How to Refer a Consumer for a Level of Care 90-Day Redetermination for Purposes of Medicaid Payment in the Nursing Facility

Transcription

1 How to Refer a Consumer for a Level of Care 90-Day Redetermination for Purposes of Medicaid Payment in the Nursing Facility The MinnesotaHelp Network online referral site allows nursing facilities to determine if a current resident meets nursing facility level of care for purposes of Medicaid payment. This step-by-step guide only provides guidance for submitting referrals for nursing facility residents (age 21+) who meet the following criteria: 1. Admitted to a nursing facility/certified boarding care/swing bed on October 1, 2014 or later AND The first quarterly MDS resulted in a PA1 or PA2 RUG classification 2. Applied for Medical Assistance after January 1, 2015 AND The most recent quarterly MDS resulted in a PA1 or PA2 RUG classification Tips for Completion: Please bookmark the online referral site for easy access. By bookmarking this page, you will always be accessing the most up-to-date version. As you complete each screen, that name of the section will turn blue in the left hand side on the navigation bar. The current screen you are located on will be highlighted in blue. 1

2 When a section is completed and you see it as blue on the left hand sidebar you can return to the page, if changes are needed. o If you enter or change any information on a screen, you must click Continue or the information on that screen will be lost. If you need to return to a previous screen and have already entered information on the current screen, click Continue before returning to the screen that requires changes. Required fields are marked (Required) after the field label. You will not be able to continue until you have completed the required information. Errors will appear in red boxes under the fields that need to be completed or corrected. After Submission: After selecting Submit Referral, you will receive an output form that contains all submitted information, as well as a confirmation number, date and time stamp to show the form was submitted. o You are encouraged to print a copy of the referral for your own records. Updating or Changing Information: There may be instances when you ve completed a referral and realize that some information provided was incorrect or has changed. There are several ways to update this information. Contact the Senior LinkAge Line via chat or phone to update: o Date of birth o Name Significant changes which may impact level of care should be done through a new submission. Technology Tips: The online referral site is compatible with newer versions of several commonly used Web browsers including the following types: Internet Explorer 10 and newer, Google Chrome, Firefox and Safari. If you notice that a number of fields are grayed-out when completing an online referral, this is often a sign that you are using an older, incompatible browser or that you are still within your agency s intranet. The following tips can be used to ensure the referral form is accessible: Ensure the Web browser is up-to-date. Open a new browser and go to a public site like Google, from Google enter the following URL: Step-by-Step Guide: Home page: This is the home page of the online referral site, where the submitter can choose which type of referral they would like to make. Choose the second option, Needs a Level of Care 90-day redetermination for Medicaid payment in the nursing facility. Once the type of referral has been selected, click the Continue button. 2

3 Please note the chat/ feature in the upper right hand corner. Senior LinkAge Line specialists are available during business hours to chat. s may be submitted after hours. This feature is available on all pages of the referral site. Start page: This page provides information about the referral protocol and completion of the online form. A series of questions are provided for the submitter to ensure a referral is necessary for Medicaid Level of Care 90 day 3

4 redetermination purposes. After reviewing the introduction and completing the series of questions, click Continue. Unnecessary Referrals If a referral is unnecessary, a message will appear in a red box explaining why the referral is not needed. Once the series of questions have been answered about the resident, the user will be allowed to click on the Continue button. 4

5 Health Care Provider Completing Information Screen: Enter information about the submitter. It is important for the Senior LinkAge Line to know who entered the information, if questions arise or clarification is needed. Providers located in Minnesota: Provider Type will default to Nursing Home/Certified Boarding Care/Swing as they are the only types of providers submitting this particular type of referral. Click the blue Search Listings button to find your provider listing. Searching for Listings Providers can be located by searching with a part of the provider name or the city. For example, if searching for Golden Living Center-Bloomington you can search by typing in Golden to find all providers with Golden as part of the provider name. Or you can simply type in Bloomington to find all providers located in Bloomington. 5

6 Once you have selected a location, by clicking on the Name of the Nursing Home/Certified Boarding Care/Swing Bed, the Provider Name, Type of Service, Address, City, State, County and Phone Number fields will auto-populate for you. Enter the name of the person actually completing the online referral. This will assist the Senior LinkAge Line, if questions or clarification is needed. Select the corresponding title of the person completing the online referral. Consumer Information Screen: The purpose of this section is to collect information about the consumer. Be sure to double check the consumer s: First name spelling Last name spelling Date of birth Age which is calculated by the date of birth that was entered 6

7 Financial Information Screen: This section provides information to help with identifying the individual in state systems. It also helps the Senior LinkAge Line determine if the consumer is on a public program, waiver, Alternative Care or managed care plan. This is crucial if the consumer needs to be referred for a Long Term Care Consultation/MNChoices face to face assessment. PMI (Person Master Index) Number: Eight numbers and must begin with the number 0. If the consumer is on Medical Assistance, this number is the same. Medical Assistance Number: Eight numbers and must begin with number 0. Does the consumer currently have a care coordinator/case manager? If Yes is selected, contact information will be required in order to continue. This could include a mental health case manager, public health, managed care coordinator or other county case manager. Nursing Facility Admit Date Enter the date the consumer admitted to the nursing facility. Nursing Facility Pay Sources: Indicate the current pay sources for the consumer s nursing facility stay. 7

8 Quarterly MDS Assessment Results: This screen will be completed based on certain values from the first quarterly MDS assessment for residents admitted on or after October 1, 2014 and the MDS resulted in a PA1 or PA2 RUG classification. For residents applying for Medicaid, this screen will be completed based on certain values from the most recent quarterly MDS assessment. It s important to note that the not all questions from the quarterly MDS are needed to determine nursing facility level of care for purposes of Medicaid payment. Therefore, only the necessary fields are provided. Nursing facilities are encouraged to have the associated quarterly MDS with them as they are completing this screen as the fields, pick list values and scripts are the same as the MDS. Some questions will prompt additional information such as: Cognitive Assessment: Did the resident actively participate in the BIMS assessment? Based on the response, the user will be prompted to answer an additional question. o If the resident participated, the user will be prompted to input the BIMs score. o If the resident did not participate, the staff assessment result will be input. When fields Bed Mobility, Transfer, Walk in Room, Walk in Corridor, Dressing, Eating, Toilet Use or Personal Hygiene have a value of 7-Activity occurred only once or twice, the user will be prompted to complete additional fields to clarify how much assistance was provided. Once the user has completed all appropriate fields on the screen, click on Continue to proceed. 8

9 Additional Health and Functional Needs: This screen captures additional information about the resident based on their current status/condition in the nursing facility. These questions are not based on the most recent quarterly MDS nor should similar values attempt to be found for comparison. The scripts for each field should be reviewed so the questions can be answered appropriately. 9

10 Review Page: This page summarizes the responses entered onto the online referral site as well as gives an initial Level of Care Result. It can only be determined that a consumer does not meet level of care through a face-to-face assessment by the lead agency (county, tribe or managed care organization). Level of Care MET The nursing facility will submit the referral to the Senior LinkAge Line and print a copy for their records. Nothing more needs to be done by the nursing facility at this point. Level of Care CANNOT BE DETERMINED The consumer will be referred by the Senior LinkAge Line to the lead agency for a Long Term Care Consultation/MNChoices face to face assessment. The consumer should be notified a referral for a face to face assessment was made on their behalf and the reason why. Please note this referral does not mean the consumer will not meet level of care; only that additional screening and information is required. By submitting the referral, you are confirming that you have gained permission from the resident to submit their information to the Senior LinkAge Line. Please take the time to ensure the information submitted is correct. If incorrect, go back to the appropriate screen to make changes. Be aware that the form will not be submitted until you hit the Submit Referral button. Without taking this final step, the information will not be submitted to the Senior LinkAge Line and will be lost once you close your Web browser. Please note, these screenshots do not show the entire Review page, only the first view and the last view of the page. 10

11 Beginning of Review Page: End of Review Page: Confirmation Page: Users can print or save the referral as a PDF. This is highly recommended for tracking purposes. If an additional copy of the referral is needed, nursing facilities can call or chat with the Senior LinkAge Line to request a copy. 11