What is Pre-Admission Review? Pre-Admission Review originates from the Social Security Act nursing facility reform of There are three basic area

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1 Pre-Admission Review Council on Aging of Southwestern Ohio Area Agency on Aging 1, PAA Tricounty Parkway Cincinnati, Ohio (513) Updated August 2012

2 What is Pre-Admission Review? Pre-Admission Review originates from the Social Security Act nursing facility reform of There are three basic areas of Pre-Admission review s involvement with hospitals and Nursing Facilities. These are: LTCC: Long Term Care Consultation PASRR: Pre-Admission i Screening and Resident Review LOC: Level of Care

3 LTCC A Long Term Care Consultation provides clients or their representatives with information about options available to meet their long-term care needs. Pre-Admission Review staff determine whether an client is required to have a LTCC or is exempt.

4 LTCC Required Client applying or intends to apply for Medicaid Client not applying for Medicaid but likely to deplete funds within 6 months Client or her/his representative ti requests a consultation.

5 Individuals exempt from LTCC Hospice enrolled Expected to be in NF for >90 days Covered by Medicare, Medicaid HMO or private insurance Will not deplete funds in the next 6 months Lacks support in the community to return home Care needs clearly exceed community services available

6 Individuals exempt from LTCC Individual has a contractual right with the NF for admission NF is a Home for the Aged Individual is enrolled in a Home and Community Based Services Medicaid waiver LTCC cannot be completed within time frames (5 days) Individual has already received a LTCC

7 PASRR PASRR is an acronym for Pre-Admission Screening and Resident t Review. i It is screening for mental illness and mental retardation/developmental disability and/or related conditions for clients who are seeking admission i to a Medicaid-certified certified Ohio nursing facility (PAS) or, in certain circumstances, are already Ohio nursing facility residents (RR). It is done to ensure that nursing facility placement is appropriate for the client and that the client s needs for mental health and MRDD services are met.

8 Why do we have to do any of this screening? Because it s the law Nursing home reforms instituted in 1987 by the Federal Omnibus Budget Reconciliation Act (OBRA) Ohio Administrative i ti Code You may read the rule online at:

9 When do we have to screen a client? A client must go through h pre-admission i screening whenever the client is a new admission i to a Medicaid-certified id certified Ohio nursing facility.

10 Definition of a new admission to an Ohio nursing facility: The admission, i to an Ohio Medicaid-certified id certified NF, of an client who was not a resident of any Ohio Medicaid-certified certified NF immediately preceding the current NF admission nor immediately preceding a hospital exemption from which the client is to be admitted d directly to a nursing facility clients with no previous NF admissions clients admitted from other states,, regardless of type of residence clients with prior NF admissions who have been discharged from the NF and did not have either an intervening hospital exemption or other NF stay immediately yp preceding the current NF admission.

11 How to complete a PASRR (3622).

12 Tip: Get an early start

13 Read the directions. Please use ink. Please do not use white out to correct errors. Draw a single line through the information to be corrected, write correction, and initial the change. Please read each question on the screen all the way to the end! Please write the client s name on every page of the screen.

14 Section A: Identifying Information For Applicant/Resident id t All areas are required. Please note that Medicaid Recipient? refers to Ohio Medicaid. (Do not indicate Yes for a client who is a Medicaid id recipient i in another state.)

15 Section B: Reason For Screening Pre-Admission Screening codes Resident Review codes

16 Section C: Dementia Questions Please read all the way to the end of each question! You will need to know what the client s physician has determined to be the primary diagnosis. If no primary diagnosis is identified by the physician, then no single diagnosis is considered primary. An Axis I diagnosis does not necessarily mean primary diagnosis. Some clients may have an organic mental disorder resulting from other medical conditions (e.g., head injury); this must be documented by the physician. Regardless of the answers in Section C, Section D must be completed

17 Section D: Indications of Serious Mental Illness Question D 1 D 1 should be answered to reflect all mental health diagnoses the client carries. If the client is taking psychotropic meds, please inquire as to the reason s/he is taking them. Substance abuse/dependence diagnoses should be accounted for under another mental disorder... /letter h, only if the client has another mental illness diagnosis..

18 Section D: Indications of Serious Mental Illness Question D 2 D 2, part (a) addresses all intensive psychiatric services the client has received in the last two years. Outpatient psychotherapy and outpatient office visits to a psychiatrist for medication management do not count as intensive services. D 2, part (b) addresses all disruptions to the client s usual living arrangement in the past two years. Disruptions include arrest, eviction, inter- or intra-facility transfer, locked seclusion and may include other situations.

19 Section D: Indications of Serious Mental Illness Question D 3 D3 addresses any functional limitations it ti the client has experienced in the last six months because of mental illness issues.. Do not address limitations from other health concerns here (e.g. difficulty with ADL s due to arthritis or Parkinson s) s). Functional limitations may be indicated by things like weight loss, medication noncompliance, inability to meet living expenses because of diverting available financial resources to purchase drugs or alcohol, or suicide attempt. You may need to speak with a reliable informant other than the client to obtain this information.

20 Section D: Indications of Serious Mental Illness Question D 4 D 4 addresses disability income the client receives due to mental illness. If the client receives disability, you will need to find out why to answer this question.

21 Section D: Indications of Serious Mental Illness Question D 5 Question D5 is an outcome of the previous answers and will help determine if a Further Review is required.

22 Section E: Indications of MR Or Related Condition Question E 1 E 1 refers only to a formal diagnosis of mental retardation. If there is collateral information or chart lore that the client is slow or mentally challenged, please clarify this with the physician to determine if there is an actual diagnosis of Mental Retardation.

23 Section E: Indications of MR Or Related Condition Question E 2 Please read all the way to the end of the question! E 2 addresses any condition which may have impacted the client s growth and development. Conditions to address in this question include, but are not limited to: seizure d/o, traumatic brain injury, anoxic brain injury, spinal cord injury, cerebral palsy, polio/post-polio syndrome, paraplegia/quadriplegia, congenital malformations, genetic disorders, neuromuscular disorders, blindness, deafness.

24 Section E: Indications of MR Or Related Condition Questions E 3, 4 and 5 Please note that these questions will only be answered if E 1 or E 2 are answered Yes. Answer these questions only as they relate to the diagnoses in E 1 and/or E 2.

25 Section E: Indications of MR Or Related Condition Question E 6 Clients who currently receive services from Developmental Disabilities Services will automatically require further review for MRDD in the PASRR process.

26 Section E: Indications of MR Or Related Condition Question E 7 Question E:7 is the outcome of the previous answers and will help determine if Further Review is required.

27 Section F

28 Section G

29 Section H

30 Section I

31 Note that Section I states: I understand that this screening information may be relied upon in the payment of claims that will be from Federal and State funds, and that any willful falsification, or concealment of material fact, may be prosecuted under Federal and State laws. I certify that to the best of my knowledge the foregoing information is true, accurate and complete.

32 Following the change in the rule on 12/1/2009, several versions of the PASRR screen were made available. Revision 11/2010 is 9 pages; must be used for cases forwarded to DODD.

33 And, please Don t forget to date your screen in section I. This is the date you actually complete the document.

34 Are there any exceptions to Pre-Admission Screening? 1. The Hospital (Convalescent) Exemption bypasses the mental illness and MR/DD screening prior to nursing facility admission for a period of 29 days if all the requirements set forth in the rule are met. 2. The client is to transfer to a non- medicaid certified facility

35 Definition of a Hospital (Convalescent) Exemption: A new admission is considered to be an admission for a convalescent exemption if it meets all of the following criteria: The client is admitted directly from a hospital after receiving inpatient care at that hospital; and the client requires the level of services provided by a nursing facility for the condition which was treated in the hospital; and the client s attending physician has provided written certification, signed and dated no later than the date of discharge from the hospital,, that the client is likely to require the level of services provided by a nursing facility for less than thirty days.

36 So for a Hospital (Convalescent) Exemption to be valid: The client must be a new admission,, admitted to the NF directly from an inpatient hospital bed.. S/he may not be admitted from home in the community, the E.R., or an observation bed. The physician (not the physician assistant, not the nurse practitioner) must have documented the convalescent exemption in writing, signed it and dated it. This means no telephone or verbal orders to nurses. The exemption must be documented no later than the date of hospital discharge.

37 Documenting a Convalescent Stay prior to 12/1/2009 Documentation of a Convalescent Stay was commonly found on the Continuity of Care (COC) or Nursing Home transfer Form or any note of an exemption signed by the MD or DO. The date of the exemption must be consistent with the original date of NF admission.

38 Documenting a Hospital (Convalescent) Exemption from 12/1/09 1/31/10 The Grace Period Follow the procedure just discussed Or Use the new JFS Hospital (Convalescent) Exemption from Pre- Admission Screening Notification Must be totally complete Must include the MD or DO signature & date

39 Documenting a Hospital (Convalescent) Exemption after 2/1/10 All convalescent exemptions MUST be documented using the JFS form Hospital (Convalescent) Exemption or by using the HENS for the exemption to be considered d valid. HENS started t locally ll in August 2011.

40 JFS Ohio Department of Job and Family Services Hospital (Convalescent) Exemption form Pre-Admission Screening Notification This form completely replaces any previously accepted documentation of a convalescent exemption or a less than 30 day stay.

41 Section A: Indentifying Information for Applicant/Resident id t

42 Section B: Diagnosis of Serious Mental Illness, Mental Retardation ti or Related Conditions

43 Section B: Diagnosis of Serious Mental Illness, Mental Retardation ti or Related Conditions Please remember to document all diagnoses of Mental Illness, MR, Developmental Disabilities, and/or Related Conditions. Checking diagnoses in this section does not delay the hospital discharge. (If the client requires Further Review, it will be addressed by the NF in the Resident Review Process.)

44 Section C: Certification for Hospital (Convalescent) Exemption Hospital discharge planners AND NF admission staff: make certain the MD or DO signs & dates this section.

45 Section D: Return to Community Living Referral

46 Section D: Home Choice Use this section ONLY if you have made a referral to the HOME Choice Transition Program

47 Section E: NF Information

48 Hospital (Convalescent) Exemption Following the change in the rule on 12/1/09, several versions of the JFS were made available. Any version of the JFS is accepted. The Hospital Exemption Notification System (HENS) is also accepted.

49 Pre-Admission vs. Resident Review PAS (Pre-Admission Screening) is the process by which COA screens clients who are new admissions to a nursing facility in order to identify those who have indications of serious mental illness (SMI) or Mental Retardation or Developmental Disabilities (MR/DD) and who therefore must further be evaluated by Ascend/ODMH or DODD RR (Resident Review) is the process by which nursing facilities screen clients who are current residents to identify those who have indications of SMI or MR/DD and therefore must be further evaluated by the state authorities.

50 Roles in PASRR PAS = Pre-Admission Screening = COA RR = Resident Review = Nursing Facilities

51 New Admission: PAS Required Not a resident of an Ohio Medicaid Certified NF preceding current admission Not a Nursing facility resident prior to hospitalization from which an client is to be admitted directly to a NF Clients admitted from other states Clients with prior NF admissions, who had been discharged from an Ohio NF, and did not have an intervening hospital or other NF stay immediately preceding the current NF admission

52 Resident Review Required NF admission - admitted under Convalescent Stay, but now requires more than a twenty-nine nine day stay NF to NF transfer and there are no PASRR records available from the previous NF NF resident has experienced a significant change in condition at any time NF resident received ed a categorical determination and the stay has exceeded the specified time limit for that category

53 PASRR COMPLETION Coding the PASRR screen (3622)

54 PASRR Codes Pre-Admission Codes Code 1 - Ohio Resident seeking Nursing Facility admission Code 2 - Out-of-State Resident seeking Nursing Facility Admission Resident Review Codes Code 3 - Expired Time Limit for Hospital Exemption Code 4 - Expired Time Limit for Emergency Admission Code 5 - Expired Time Limit for Respite Admission Code 6 - NF transfer no previous PASRR records Code 7 - Significant Change in Condition

55 Actions to take Identify expired convalescent exemption Identify expired categoricals Identify NF to NF transfers Identify significant change of condition

56 How to initiate the RR Fill out 3622 with appropriate p code in Section B If the client does not have indications of SMI or MR/DD, place 3622 on chart. Do not send anywhere. If the client does have indications, fax 3622, MDS, Physicians Orders, functional assessments, therapy evaluations and progress notes, discharge potential, and a list of medications to Ascend and/or DODD.

57 Expired Convalescent Stay Date Due RR is initiated as soon as (and no later than the 29 th day from the date of admission) the NF has reason to believe the client may need to remain in a NF for thirty days or more.

58 Expired Convalescent Stay Payment Dates if Late If done late NF is paid for first 29 days. Payment then stops and re-starts on day RR is initiated. If resident needs further review, payment re-starts seven days after the state authority or Ascend receives the 3622.

59 Expired Emergency Stay Date Due Used only for clients who have been approved for a 7 day emergency stay by Ascend/ODMH and/or DODD. RR is initiated no later than the client s 7th day at the NF.

60 Expired Emergency Stay Payment Dates if Late If done late NF is paid for first 6 days. Payment then stops and re-starts seven days after the state authority or Ascend receives the 3622.

61 Expired Respite Admission Date Due Used only for clients who have been approved for a 14 day respite stay by Ascend/ODMH and/or DODD. RR is initiated iti t no later than the client s 14th day at the NF.

62 Expired Respite Admission Payment Dates if Late If done late NF is paid for first 13 days. Payment then stops and re-starts seven days after the state t authority or Ascend receives the 3622.

63 No Previous PAS/RR Records Date Due Used only for clients who transferred from another Ohio NF Used only if discharging NF and COA cannot find evidence that a PAS/RR was done RR is initiated iti t as soon as the NF finds that t no PASRR records are available from the previous NF placement. pace e This is a change. Prior to 12/1/09, Resident Review was due prior to day 30 at the NF

64 No Previous PAS/RR Records Payment Dates If the PAS was not completed at a previous NF, payment for subsequent NFs will not be impacted, unless a Further Review is in process.

65 Significant change of condition Change in clients current diagnoses, mental health treatment, functional capacity, or behavior such that as a result of the change, the client who did not previously have indications of SMI or MR/DD now has such indications (this includes any client who may have had indications of one or the other but now have indications of both SMI and MR/DD). Also includes those who were previously determined not to have SMI now does have SMI. The change is such that it may impact the mental health treatment or placement options of an client previously identified as having SMI and/or may result in a change in the specialized service needs of an client previously identified as having MR/DD

66 Contact Information DDM Ascend: Located in Nashville, Tennessee Fax: Toll-free phone: *ask for an Ohio Quality Team Member

67 ODMH (Ohio Department t of Mental Health) Address: 30 East Broad St. Columbus Ohio Phone number: (614) Fax number: (614) ** *help desk for Resident Review questions phone number: **unless specifically requested, fax all RR to ASCEND

68 DODD (Ohio Department of Developmental Disabilities) Address: 30 East Broad Street, 13 th Floor Columbus, Ohio Phone: (800) Fax: (614)

69 Payment When RRID is not initiated by the NF within the time frames, but is performed at a later date, Medicaid vendor payment is not available for services furnished to the eligible client from the date the RR was due through the seventh calendar day following the receipt of the ODHS 3622 form by Ascend or DODD.

70 Responsibilities of NF s Know when to initiate RR Timelines Definitions iti Record Retention: be certain you have received the 7000 form, HENS or the PAS review results letter, with an X indicating the PAS outcome.

71 Other Details If a level of care request was submitted after the RR was due, the PAA must obtain evidence of when it was initiated and must see the 3622 PAS/RR. Furthermore, if a further review was involved, evidence of the date that t it was forwarded d to the state t authority needs to be seen. If PAS requirements were not met upon admission, a review by the PAA must be conducted and the RR is not relevant. The level of care effective date is date PAS is determined. If RR/ID was never completed, Medicaid payment may not be available. However, the client does have hearing rights.

72 Level of Care Think of a level of care request as the clinical necessity certification required for a client to receive nursing facility care paid for by Ohio Medicaid. The Department of Job and Family Services makes the determination of financial eligibility for clients seeking Medicaid payment for NF care and the Council on Aging makes the determination of clinical necessity.

73 A Level of Care determination must be completed whenever 100% of a client s NF care is to be paid for by Ohio Medicaid. This does not include copayment days (days ) 100) of a client s NF care under her/his Medicare benefit. This does not include the care of hospice- enrolled clients or clients enrolled in Managed Care Plans. This does include the care of clients who intend to have Ohio Medicaid assume the cost of the NF care, but who have not yet completed an application for Ohio Medicaid. id

74 For LOC, we need all of the following: Demographic information Medicaid id # or pending Medicaid id # or application # All current diagnoses, with the primary diagnosis identified All medications, treatments and professional services (PT/OT/ST/RT/SN/dialysis) and their frequency Assessment of the client s ability to perform ADL s, including the ability to self-administer medications Current mental/behavioral status, including the client s need for supervision due to cognitive impairment (either less than 24h/day or 24h/day) Stability of client s condition (stable or unstable) Level of care/service setting being sought Estimated length of the client s stay in the NF Rehabilitation potential and Prognosis Assessment of the client s informal support system Statement that the client s physician has reviewed all information and that it is a true and accurate reflection of the client s condition Physician s s certification with signature and date

75 Activities of daily living ( ADL s ) ADLs) Mobility Bed mobility, transfer and locomotion Bathing Grooming Oral hygiene, hair care and nail care Toileting Use of commode, bedpan, urinal, changing an absorbent pad, cleansing the perineum, management of ostomy or catheter Dressing Donning and doffing all items of clothing and prostheses Eating Process of getting food to mouth, chewing, swallowing, management of feeding tube Medication administration

76 Instrumental Activities of Daily Living ( IADLs ) Shopping Meal Preparation Personal Laundry Environmental management Housecleaning, heavy chores, yard work/maintenance Community Access Using the telephone, accessing transportation, handling finances

77 Hands-on assistance or supervision? Hands-on assistance means the hands-on provision of help by another person in the initiation and/or completion of a task. Supervision means either reminding the client to perform or complete an activity or observing while the client performs an activity to ensure the client s health and safety. If the client makes an informed choice not to perform an activity, but could physically do the task if he chose, he is not considered to need hands-on assistance. Clinical judgment is a factor in deciding whether an client needs hands-on assistance or supervision.

78 Skilled or intermediate? Medicaid recognizes two nursing facility levels of care: : skilled and intermediate. t Intermediate level of care ( ILOC ) applies to clients who require: hands-on help with medication administration i ti + 1 ADL or hands-on help with 2 ADL s or 24-hour-per-day supervision due to cognitive impairment or one or more skilled nursing/rehabilitation services at less than a skilled level of care. Skilled level of care ( SLOC ) applies to clients who exceed an intermediate level of care and require skilled nursing services at a skilled level (7 days/week) or skilled rehab services at a skilled level (5 days/week), because of instability of condition and complexity of service or special medical complications.

79 Medicaid Level of Care Criteria PROTECTIVE (PLOC) The client s physical and mental condition and/or service needs do not meet all of the criteria for a skilled LOC, Intermediate LOC, or an ICF-MR level of care; and The client requires one of the following: Supervision of one ADL and assistance with three IADLs; or Supervision of self-administration of medication and assistance with three IADLs; or Due to a cognitive impairment, including but not limited to dementia, the client requires the presence of another person, on less than a twenty-four hour basis for the purpose of supervision to prevent harm.

80 Medicaid Level of Care Criteria INTERMEDIATE (ILOC) The client s physical and mental condition and/or service needs require services beyond protective level of care, but do not meet the minimum criteria for a skilled level of care; and At least one of the following applies: The client requires hands-on assistance with the completion of at least two ADL s; or The client requires hands-on assistance with the completion of at least one ADL and hands on assistance with medication administration; or The client requires one or more skilled nursing services or skilled rehabilitation services at less than a skilled care level; or Due to a cognitive impairment, including but not limited to dementia, the client requires the presence of another person, on a twenty-four hour a day basis for the purpose of supervision to prevent harm.

81 Medicaid Level of Care Criteria SKILLED (SLOC) The client s physical and mental condition requires services beyond the minimums for a protective level of care and an intermediate level of care; The client is considered to have an unstable medical condition; and at least one of the following applies; The client s condition necessitates, and the client s physician has ordered that at least one skilled nursing service be provided at the skilled care level; or The client s condition necessitates, and the client s physician has ordered, that at least one skilled rehabilitation service be provided at the skilled care level.

82 Stable or unstable? Instability of the client s condition means that clinical signs and symptoms are present in an individual id and the physician i has determined: The signs and symptoms are outside the normal range for the individual; Require extensive monitoring and ongoing evaluation of the individual s status and care and there is supporting diagnostic or ancillary testing reports that justify the need for frequent monitoring or adjustment of the treatment regimen Changes in the individual s medical condition are uncontrollable or unpredictable and may require immediate interventions A licensed health professional must provide ongoing assessments and evaluations of the individual that will result in adjustments to the treatment regimen as medically necessary. The adjustments to the treatment regimen must happen at least monthly, and the designated licensed health professional must document that the medical interventions are medically necessary.

83 Processing timeframes, from when the request is complete For clients in the community (including the E.R.), who require emergency NF placement (as defined by rule): 1 business day For clients in an inpatient hospital bed: 1 business day For clients in NFs and non- Medicaid clients in the community: 5 calendar days For clients in the community being admitted d to a NF under Medicaid: ten calendar days For clients working with APS: 1 business day with a 3697, 2 business days without a 3697

84 Some Frequently Asked Questions

85 Q: Are you sure I don t need a level of care for a hospice-enrolled enrolled client with Medicaid? A: No level of care is required for a hospice- enrolled client. However, you will need to complete the PASRR screen or the 7000 hospital exemption form or use the HENS.

86 Q: Do I need a Level of Care for a client enrolled in an HMO or Managed Care Medicaid? A: The HMO or Managed Care company will tell you if a Level of Care is required. *You will need to complete a PASRR screen or a 7000 form or a HENS

87 Q: Sometimes the client is ready for discharge from the hospital before DJFS has gotten back to me with the pending Medicaid number. What then? A: If the pending Medicaid number is the only missing piece of information, we will establish that the client meets level of care and advise you as to whether the client may transfer. We will follow up with the NF to obtain the Medicaid number and complete the level of care authorization.

88 Q: So, if my client has a completed HENS (or 7000 form) and Medicare is the funding source for his NF care, do I need anything from COA? A: No. But make certain the HENS or 7000 Hospital Exemption form is complete.

89 Q: How do I admit someone on Medicaid from the community? A: If the client is seeking Medicaid to pay for their stay from the day of admission, call Pre-Ad Ad. We will schedule an assessment and handle the PAS process and LOC. This includes people who will be applying for Medicaid in hopes that it will be retroactive to cover their entire NF stay from the date of admission.

90 Q: When can the Medicaid client be admitted from the community? A: If the client appears to meet LOC criteria, the assessor will inform the client of the outcome and give the client the PASRR screen and Review Results letter. If the client requires further review for mental illness and/or MRDD, the client will be notified of the outcome and COA will fax these forms to the NF.

91 Q: When is the community client s LOC authorized? A: Once Council on Aging obtains the attending MD s signature, the LOC authorization ti is faxed to the NF.

92 Q: How do I admit a client from the community who has Medicare skilled days, private insurance, or who will be private pay for a while including recently discharged clients who have gone home, but are not managing in the community? A: Fax a PAS screen, H&P done within the last 180 days signed by an MD, and the information on the cover sheet for a non-medicaid community admission to Pre-Ad at

93 Q: When can the non-medicaid client be admitted d from the community? A: COA is required to determine if a client would benefit from a Long Term Care Consultation. When Pre-Admission Screening is complete COA will fax you the Review Results letter indicating that the client may be admitted.

94 Q: How do I get a client in the ER or an observation bed into the NF? All clients must have a PAS processed by COA. The LTCC is conducted at a later time if it is required. If the client s payer source is Medicaid and no assessor from COA is available, a paper review for PAS and LOC is processed by Pre-Ad.

95 Q: What is the rule regarding state residency and convalescent exemptions? A: An out of state resident in an out of state hospital CANNOT be a convalescent exemption. An out of state resident in an Ohio hospital MAY be a convalescent exemption. An Ohio resident in an out of state hospital MAY be a convalescent exemption.

96 Q: What about clients from outside of Ohio? A: Clients who wish to be admitted to an Ohio NF from another state are considered new admissions and must go through Ohio s PAS, even if they were living in a nursing facility in the other state and/or have completed that state s pre-admission screening process. The request for Ohio pre-admission screening should be made to the area agency which serves the county in Ohio where the client is seeking NF placement. Please note that Ohio s PAS requirements apply and that Ohio may view the client s mental health history differently from the client s state of origin! Clients who require further review for SMI/MRDD by Ohio s standards will have to have the equivalent further review evaluation in their state of origin for consideration by ODMH or DODD. Clients who have Medicaid in the state of origin are treated as private pay clients until they establish Ohio residency/apply for Ohio Medicaid.

97 Q: If a client was in a NF but discharged to the community, what do they need to get re- admitted? A: If the payer source is non-medicaid, the client will require a new PAS. If the payer source is Medicaid, then a new face-to-face PAS and LOC assessment is needed.

98 Q: What about weekends? A: Extended coverage is available from 4:30 PM on Fid Friday through h midnight i on Saturday. For weekends which include a Monday holiday, coverage is extended through midnight on Sunday. To access extended coverage, fax your request to: (419) For best results, please make sure your extended coverage request is complete and accurate. Extended coverage is provided for the entire state by the Area Agency on Aging, District 3, in Lima, Ohio. Please be certain to identify yourself clearly on your fax, including your return fax number, with area code

99 For handy information and forms: Visit Council on Aging website to view the Pre-Admission Review section

100 Pre-Admission Review Staff Kim Clark, LSW Business Manager (513) Diane Kurtz, RN (513) Lucille Robins, RN (513) Kari Clore, LSW (513) Mary Turner, RN (513) Karen Zimmer, RN (513) Jane Oakley, MA, LSW (513) Anginette Sanders LOC/PASSPORT support specialist Kim Hotel Clinical Consultant Nursing Home Diversion/ Transition (513)

101 Contact Information for Pre-Admission Review at the Council on Aging Main telephone number (513) Hospital & Hospice fax: NF fax: Mail: 175 Tricounty Parkway Cincinnati, OH Hours: Monday through Friday 8:00 AM-4:30 PM