0815.025.00 Preadmission Screening for Entry into Nursing Facilities

Effective January 1, 1989, all potential residents of MO HealthNet (MHN) certified beds in nursing facilities must be screened for intellectual disabilities (formerly mental retardation and mental illness) (MR or MI) and developmental disabilities (DD) prior to admittance to a MHN certified bed. The nursing facility or hospital is responsible for completion of the prescreening process. Applicants for vendor benefits are subject to this requirement unless the individual resided in a MHN certified bed prior to January 1, 1989.

Completion of the DA-124C Level One Nursing Facility Pre-Admission Screening for Intellectual Disabilities or Related Condition form with a physician's signature is a Level I screening. Every potential resident of a MHN certified bed must have a Level l screening. If a potential resident is suspected of being MR, MI or DD, the Department of Mental Health (DMH) must complete a Level II screening to determine whether placement in the nursing facility is appropriate.

0815.025.05 Preadmission Screening Process

Prior to placement in a MO HealthNet (MHN) certified bed, the potential resident's attending physician completes the DA-124C. If the physician does not suspect the potential resident of being MR, MI, or DD the nursing facility may admit the resident without further screening. A copy of the DA-124C will be kept in the resident's record at the nursing facility. If the resident requests MHABD vendor, the facility will submit a copy of the DA-124C with the DA-124A/B to COMRU for a level of care (LOC) certification. COMRU will enter the LOC on the DA 124 Inquiry Report screen (I124).

If the potential resident is suspected of being MR, MI or DD:

1. The potential resident may not be admitted to the nursing facility unless they meet a valid special admission category. There are 5 special admission categories that would qualify a potential resident suspected of being MR, MI or DD to enter a NF prior to the Level II screening being completed. See form DA-124C for a list of special admission categories.
2. If the potential resident does not meet a special admission category, the nursing facility, hospital, or attending physician sends the DA-124A/B and C forms to the Department of Health and Senior Services, Division of Senior and Disability Services, Central Office Medical Review Unit (COMRU).
3. COMRU reviews the DA-124A/B and C forms and certifies if the individual is in need of the level of care (LOC) provided by a nursing facility.
4. For individuals suspected of being MR, MI or DD, COMRU forwards the DA-124A/B and C forms to the Department of Mental Health (DMH) Division of Behavioral Health for a Level II screening.
5. The DMH will notify COMRU if the individual may be admitted to the nursing facility.
6. COMRU notifies the facility and the individual/responsible party of the decision, and enters the information on the DA-124 Inquiry Report screen (I124). When a Level II screening is completed, the FSD designee must receive a copy of the Level II Notification for FSD form (DA-625) prior to authorizing payment or denying vendor benefits.

0815.025.10 Verification of Preadmission Screening

If a MO HealthNet for the Aged, Blind or Disabled (MHABD) applicant or participant enters the facility on or after January 1, 1989, verify that the preadmission screening was completed and the date it was completed. Verification may be obtained by viewing the DA-124 Inquiry Report screen (I124). Print and file a copy of the report in the case record.

For individuals who must have a Level II screening, the date the DMH reaches a decision on proper placement is the date the preadmission screening is considered complete. If a Level II screening is indicated on the DA-124 Inquiry Report Screen, (Codes MI or MR), the FSD must receive a copy of the Level II Notification for FSD form (DA-625) prior to authorizing payment or denying vendor benefits.

If an individual transfers from a non-certified bed to a MHN certified bed whether or not the transfer is made within the same facility or a different one, the nursing facility must complete the Level I screening process. If a Level II evaluation is needed, this must be performed prior to transfer.

An individual transferred from an out-of-state nursing facility to a facility in Missouri must be screened under Missouri's process prior to approval for MHABD vendor benefits. Therefore, a Level I and Level II screening, where applicable, must be performed before vendor benefits are authorized.

Do not delay authorizing approvals or changes to vendor benefits for verification of preadmission screening when no new DA-124C form is required. There is no need for a new DA-124C form when:

• An individual is placed in a bed that is not MHN certified.

  NOTE: The Eligibility Specialist should explore MHABD Spenddown/Non-spenddown or Supplemental Nursing Care (SNC) as appropriate

• A participant transfers from a MHN certified bed in one facility to a MHN certified bed in another facility;
• A participant is discharged from a MHN certified bed to a hospital and returns to a MHN certified bed, whether in the same or in a different skilled nursing or intermediate care facility;
• A participant is discharged from a MHN certified bed or hospital to home or other non-vendor living arrangement but returns to a MHN certified bed in the same or a different nursing facility within 60 days. If the period of time the individual is at home or in a non-vendor living arrangement is more than 60 days, another Level I screening (DA-124C) must be performed.