1002 Preadmission Screening (PAS) Process

Policy

The PAS Assessor shall use the PAS instrument as described below to determine whether the following customers are at immediate risk of institutionalization:

·        The Assessor shall use the appropriate PAS instrument described in MA1003 to assess customers with a physical disability who are at least six years old. After assessing a child with a physical disability who is at least six years but less than 12 years, the Assessor shall refer the child for a physician consultant review as described in MA1006.

·        The Assessor shall use the age-specific PAS instrument described in MA1005 to assess a customer who has a physical disability and less than six years old. After assessing the child, the Assessor shall refer the child for physician consultant review.  

·        The Assessor shall use the PAS instrument described in MA1005 to assess customers who are not living in a nursing facility (NF). After assessing a child less than six months of age with a developmental disability, the Assessor shall refer the child for physician consultant review.

·        The Assessor shall use the PAS instrument described in MA1003 for customers with a developmental disability living in a Nursing Facility (NF).

·        The Assessor shall use the PAS instrument described in MA1003 or MA1005, whichever is applicable, to assess a customer classified as ventilator dependent under Section 1902(e)(9) of the Social Security Act.

The PAS assessment is completed by a PAS Assessor who is a registered nurse or social worker:

PAS assessments are completed face-to-face, by telephone, or virtually with a customer, except when the customer is deceased. The Assessor makes reasonable efforts to obtain the customer’s available medical records. The Assessor may also obtain information for the PAS assessment from interviews with the:

·        Customer;

·        Parent;

·        Guardian;

·        Caregiver; or

·        Any person familiar with the customer's functional or medical condition.

Using the information described above, the Assessor completes the PAS assessment using his or her education, experience, professional judgment, and training.

After the PAS assessment is completed, the PAS score is calculated and compared to the established threshold score in MA1003 and MA1005. Except as determined by physician consultant review, the threshold score is the point at which a customer is considered to be at immediate risk of institutionalization.

Upon request from a person acting on behalf of the customer, the Administration shall conduct a PAS assessment to determine whether a deceased customer would have been eligible to receive ALTCS benefits during the time period covered by the application or in any prior quarter month.

A Private Request PAS assessment may be requested for a customer who is not applying for ALTCS to determine if the customer is at risk of institutionalization and requires care equal to that provided in a NF or Intermediate Care facility (ICF). The PAS is completed without charge. Private Request PAS assessments are processed through Eligibility Review (see MA1006). A face-to-face assessment must be conducted for a Private Request PAS.

An eligible PAS, including a Private Request PAS, may be used for up to 180 days when a customer is denied and later reapplies. An ineligible PAS is never used for a new application.

Definition

Proof

Proof of immediate risk of institutionalization demonstrated through:

·   A PAS score equal to or higher than the applicable PAS threshold;  or

·         Finding by a physician consultant reviewer that the applicant or member has this status.

Legal Authority