Module 10: Completion of the Screen and Notes

Contents

• 10.1 Screen Completion Date
• 10.2 Face to Face Contact with Person
• 10.3 Collateral Contacts
• 10.4 Paper Work
• 10.5 Travel Time
• 10.6 Notes
• 10.7 Calculating Eligibility
• 10.8 COP Level 3
• 10.9 No Active Treatment

Objectives

By the end of this module you should be able to:

• Accurately complete the time it took to complete a screen.
• Utilize the Notes utility built into the LTC FS application.

10.1 Screen Completion Date

Indicate the date on which all sections of the LTC FS were complete. It may take more than one day to complete all sections (ADL, IADL, HRS table, etc), especially if a screener must wait for information from health care providers. It is acceptable for one person to enter the demographic information (module 1) and for the certified screener to complete the clinical entries (module 2-6). However, all of the screen entry time should be combined and put under the certified screener's name.

When correcting information on a screen, do not change the "screen completion date." Enter the exact time it took to correct or update a screen. If you are simply making changes to the demographics (e.g., change of address), then enter "0". You must re-calculate eligibility after making screen corrections as required in section 10.8.

Note: The screen completion date is the date when all sections were completed by the certified screener, not the date information is entered into the computer.

10.2 Face to Face Contact with Person

This is the amount of time the screener spent face-to-face meeting with the consumer.

10.3 Collateral Contacts

This is the amount of time the screener spent face-to-face meeting with collateral contacts (family members, friends, health care providers, etc). And/or the amount of time the screener spent on the phone talking with collateral contacts. Please round time to the nearest 15 minutes (00, 15, 30, 45).

10.4 Paper Work

This is the amount of time the screener spent doing paperwork and paper research to complete the LTC FS. Phone contact with the consumer should be included in this category. Please round time to the nearest 15 minutes (00, 15, 30, 45).

10.5 Travel Time

This is the amount of time the screener spent traveling to and from appointments associated with the gathering of information necessary to complete the LTC FS. Please round time to the nearest 15 minutes (00, 15, 30, 45).

• Write all times as hours and minutes rounded to the nearest 15 minutes.
• The LTC FS application will sum them up for the total time.

10.6 Notes

Throughout all sections of the LTC FS screeners may click on the "Notes" link on the left bar of the screen to enter notes.

• Notes should be dated and initialed by the screener.
• Notes should be concise and provide additional information that the screener thinks would be of value to the LTC program selected by the person being screened.
• Example of appropriate note entry:
  "January 12, 2003:
  "Ms. Washington has many throw rugs on her wooden floors. We spoke briefly about falling, but this should be pursued further. She is able to prepare meals, but is inclined to get by on sweets because it is too much trouble to "cook for one."
  "--S. Smith, RN

10.7 Calculating Eligibility

The act of calculating eligibility is the final step that makes a functional screen 'complete'. This applies to new screens, or updates to existing screens.

When you enter a new screen, that screen will be considered 'incomplete' until eligibility is calculated. If there is no red check mark next to eligibility on the left-hand navigation bar, then the screen is currently 'incomplete'. You must calculate eligibility to make this screen 'complete', which will show up as a red check mark next to eligibility on the left-hand navigation bar.

When you are making a change to an existing screen, there are some times when you must re-calculate eligibility, and some times when re-calculating eligibility is not required.

Any time you change any data which may cause a change in eligibility (i.e., a change to ADLs or IADLs or HRS, etc), you must re-calculate eligibility, even though the LOC scores may not have changed. In addition, any time you make a change to applicant name, applicant SSN, or applicant birth date, eligibility must be re-calculated, even though these data items won't have any affect on LOC score.

If you change any of the following data, you will not have to re-calculate eligibility:

• Applicant address
• Applicant phone number
• Applicant gender
• County/tribe of residence
• County of responsibility
• Directions
• Screener's name
• Referral date

How can you tell when you need to re-calculate eligibility? Always check for the red check mark next to eligibility on the left-hand navigation bar. If there is a red check mark, the screen is considered 'complete'. No red check mark means the screen is considered 'incomplete'.

10.8 COP Level 3 (For Home and Community Based Waiver Counties Only)

The COP Level 3 page is optional and should be used after the person has been fully screened to test for waiver eligibility.

Part A - Alzheimer’s and related diseases:
1. The person has a physician's written and dated statement that the person has Alzheimer's and/or another qualifying irreversible dementia.

2. The person needs personal assistance, supervision and protection, and periodic medical services and consultation with a registered nurse, or periodic observation and consultation for physical, emotional, social or restorative need, but not regular nursing care.

Alzheimer’s disease and other irreversible related dementia describes a degenerative disease of the central nervous system characterized especially by premature senile mental deterioration and also includes any other irreversible deterioration of intellectual faculties with concomitant emotional disturbance resulting from organic brain disorder.

Irreversible dementia diagnoses include:

• Alzheimer’s Disease
• Creutzfeld-Jacob Disease
• Friedrich’s Ataxia
• Huntington’s Disease
• Irreversible Multi-Infarct Disease (DSM III, 290.4x)
• Parkinson’s Disease
• Pick’s Disease
• Progressive Supranuclear Palsy
• Wilson’s Disease

Part B – Interdivisional Agreement 1.67:
1. The person resided in a nursing home or received CIP II/COP-W services and was referred through Interdivisional Agreement 1.67 in accordance with s. 46.27(6r)(b)(3).

Applies to individuals for whom a DHS/Division of Quality Assurance nursing home surveyor has issued a 1.67 administrative order to refer the individual to the county for nursing home discharge and alternative living arrangement (or other needed services).

10.9 No Active Treatment (NAT) (Family Care MCO Counties Only)

To augment your understanding of the text that follows, refer to the NAT page on the paper form and the NAT algorithm in the Appendices at the end of this instruction manual.

"No Active Treatment" (NAT) is a designation given to individuals with a developmental disability who, for either health reasons or because of advanced age, no longer require treatment related to their developmental disability. In addition, a person with a developmental disability such as cerebral palsy but with a normal IQ could be appropriate for a NAT designation.

In order to use Medicaid funds for Family Care (FC) services, the U.S. Center for Medicaid and Medicare Services (CMS), has granted Wisconsin two separate home and community-based waivers. One is for frail elders and people with physical disabilities, and one is for people with developmental disabilities. CMS requires that individuals with a developmental disability receive services through the developmental disabilities waiver unless there is documented evidence that active treatment for the developmental disability is not required. This decision would result in a NAT designation for such an individual.

There are limited circumstances in which a NAT designation would be beneficial to a FC consumer. The care planning process in FC is the same for all members, whether they have a developmental disability or not, so any appropriate active treatment would be included no matter which waiver they are in. The only reason to process a NAT designation is related to a difference in the residential services allowable for people enrolled in the FC developmental disabilities waiver, versus people enrolled in the FC elderly/physical disabilities waiver. Residential services for individuals in the FC developmental disabilities waiver must be provided in a setting of 4 or fewer beds (MCOs can obtain a waiver for settings up to 8 beds). For individuals in the FC elderly/physical disabilities waiver, there is no limit on size or type of residential facility.

The county Economic Support (ES) unit must enter the appropriate waiver and level of care on the CARES system to complete the eligibility determination and FC enrollment process. In non-FC counties, the assessment and care planning activities occur before eligibility determination, so the long-term care program has had an opportunity to determine if an individual with developmental disabilities should receive active treatment, or whether he/she should have a NAT designation. In Family Care counties, the MCO does the assessment and care plan after the individual enrolls.

In order for an appropriate waiver to be designated at enrollment, before the MCO has finished the comprehensive assessment and care plan, the initial Long Term Care Functional Screen (LTC FS) will automatically designate the developmental disabilities waiver if the individual has been checked as being in the federal developmental disabilities target group, (regardless of other target groups checked). Similarly, if a diagnosis normally associated with a developmental disability (i.e., cerebral palsy, muscular dystrophy) has been checked, the LTC FS will default to the FC developmental disabilities waiver.

A NAT designation can be entered if the resource center has certain information, or if the MCO comprehensive assessment supports an NAT designation.

The resource center may check the NAT screen if any of the following are true:

• The person has a terminal illness;
• The person has a documented IQ greater than 75 (The RC must give the documentation about IQ level to the MCO); and/or
• The person is ventilator-dependent.

After completing the comprehensive assessment, or at the time of a re-certification or change of condition screen, the MCO may indicate a NAT designation on the LTC FS, or may request the resource center to do so, if:

• The person meets any of the criteria described in the above paragraph;
• The person has physical or mental incapacitation due to advanced age such that his/her needs are similar to a geriatric nursing home resident;
• The person is elderly (over 65) and would no longer benefit from or no longer wants to participate in active treatment for his or her developmental disability; and/or
• The person has severe chronic medical needs requiring skilled nursing care.

Documentation that supports why the person has a NAT designation must be part of the member’s record at the MCO. The Department will monitor the appropriateness of NAT designations by including individuals with NAT designations in targeted care plan reviews.

Last Revised: March 01, 2012
Wisconsin Department of Health Services
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