Changes to LTSS Screenings: Nursing Facilities and Acute Care Hospitals (2024)

The purpose of this bulletin is to notify providers and LTSS screening teams of new requirements for LTSS screening resulting from the 2024 General Assembly passing ofHouse Bill 291 andSenate Bill 24.

Effective immediately, LTSS screenings are no longer required when a Medicaid member is discharged from an acute care hospital to a nursing facility to receive skilled services, including rehabilitation services. Previously, any individual who was enrolled in Medicaid or may become Medicaid eligible was required to have the LTSS screening conducted by a hospital screening team prior to admission to a nursing facility for skilled services.Hospital screening teams must continue to conduct LTSS screenings when a Medicaid member requests the screening or when the Member is discharged to a nursing facility for LTSS service or custodial care. They must also conduct screenings when the individual is discharged to the community and may need LTSS home and community-based services.

Nursing facility screening teams can conduct LTSS screenings when Medicaid members receiving skilled services are expected to need LTSS/custodial care after the skilled nursing stay.

The screening, including physician certification, must be completed within three business days of initiating LTSS/custodial care to receive Medicaid reimbursem*nt from the initiation date. If the screening is not conducted within three business days, reimbursem*nt for the services may not begin until after the screening has been completed.

Additionally, as an update to the Medicaid Bulletin “Post-Admission Long-Term Services and Supports Screenings by Skilled Nursing Facilities Effective July 1, 2023” on August 10, 2023, any individual who was previously not screened prior to admission to a nursing facility for LTSS/custodial care, may have a LTSS screening performed by the NF screening team. All other requirements, as outlined in the August 10, 2023, bulletin still apply and remain in effect.

When Medicaid members residing in the community are in imminent need of nursing facility placement and the community-based screening team cannot conduct the screening within 30 days of the screening request, the nursing facility may collaborate with the community-based team to determine which entity can conduct the screening most expeditiously. The nursing facility must document the agreement for the nursing facility to conduct the screening in their records. This documentation must be available for review upon DMAS's request. It should include the individual's name, Medicaid identification number, the name of the community-based screener, and the nursing facility staff member, as well as details of the agreement.

When a nursing facility conducts an LTSS screening, the individual must be offered a choice between institutional or home and community-based services. This includes the Commonwealth Coordinated Care Plus (CCC Plus) Waiver and the Program of All-Inclusive Care for the Elderly (PACE). A choice must be offered to all individuals found to meet the nursing facility's level of care.

None of these changes impact the Pre-Admission Screening and Resident Review (PASRR) requirements, which are federally mandated. All individuals who seek admission to a nursing facility require the PASRR Level I screening to be completed prior to admission. If the individual is determined to have a serious mental illness (SMI) or intellectual disability during the PASRR Level I screening, the Level II screening must also be completed prior to the individual’s admission to the nursing facility.

For questions, please emailscreeningassistance@dmas.virginia.gov