Provider Notice created 02/20/2019

Date:  February 20, 2019                                                  
 
To:     Supportive Living Program (SLP) providers
 
Re:     An Overview of the Preadmission and Conversion Screenings Process for Potential Supportive Living Program Participants
______________________________________________________________________
 
This Notice provides additional clarification and guidance to the Informational Notice dated 06/22/11 entitled Preadmission and Conversion Screening.  Please note that some processes have been updated or changed, while others remain the same.
 
The Supportive Living Program (SLP) operates under the authority of a 1915 (c) Home and Community Based Services (HCBS) waiver of the Social Security Act, rather than a State Plan service.  The SLP waiver participants are individuals aged 65 years and over or individuals ages 22-64 years with physical disabilities. The SLP provides a combination of medical and non-medical services to individuals that are eligible for a Nursing Facility (NF) Level of Care (LOC) but are independent enough that their needs can be met within the community rather than in an institutional setting.
The purpose of this notice is to ensure Supportive Living Program (SLP) providers understand the general processes relating to preadmission and conversion screens. As the SLP is an HCBS waiver alternative to NF placement, this screening process also allows the opportunity for the individual to explore options for other HCBS.  
Preadmission Screens
The preadmission screen is a required screen which will assess the Level of Care functional needs of an individual using the Determination of Need (DON), or successor, assessment tool and determine if placement in the SLP is appropriate. The SLP requires that an individual must meet the NF LOC to be eligible for Medicaid payment. DON scores below the currently established threshold, indicate the individual does not require the level of care provided in a SLP and Medicaid payment will not be approved.
The SLP must contact the appropriate screening agency when an individual plans to seek admission to the SLP to request the preadmission screen.
 
  • The Department on Aging (DoA) contracted Care Coordination Unit (CCU) screening agency completes the preadmission screen for individuals aged 60 years and older.
  • The Department of Human (DHS) Services Division of Rehabilitation (DRS) screening agency completes the preadmission screen for individuals aged 18-59 years entering a SLP from the community. DHS DRS has contracted with the DoA CCU’s to complete the preadmission screens for individuals aged 18-59 years when discharging from the hospital into the SLP. 
The DoA CCU or DHS DRS screening agency will obtain information directly from the individual and other appropriate person(s) that is necessary to complete the preadmission screen. The screening agency will assess whether there is a suspicion of an intellectual/developmental disability or mental illness. The presence of a serious mental illness does not automatically preclude the individual’s admission to the SLP. 
If the preadmission screen completed by the DoA CCU agency or the DHS DRS agency identifies a suspicion of an intellectual/developmental disability or mental illness, an additional evaluation must be completed by the appropriate DHS Division.
  • The DHS Division of Developmental Disability (DDD) Independent Service Coordination (ISC) agency completes the additional evaluation to determine whether there is an intellectual or developmental disability.
  • The DHS Division of Mental Health (DMH) designated Mental Health Prescreening and Resident Review (MH PASRR) agency completes the additional evaluation to determine the seriousness and persistence of risks and needs  related to any serious mental illness  and whether these exceed the capacity of the SLP.
If the evaluation determines the individual has an intellectual/developmental disability or a serious and persistent mental illness in which those needs of the individual are not able to be met by the SLP, the individual will be determined to not be appropriate for SLP admission.
Conversion Screens
An individual who enters the SLP as private pay and later converts to Medicaid while in the SLP, must complete the preadmission screening process at that point in time. The conversion screen will be performed by the Department of Healthcare and Family Services' Bureau of Long Term Care (BLTC) field staff. The SLP should contact their BLTC regional office to schedule a conversion screen when the resident becomes Medicaid-eligible. As with the preadmission screen, a conversion screen requires the individual to meet the NF LOC using the DON, or successor, assessment tool to allow Medicaid payment.
Transferring From a NF to SLP or from SLP to SLP
A resident transferring from a NF to a SLP, from SLP to SLP or returning from a temporary absence of less than 60 days does not require another determination of eligibility through completion of a new DON. However, if the individual has a history of an intellectual/developmental disability or mental illness, as evidenced in the medical history accompanying the individual that is transferring, the SLP provider must complete a referral for the special SLP evaluation to be completed by the appropriate DHS DDD or DHS DMH agency.  The additional evaluation must be completed prior to the individual’s transfer to the SLP. This is a change from prior procedures, in which the special MH PASRR evaluation could be requested and completed after transfer to SLP.
The SLP provider shall not complete an extensive investigation of the individual’s intellectual/developmental disability or mental health history, including mental health diagnoses, conditions, or medications until the results of the DDD ISC or DMH PASRR evaluation have been received. The SLP provider shall reserve the determination of whether it can meet the needs of the individual until after these processes have been completed.  SLP provider non-compliance with the preadmission or conversion screening processes detailed above may result in findings and recovery of payments, if appropriate. 
Right to Appeal
The results of the determination for a NF LOC eligibility completed by the DoA CCU or the DHS DRS agent shall be made available upon request to potential participants of the SLP. The individual has the right to appeal the results.
The results of the MH PASRR shall be made available to all potential participants of the SLP.  If an additional evaluation was completed by the DHS DMH PASRR or DHS DDD ISC agent, the individual may appeal the determination pursuant to 89 Ill. Adm. Code Section 104. 
  • An individual screened by the DHS DMH PASRR agent may file an appeal of the  determination by sending a written request to the Coordinator of PASRR Services, Division of Mental Health, 319 East Madison, Ste 3B, Springfield, IL  62701.
  • An individual screened by the DHS DDD ISC agent may file an appeal of the determination as outlined on Form IL462-1202 Notice of Individual's Right to Appeal Medicaid Waiver Determinations.pdf
Non-Discrimination Statement
No individual participating in the Supportive Living Program (SLP) shall be discriminated against because of race, color, religious belief, political affiliation, sex, national origin, or disability.
 
No person shall be improperly excluded from or denied participation in the SLP based solely on the diagnosis of mental illness if the State’s designated screeners find the individual otherwise eligible and appropriate for services within the Program. Following completion of this screening, the SLP Providers shall individually assess each eligible applicant in order to determine whether the SLP Provider can meet the person’s needs.  The SLP Providers remain subject to all applicable State and Federal law, including the Americans with Disabilities Act and the Fair Housing Act.
Contact the Bureau of Long Term Care at 1-844-528-8444 toll free with questions regarding this notice.
 
 
Kelly Cunningham
Interim Administrator   

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