LTCFS Instructions Module 11: Completion of the LTCFS and Notes

Glossary of Acronyms, P-01010 (PDF) | LTCFS Paper Form, F-00366 (PDF)

Contents

• 11.1 Screen Completion Date
• 11.2 Face-to-Face Contact with Person
• 11.3 Collateral Contacts
• 11.4 Other Screen-Related Activity (Paperwork)
• 11.5 Travel Time
• 11.6 Notes
• 11.7 Calculating Eligibility
• 11.8 No Active Treatment

Objectives

By the end of this module, the screener should be able to:

• Record the screen completion date.
• Accurately record the time it took to complete a screen.
• Record face-to-face and collateral contact time.
• Record paperwork and contact time.
• Utilize the Notes utility built into the LTCFS application.
• Calculate functional eligibility (level of care).
• When applicable, complete the No Active Treatment section.

11.1 Screen Completion Date

Indicate the date on which all sections of the LTCFS 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. Therefore, the “Screen Completion Date” is not always the date information is entered in the online LTCFS.

When correcting information on a screen, do not change the “Screen Completion Date.” Change this date when entering information that reflects a change in the functional abilities of the person being screened.

Do not change the Screen Completion Date when transferring a screen to another screening agency or to the IRIS program.

11.2 Face-to-Face Contact with Person

This is the amount of time the screener spent face-to-face meeting with the person being screened. The screening process requires face-to-face contact with the individual being screened. No screen may be completed without meeting with the individual, even if they are unable to communicate, or has a guardian of their person or an activated power of attorney for healthcare.

The following types of contacts are not to be recorded as face-to-face contact:

• Face-to-face contact with the person's guardian, authorized representative, or any other collateral contacts.
• Telephone contact, video conference, internet video, fax or email communication with the person being screened, their guardian, authorized representative, or any other collateral contacts.

When multiple screeners are present, record the combined amount of time they spent in face-to-face contact.

Round all contact time to the nearest 15-minute increment.

Waiving the Face-to-Face Contact Requirement for the Initial Screen for an Applicant Out of State
In rare instances, there may be a need to complete a screen for a person who is currently located or residing in a state other than Wisconsin. In these instances, the screening agency must obtain approval from the Department of Health Services (DHS) to conduct a screen without face-to-face contact.

Requests from a screening agency to waive this requirement will be considered for the initial functional screen, only on a case-by-case basis, when the following criteria are met:

• There is a compelling reason to conduct the screen, even though the person being screened is not physically located in Wisconsin. Program policies define when an agency must provide screening and assessment for state and federal programs. Agency protocols should indicate when and why a screen may be conducted prior to the physical presence of an individual in the agency’s service area.
• Traveling to conduct the screen is a hardship to the agency. Hardships might include the need for air travel, overnight stay, excessive loss of work time (more than one workday), etc. It is not considered a hardship when the individual requesting screening lives in a bordering state to which a screener could travel without excessive cost or loss of work time.
• The screening agency has attempted to arrange for screening to be performed by a screening agency located closer to the individual, or such an attempt is unreasonable. The screen is site neutral and screening instructions are uniform across all adult LTC programs.
• The screening agency does not have other responsibilities for the person who requires face-to-face contact. If the screening agency is the placing agency or county of responsibility for an annual Watts Review, or has other court-ordered responsibilities for an individual, screening should occur in conjunction with these other requirements.

If DHS waives the face-to-face requirement, the functional screen must be completed based on a review of records and must occur during a telephone or video conference call, or internet video that includes the individual, their parent (if a minor), guardian or legal representative, and a credentialed professional knowledgeable about the individual and their daily care needs (e.g., nurse, teacher, or caregiver). The Notes section of the screen that is completed based on a waiver of this nature must indicate whether the screen was completed during a telephone call, video conference call, or internet video, and include the date of the DHS approval to waive the face-to-face contact requirement.

When a screening agency has received a waiver of face-to-face screening for any individual, a subsequent face-to-face screening must occur within 30 days of enrollment into a long-term care program.

When a screening agency has received a waiver of face-to-face screening for any individual, the agency must inform the individual that screening results are preliminary, as screen information was based on records and verbal responses only. The individual must also be informed that long-term care programs have financial and residency requirements, and may have waiting lists. Eligibility based on the screen, alone, does not guarantee the provision of services.

Process for Requesting Waiver of Face-to-Face Contact for an Initial Screen:

• The screening agency’s LTCFS liaison will email the request to DHS LTCFS Team. The submission must include the reasons for the request, based on the criteria listed above.
• As needed, the Functional Screen Section will consult other state program staff to determine the appropriateness of waiving the face-to-face contact requirement.
• Within 10 working days of the request, the Functional Screen Section will notify the screening agency’s liaison of approval or denial of the agency’s request.

11.3 Collateral Contacts

Collateral contact is the amount of time the screener spent face-to-face or by telephone in a two-way exchange of information with collateral contacts to confirm information provided by the person being screened. Collateral contacts may include, but are not limited to, a person’s guardian, family members, friends, health care providers, an authorized representative, and service providers.

Time spent conversing with others who are present while a person is being screened:
If a person’s caregiver is present during the time a screener is conducting a screening, the time spent is recorded as face-to-face time with the person being screened. None of the time is recorded as collateral contact with the caregiver.

The following contacts are not collateral contacts and should be recorded under 11.4, “Other Screen Related Activity (Paperwork)”:

• Communication with the person being screened, by:
  • Telephone
  • Telephone voice mail
  • Video conference
  • Internet video
  • Written information
  • Fax
  • Email
• One-way communication with someone other than the person being screened (e.g., guardian, healthcare providers), by:
  • Telephone voice mail
  • Written information
  • Fax
  • Email

Round all contact time to the nearest 15-minute increment.

11.4 Other Screen-Related Activity (Paperwork)

Count as other screen-related activity the amount of time spent completing paperwork, paper research, indirect or non-face-to-face contact with the person being screened, and in one-way communication with others to complete the LTCFS.

The time spent completing the following paperwork tasks and one-way communication of information must be recorded as screen-related activity:

• Communication with the person being screened, by:
  • Telephone
  • Telephone voice mail
  • Video conference
  • Internet video
  • Written information
  • Fax
  • Email
• One-way communication with someone other than the person being screened (e.g., guardian, healthcare provider), by:
  • Telephone voice mail
  • Written information
  • Fax
  • Email
• Review of previous Adult LTCFS or Children’s Long Term Support functional screen, written documentation, test results, evaluation reports, or other medical information.
• Consultation with the agency screen liaison, coworkers, or DHS staff regarding any aspect of an individual’s screen.
• Completing the online LTCFS.

Round screen-related activity time to the nearest 15-minute increment.

11.5 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 LTCFS.

When multiple screeners are present, record their combined travel time.

Round travel time to the nearest 15-minute increment.

11.6 Notes

Screeners are strongly encouraged to enter additional explanatory information in the Notes sections of the online LTCFS. Notes clarify why a selection was made on the screen and substantiate the screener’s selections on the screen should the individual who was screened file an appeal of their level of care. Notations that explain how diagnoses were verified are particularly helpful.

Use the following guidelines when entering notes:

• Notes should be dated with the month, day, and year.
• When new notes are added, the most current notes should be entered at the top of the Notes section.
• At a minimum, notes should be initialed by the screener. It is best practice to include the screener’s full name, screening agency, and professional designation at the end of any notes.
• Notes should be concise and provide person-specific information only. Notes should be written in a style that is factual, objective, unbiased, without jargon, and concise. Notes should be easily read and understood by others, including the person being screened should he or she request a copy of the screen.
• Notes must indicate the source of referenced information. For example: “SSA verified disability code as 3180 (MR). Neuropsychiatric evaluation on 12/23/15 by John Smith, PhD, lists diagnoses of ID, ADHD, and depression. Full Scale IQ 68” or “1/13/16 phone call with Dr. Smith’s nurse verified the Parkinson’s disease with dementia diagnosis.”
• Notes that are no longer accurate or relevant should be deleted. These notes are saved in screen history.
• Notes should not include personal information about people other than the individual who is being screened.
• Example of an appropriate note: “January 12, 2016: 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. --Susan Smith, RN, Wisconsin MCO”

11.7 Calculating Eligibility

Calculating eligibility is the step that makes a functional screen “complete.” Both initial and rescreens must be calculated to be complete. Do not calculate eligibility until you enter all information into the screen, including notes.

When a screener first enters information into FSIA, the screen is incomplete until eligibility is calculated. The screen shows as incomplete when a blue arrow is found next to the Eligibility section in the LTC Screen Status column, in the left-hand margin of the screen. To direct FSIA to complete a screen and calculate eligibility, the screener selects the Calculate Eligibility button. Once eligibility is calculated, the blue arrow becomes a green checkmark.

Not all edits or changes made to an existing screen require recalculation of eligibility. However, eligibility must always be recalculated when a change is made related to an individual’s functional status, diagnosis, HRS, ADLs, or IADLs.

Incomplete screens cannot be transferred to another screening agency. Therefore, eligibility must be calculated in order for a screen to be transferred; however, the screener does not need to recalculate eligibility before transferring a screen to another screening agency.

Once eligibility has been calculated for a particular screen and individual, the screener cannot change the individual’s name, Social Security number, or date of birth. When a correction is needed regarding these items, contact the DHS SOS Help Desk by emailing DHS SOS Help Desk or calling 608-266-9198 for assistance.

Unexpected Outcomes are target group and level of care results that do not appear to the screener to be congruent with the needs of the person being screened. The results may be different from prior screens, but if that change appears appropriate, then the results are not unexpected.

Whenever the results of a functional screen are unexpected by the screener, the screen is not considered complete and accurate. If the screen outcome results in an individual to be ineligible to enroll in a program or may result in a potential disenrollment of the individual from a long-term care program, no action should be taken until the screener agrees that the screen results are appropriate based on a complete and accurate screen.

The screener should request a review by the screen liaison in their agency. If, after that review, the results continue to be unexpected, the agency screen liaison should contact a functional screen quality specialist at the Department of Health Services who will perform a full review of the screen and consult with the screen liaison until the screen results are considered complete and accurate. Once the screen is considered complete and accurate, the screener takes the action that is required of them by their screening agency based on the results of the screen.

Note: When a screener believes the screen results accurately reflect the individual’s needs, the screener does not need to request a follow-up review, even if the results have changed from the previous screen.

11.8 No Active Treatment

The LTCFS No Active Treatment (NAT) section must be completed for any individual who has at least one A1-A10 diagnosis selected on the Diagnoses Table. The NAT section cannot be completed for individuals who do not have at least one A1-A10 diagnosis selected on the Diagnoses Table.

A NAT determination is not the same as a Pre-Admission Screening and Annual Resident Review (PASARR) determination. When an individual has received a determination of NAT, he or she is not necessarily exempt from a PASARR determination.

“No Active Treatment” (NAT) is a designation given to individuals with an intellectual/developmental disability who, for either health reasons or because of advanced age, no longer require treatment related to their intellectual/developmental disability. In addition, a person with an intellectual/developmental disability such as cerebral palsy, but with a normal IQ, could be appropriate for a NAT designation. An NAT designation can impact allowable residential settings for a person. Questions regarding NAT should be directed to the program’s DHS oversight team.

Instructions
The NAT section contains two parts, A and B. Part A statements will have automatic default selections based on entries made on the Diagnosis Table. If a screener needs to change a default selection in Part A, they should include an explanatory note about why the default selection was changed. 

Part A statements:

Statement 1: The person has a terminal illness.

• Yes: Selected if Terminal Illness is selected on the Diagnoses Table
• No: Selected if K3 Terminal Illness is not selected on the Diagnoses Table

Statement 2: The person has an IQ greater than 75.

• Yes: Selected if IQ score on the Diagnoses page is greater than 75
• No: Selected if IQ score on the Diagnoses page is less than or equal to 75
• N/A: Selected if IQ score on the Diagnoses page is selected as unknown.

Statement 3: The person is ventilator-dependent.

• Yes: Selected if F4 Ventilator Dependent is selected on the Diagnoses Table
• No: Selected if F4 Ventilator Dependent is not selected on the Diagnoses Table

After an individual enrolls in Family Care, PACE, Partnership, or IRIS, the program’s screener should complete Part B of the NAT section of the LTCFS.

Part B Statements:

Statement 1: The person has physical or mental incapacitation, typically but not always due to advanced age, such that their needs are similar to those of geriatric nursing home residents.

• Yes: Select Yes if person of any age has needs that are similar to those of geriatric nursing home residents 
• No: Select No if person of any age does not have needs similar to those of geriatric nursing home residents

Statement 2: The person is age 65 or older and would no longer benefit from active treatment.

• Yes: Select Yes if person is age 65 or older and the program has determined the person would no longer benefit from active treatment
• No: Select No if person is under age 65

Statement 3: The person has severe, chronic medical needs that require skilled nursing care.

• Yes: Select Yes if person of any age has severe, chronic medical needs that require skilled nursing care
• No: Select No if person of any age does not have severe, chronic medical needs that require skilled nursing care