gov

7.  How will it identify the amount of the Medicaid Income?
     The DOM-317 form documents the most recent date of medicaid eligibility and the amount of Medicaid income due from the beneficiary each month. Hospice providers can request a copy of each 317 from the LTC facility or contact PBS and be given the amount verbally. The 317's are mailed only to the LTC facilities.

8.  When do we need to do a PAS?
     For HCBS- in the same situations that you have used a 260 in the past. Same for Nursing Facility, especially when Medicaid Long Term Care eligibility being sought.

9.  Can you do a PAS prior to admission when you are expecting the 100 Day SNF stay and it still be in place at the 100th day?
     The PAS physician cert is current for 30 days. If application for Medicaid exceeds 30 days from completion, another PAS would be required.

10.  Do you have to complete a PAS during a SNF stay in order to cover bed hold when the resident goes to the hospital?
     A PAS with a score of 50 and 317 changing Medicaid benefits to LTC eligibility is necessary.

11.  Do you have to complete a PAS if the resident is transferring from another facility and was previously on Medicaid?
     Yes.

12.  Do we still need the 2 page 260 prior to SNF stay if the PAS is complete?
      No.

13.  Do we still need the 2 page 260 prior to SNF stay if the PAS is not completed?
     No. The PAS replaces the old 260.

14.  Can we have written instructions to give to facility personnel on the "submit, save, print/save, print, submit" steps?
     Click the following link to open the PAS Web Portal Training 2007 Document.

15.  Can you obtain the score prior to submitting the MD signatures?
     If submitting electronically, the score is generated after sections I-IX is completed. The MD signature is required on the page where the score is generated (section X).

16.  What e-mail address can people scan the hard copy of the PAS?
     The hard copy PAS can not be emailed due to HIPAA requirements.

17.  Does the PAS have to be redone annually on residents already in the nursing home?
     No, not at this time.

18.  If someone is already in the nursing home and they are currently Medicaid pending, and will still be Medicaid pendingas of October 1, 2007, will a PAS need to be done on the resident?
     The RO will require a valid PAS after 10/1/07 with the 317.

19.  Medicare part A residents do not need the PAS done prior to admission as Medicaid is not the primary payer source. What if Part A patient goes to the hospital and Medicaid becomes primary (due to bed hold). Is a PAS needed in order for Medicaid to pay the bed hold?
     Medicaid Long Term Care eligibility must be established prior to hospitalization and does require a PAS score 50 or greater.

20.  Is there a penalty for doing a PAS early?
     For HCBS, the policy (section 64.14) states the recert PAS is to be done no earlier than 90 days prior to the expiration of the current PAS. For NF: only if greater than 30 days from physician signature.

21.  Do we still fill out a 260 form for level II determination?
     No. Level II determination can be found on the PAS section X.

22.  Is the 260 form still in use for LTC or any reason?
     Yes, for ICF/MR placements and MR/DD waiver only.

23.  Can the PAS be sent without a family member/significant other signature?
     In certain extenuating circumstances, yes. These must be addressed by Medicaid on a case by case basis.

24.  Can a nurse practitioner sign the PAS?
     No.

25.  Does the PAS expire in any other situation?
     For HCBS, the PAS is good for 364 days after the MD signature.

26.  If a score of below 45 is generated at the time of the first submission, can you immediately do another one (given the nurse overlooked something or made a data entry mistake which caused the score to fall below the threshold?)
     Yes, the application has not been submitted to DOM until a case# is generated

27.  What does the facility actually receive (other than the score on Section X) showing the clinical approval with the effective date?
     Electronic submissions with a score of 50 or greater will not generate correspondence other than communicating the score. For hard copy submission, a letter of approval along with section X will be mailed or faxed.

28.  The training material kept referring to a "PAS-Informed Choice form" as though it were separate from Section VIII. Is there a separate form or does this refer to Section VIII?
     The informed choice is section VIII of the PAS. It must be signed and uploaded as a separate attachment to the application.

29.  After the second submission of the PAS (meaning we've sent Section X with the certification and informed consent form) a case number is generated and replaces the reference number initially generated after submitting Section I - IX. Does this case number relate in any way to billing for the resident or is it just a reference number for the PAS?
     No. This case number will be used by DOM to open the application and review it. The previous reference number is no longer valuable after a case # is generated.

30.  If the resident is on Medicaid bed hold and exceeds the 15 days, stays in the hospital and returns directly to the facility is another PAS required?
     No

31.  If the resident is on Medicaid therapeutic bed hold and exceeds the 15 days and comes back on day 18, is another PAS required? Are there any other situations where a new PAS would be needed?
     1) Yes. 2) Transfer to a different NF; loss of Medicaid eligibility and reapplication.

32.  The training materials state that in the final submission, when we attach the physician certification and the informed consent form, the MD has to AT LEAST enter the primary dx code, physician comments, and enter his name/license/date. What is expected to be seen in the physician comment section? Is this just for any additional information the Dr. feels would be helpful or is the MD required to notate something in particular?
     Any additional information that may pertain to the application.

33.  If we fail to attach the physician certification and/or informed consent form, does that trigger a denial or does the facility get the option to forward them separately?
     The application can not be submitted electronically without checking the boxes that state these documents are attached.

34.  The training materials state that reviews will be completed within 30 days of PAS triggering an automatic secondary review. I am assuming this means a score of 45-49. Is these 30 days from the first submission (Section I - IX) or the final submission (Section X with the attachment)?
     The final submission. The application is not submitted to DOM until the case # is generated.

35.  Is an informed choice form (section 8) needed when a resident is transferring from one nursing facility to another?
     Yes.

36.  Who should complete the PAS for a resident who transfers from one nursing facility to another nursing facility? The transferring facility or the receiving facility?
     Division of Medicaid does not prescribe who will complete the PAS; only that it must be completed.

37.  When a patient is transferred to the hospital and then returns what admission date is used? Is the original admission date or the date the patient returned from the hospital to the NF?
     When a patient is transferred to the hospital and then returns the original admission date is used as long as the patient is not discharged due to the number of days per admission or readmission. If the patient is discharged from the NF and readmitted, the new admit date is used.

38.  Where is the "stand alone" Plan of Care Form?
     It is now called a Prior Authorization Form and has an option under the HCBS menu.

39.  What are the actual approval /application process for MS Medicaid Hospice?
     There is no longer a hospice category of eligibility. Hospice is a Medicaid state plan benefit. The Medicaid Regional Offices process the applications for MS Medicaid.

40.  How do Hospice Lock-ins work, and how are they corrected?
     Hospice "lock-in" is a process completed by Xerox upon receipt of proper and complete Hospice enrollment documentation being received from the Hospice provider. Lock-ins are initiated by the enrollment application. The lock in can be verified by calling Xerox Provider and Beneficiary Support Call Center at 1-800-884-3222. If there is an error on the enrollment form, the form should be corrected and mailed to Xerox.

41.  What is the time frame for lock-ins?
     Providers should submit the enrollment form immediately as claims will deny until the lock-in segment is updated. The goal of Xerox is to update the lock-in segments within 5 business days of receipt. Does not currently apply to HCBS waiver providers.

42.  At what point can a beneficiary be billed for hospice services?
     Section 3.09 and 3.10 of the Medicaid Policy address when a beneficiary can be billed. Policy can be accessed on the provider drop down menu/provider specific information/"provider type" Policy or on the Division of Medicaid website: www.medicaid.ms.gov

43.  How will it identify the amount of the Medicaid income?
     The DOM-317 form documents the most recent date of Medicaid eligibility and the amount of Medicaid income due from the beneficiary each month. Hospice providers can request a copy of each 317 from the LTC facility or contact PBS and be given the amount verbally. The 317's are mailed only to the LTC facilities.

44.  How do I obtain the hard copy version of the PAS?
     A hard copy of the PAS may be obtained by contacting Xerox at 1-800-844-3222, choosing option 6; Dom Bureau of LTC at 601-359-9547; or www.medicaid.ms.gov then link to the following topics: Long Term Care /Long Term Care Alternatives; Pre-Admission Screening LTC Application.

45.  What portion of the hard copy PAS is submitted for processing?
     In order for the submitter to receive a score for the PAS,
1.    The entire PAS must be submitted to the Bureau of Long Term Care (LTC), Division of Medicaid (DOM) via facsimile or mail;
2.    The submitter must transfer the PAS information to the summary pages (Section X) with the signed Physician's Certification; and the signed informed Choice form to 601-359-1383 (fax) for Nursing facility eligibility determination, or 601-359-9532 (fax) for eligibility determination to PAS participating waiver programs; or mailed to:
Division of Medicaid
Attention: Bureau of Long Term Care
Office of the Governor
550 High Street, Suite 1000
Jackson, MS 39201-1399
Written notification of the applicant's approval or denial will be provided.

46.  Where do I access the electronic version of the PAS?
     The electronic version is available on the Envision web portal by selecting the Provider tab, then linking to the following topics; Long Term Care PAS App for potential Beneficiary or HCBS App Medicaid Beneficiary for wavier re-certifications. The Electronic version is user friendly and provides on-line prompts for each section. This version will automatically score the application and generate the summary pages for the physician certification signature. The applicant's informed Choice form and the physician's certification must be uploaded as an attachment or submitted by facsimile. If you experience any problem relative to the electronic version, please contact Xerox at 1-800-884-3222.

47.  If the physician cannot submit his/her certification electronically, can the physician's signature be obtained manually?
     The PAS form can be completed and submitted to obtain a score and populate the summary pages for the physician's certification of the most appropriate "placement" taking into consideration the applicant's informed choice. The Physician can sign the summary.

48.  Will a PAS be required for Medicare Part A hospital discharges into a Skilled NF?
     A PAS will not be required for admission of a post hospital Medicare Part A to a Medicare Part A Skilled NF. The PAS is required only when Medicaid eligibility is being sought.

49.  What information is required to be forwarded to the Medicaid Regional Offices?
     Only Section X (PAS Summary), signed physician certification and the DOM 317 for Eligibility determination should be forwarded to the Medicaid Regional Office. All notifications to the Regional Office (with the exception of the now obsolete DOM260) will continue to be submitted as previously required.

50.  Is it possible to provide a medical summary of the applicant health status for review as opposed to completing the medical summary in the application?
     Any additional information may be submitted electronically as a scanned attachment; or if the hard copy version is completed, the medical summary may be submitted via facsimile or mail.

51.  Will the current (prior to October 1, 2007) Long Term Care eligible Medicaid NF residents be exempt from completing the PAS?
     Residents currently In the nursing facility will not be required to complete an application.

52.  Will PAS recertification be required annually for persons residing in a nursing facility?
     Unless there is a change in Medicaid financial eligibility or a break in institutionalization the PAS recertification is not currently required for NF beneficiaries.

53.  Will a new PAS be required for residents that are discharged from the nursing facility after exceeding 15 consecutive days of hospital leave?
     No, not as long as there is no break in institutionalization and the beneficiary return to the same nursing facility. If the resident goes into the home setting prior to returning to the nursing facility or if they enter a different nursing facility a new PAS would be required.

54.  Will a new PAS be required for residents that are discharged from the nursing facility after exceeding 15 consecutive days of therapeutic leave?
     Yes.

55.  Will a PAS be required for a person desiring to leave the nursing facility and return to the community?
     The NF should review the MDS for Questions Q1a, Q1b, and Q1c during each assessment period to determine if the resident desires to return to the community. A PAS should be completed at that time to determine if the resident desires to return to the community. A PAS should be completed at that time to determine all possible Long Term Care Waiver Program choices and the most appropriate placement.

56.  Is additional information regarding the health status of the applicant allowed to be submitted; e.g., history, hospital discharge summary, current medications?
     The electronic version will allow attachments and/or scanned documents to be submitted. Hard copy applications may be sent via mail or facsimile with necessary attachments.

57.  Should the pre-admission screening form be completed by a nursing facility representative, a hospital representative, waiver program representative or a DOM representative?
     The PAS must be completed and Medicaid eligibility established prior to the Medicaid beneficiary's placement into a Medicaid primary pay NF bed or into a Long Term Care Waiver Program. The Division of Medicaid does not prescribe which entity will complete the PAS.

58.  If the PAS form is to be completed by a nursing facility representative; does the representative have to be a Registered Nurse?
     No. The PAS must be completed by qualified individuals. Qualified individuals may include a physician, registered nurse, licensed social worker, rehabilitation counselor, or designee by facility/setting. (Specific qualifications are required by some programs).

59.  If the PAS must be reviewed and/or approved by DOM prior to admission, what is the anticipated turn around time?
     The electronic PAS will generate an immediate score at the time of submission. Applications with a score of 45-49 will require a secondary review. Electronic applications that require a secondary review have an estimated response time of three (3) business days. Hard copy applications have an estimated response of seven (7) business days.

60.  When the PAS form is completed by a long term care facility employee, how can information regarding the various waiver programs be obtained to assist the applicant in making an informed choice?
     The PAS form is a tool that assists in identifying appropriate choices for program or facility placement for the applicant. The informed choice section of the completed PAS will reflect a summary of the services for each of the approved waiver programs. Additional information for specific services provided by each waiver program can be viewed at www.medicaid.ms.gov

61.  How will the assessor know a drug is prescribed as a psychotropic?
     The assessor may refer tot the Physician's Desk Reference (PDR) or other acceptable professional resource.

62.  Will there be a place for a witness to sign if the applicant is unable to sign?
     Yes, On the informed Choice Form there is a space for a witness signature.

63.  When is the beneficiary's certification date? Is it the date the assessment is completed or is it the date the physician signs the form?
     The certification date is the date the physician signs the form ,unless specified by DOM under certain circumstances.

64.  Will the assessor be paid for assessment done when the applicant chooses another service?
     No.

65.  Will DOM consider the assessment date for the certification date so the case managers can be paid?
     No. The certification date will be the date the MD signs the Payment to begin at that date.

66.  Do you have to explain the other long term care services available during a recertification?
     Yes. This will ensure informed choice.

67.  Will there be a grandfather period for those already on a waiver?
     Individuals currently on the waiver will remain on the waiver and will be reevaluated for continued wavier services at the time of recertification.

68.  Do you or how do you assess implanted medication pumps?
     If the client has a medical condition or device that is not on the PAS, there is a comment box at the end of each section for documentation.

69.  Will the review staff at DOM be allowed to change the score if they disagree with the answers?
     No. The score will be determined electronically.

70.  How do you score a person if they are not on insulin, but frequently check their blood/glucose level?
     You may enter that information in the comment section.

71.  If an applicant is assessed by one program and found to be better served on another program, how will they fall on that waiting list?
     Each request will be considered individually and the recipient will be admitted to the program as soon as possible.

72.  How long is the assessment good for?
     Case Manager(s) perform the assessment. The PAS is submitted to MD to complete section 10. Until the physician completes section 10 and returns it to the provider, the PAS continues to be valid. After the MD has completed section 10, the entire PAS (sections 1-10) must be submitted to DOM within 30 days.

73.  Will DOM accept faxed copies of the PAS?
     Yes, DOM will accept FAX copies of the PAS but reserves the right to require all PAS to be submitted electronically in the future.

74.  Will DOM continue to accept paper copies of the PAS, since some people do not have internet access?
     Yes, but DOM reserves the right to require 100% electronic submissions in the future.

75.  Are the ICD-9 codes necessary as many physicians do not adhere to proper terms for diagnosis?
     One ICD-9 Code is required.

76.  If an individual is applying to a Medicaid-certified (Title 19 only) nursing facility, must they have the PAS and Level II?
     Yes. The individual must have the PAS and Level II Evaluation whether they are seeking Medicaid reimbursement for the bed or if they are private pay.

77.  If an individual is applying to a nursing facility which has Medicare-certified beds (under Title 18) and Medicaid-certified beds (under Title 19), is the PAS required?
     When the individual goes into the Medicare-certified skilled nursing facility bed, the PAS is not required, nor is the level II required.

78.  If an individual is transferred from a Medicare-certified (Title 18) skilled nursing facility bed and admitted to a Medicaid-certified (Title 19) nursing facility bed at the same facility, is the PAS required?
     Yes. The PAS is required when the person is admitted to the Medicaid-certified bed. If a Level II is indicated, it should be completed at that time. It is expected this function would be the responsibility of the nursing facility.

79.  If an individual is applying to a Medicare only (Title 18) skilled nursing facility bed, is the PAS required?
     No. The PAS is not required. The Level II is not required.