|
|
|
To qualify for Arizona Long Term Care System (ALTCS) institutional or home and community based services, a person shall have a nonpsychiatric medical condition or have a developmental disability that, by itself or in combination with other medical conditions, necessitates the level of care that is provided in a nursing facility or intermediate care facility. This is determined using the pre-admission screening (PAS) assessment.
The PAS assessment is completed by a PAS Assessor who is a registered nurse or social worker.
An assessor shall conduct a PAS assessment with an applicant or member, except when the customer is deceased. PAS assessments are completed face-to-face, by telephone, or virtually with a customer.
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.
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 (PRP) assessment may be requested for a customer who is seeking admission to a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) but is not yet applying for ALTCS. The PRP is used to determine if the customer is at risk of institutionalization and requires care equal to that provided in a SNF or ICF. The PRP is completed as a courtesy to the customer.
An eligible PAS, including a PRP, 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.
Using the information described above, the Assessor completes the PAS assessment using his or her education, experience, professional judgment, and training.
Once the PAS assessment is completed, the PAS score is calculated and compared to the established threshold score in MA1003 for EPD and MA1005 for DD. The threshold score is the point at which a customer is considered to be at immediate risk of institutionalization, except as determined by physician consultant review.
|
Term |
Definition |
|
Medically eligible |
Immediate risk of institutionalization. The status of an applicant or member under ARS § 36-2934(A)(5) and as specified in ARS § 36-2936 and in the Administration’s Section 1115 Waiver with the Centers for Medicare and Medicaid Services (CMS). |
|
PAS Assessor |
Determined by the Department of Economic Security/Division of Developmental Disabilities in accordance with ARS 36-551.Social worker as defined in this section or a licensed registered nurse who:
|
|
Social Worker |
An individual with either of the following:
|
Proof of immediate risk of institutionalization shall be demonstrated through:
Applicant or member score equal to or higher than the applicable PAS threshold score; or
Finding by a physician consultant reviewer that the applicant or member has this status.
|
Program |
Legal Authorities |
|
ALTCS |
42 CFR 441.302 ARS 36-551 ARS 36-2934(A)(5) ARS 36-2936 AAC R9-22-101 AAC R9-28-302 |