P1007 PAS Reassessments

MA1007

Review the case, including the previous PAS and records in DocuWare.

Attempt to contact the Case Manager (CM). If unable to reach the CM attempt to contact the supervisor. At least three attempts should be made. Document each attempt in the HEAplus case notes. Was contact made?

• If YES, continue to step 3.

• If NO, schedule a face-to-face reassessment. Skip to step 5.

NOTE     The CM is listed in HEAplus on the Case Summary screen under Case Management. The supervisor can be found on the Statewide Mercy Care CM List or Statewide United HealthCare CM List

Request the following information from the CM or supervisor:

• A description of the customer’s current functional and medical status;

• Verification of the customer’s current address, phone number, and most appropriate contact person; and

• The last two Long-Term Care (LTC) quarterly assessments.

Based on the information gathered in step 3, does the customer still appear to be medically eligible for ALTCS?

• If YES, schedule a virtual or telephonic reassessment. Continue to Step 5.

• If NO, schedule a face-to-face reassessment. Continue to Step 5.

NOTE     Customers in a skilled nursing facility (SNF) can be reassessed virtually or telephonically as long as the information from the nursing staff coincides with the CM.

Complete the PAS Reassessment. Be mindful of the following:

• Reassessments require at least two personal contacts, such as the CM and a caregiver. Include their name and contact information on the Person Contact Detail screen.

• If possible, the customer should always be interviewed. Ask the CM or caregiver to explain any discrepancies between the customer’s response and the CM or caregiver’s response.

• All PAS reassessments that are no longer scoring eligible, or score Transitional and live in a SNF require a Physician Review (PR). See MA1006.2.

Review the decision letter. See HEA PAS Notice desk aid for PAS Assessors for guidance reviewing the letter. More information on reviewing reassessment decision letters is found in PAS Completion.

Review the case, including the previous PAS and records in DocuWare.

Compare the customer’s date of birth (DOB) to the PAS reassessment due date. Will they be turning an age where additional questions are asked, or a different PAS tool is used before the due date?

• If YES, wait until after the change in age to complete the PAS reassessment.

• If NO, continue to step 3.

Attempt to contact the Support Coordinator (SC). If unable to reach the SC attempt to contact the supervisor. At least three attempts should be made. Document each attempt in the HEAplus case notes. Was contact made?

• If YES, continue to step 4.

• If NO, schedule a face-to-face reassessment. Skip to step 8.

NOTE     The SC and supervisor is listed in HEAplus. From the Case Summary screen click the FOCUS Response Summary link.

Is the customer turning 6 before the reassessment due date?

• If YES, ask the SC or supervisor if DDD will be continuing eligibility. Continue to step 5.

NOTE     If the SC has scheduled their Re-determination for no more than two months after the due date of the PAS reassessment, wait until DD has completed their Re-determination.

• If NO, skip to step 6.

Will DDD be continuing eligibility?

• If YES, continue to step 6.

• If NO, STOP. Ask the SC or supervisor for a copy of the Notice of Intended Action (NOIA), as well as the information from step 6. Wait until the appeal date on the letter has passed, then schedule a face-to-face interview for an EPD assessment.

Request the following information from the SC or supervisor:

• A description of the customer’s current functional and medical status;

• Verification of the customer’s current address, phone number, and most appropriate contact person; and

• The last two Long-Term Care (LTC) quarterly assessments.

Based on the information gathered in step 6, does the customer still appear to be medically eligible for ALTCS?

• If YES, schedule a virtual or telephonic reassessment. Continue to step 8.

• If NO, schedule a face-to-face reassessment. Continue to step 8.

Complete the PAS Reassessment. Be mindful of the following:

• Reassessments require at least two personal contacts, such as the CM and a caregiver. Include their name and contact information on the Person Contact Detail screen.

• If possible, the customer should always be present during the interview.

• All PAS reassessments that are no longer scoring eligible or score Transitional and live in a (Skilled Nursing Facility) SNF or (Intermediate Care Facility) ICF require a Physician Review (PR). See MA1006.2

Review the decision letter. See HEA PAS Notice desk aid for PAS Assessors for guidance reviewing the letter. More information on reviewing reassessment decision letters is found in PAS Completion.