SNF admissions and LTSS screening notice

Purpose

HealthKeepers, Inc. would like to remind skilled nursing facility (SNF) and nursing facility (NF) providers of the requirements of the long-term support and services (LTSS) screening as it relates to Anthem HealthKeepers Plus members, when the screening is required and the length of time the LTSS screening is valid.

What to do after LTSS screening is complete

As a reminder, once an LTSS screening has been completed and it has been documented that the member meets LTSS criteria, the screening is valid for up to one year from the date of the physician’s signature. Once LTSS services — including NF stays — Program of All-inclusive Care for the Elderly (PACE), or Commonwealth Coordinated Care Plus (CCC Plus) Waiver services have been initiated, the member must receive continuous LTSS services, or a new screening is required. The Department of Medical Assistance Services (DMAS) allows up to a 30-day period from the end date of LTSS services (NF, PACE, CCC Plus Waiver) to initiate new LTSS services without a new screening.

All requirements related to level 1 screenings for mental illness, intellectual disability, and related conditions apply when a member transitions from the CCC Plus Waiver or PACE to a NF.

SNF admission documentation

SNF admissions are to be treated as such when determining the validity of a screening that was completed prior to the SNF admission.

Example: LTSS screening completed on November 28, 2022. Member entered a SNF April 14, 2023, and was discharged from the SNF on May 7, 2023.

When is a new screening needed?

If Waiver or other LTSS services are started within 30 days of the discharge date, no new screening is needed. If more than 30 days elapse before the initiation of LTSS services, a new screening is needed before those services can start. This applies even if the facility admission was for a skilled or rehab stay.

The same rules apply for other LTSS services. If there is a gap of more than 30 days without services after the end-date of the previous services, a new screening is needed.

Note: If a CCC Plus Waiver is terminated because the member no longer meets criteria for the Waiver, a new LTSS screening is required prior to the initiation of LTSS services (except in appeal situations).

Responsibility of providers

Providers are responsible for promptly notifying the health plan when a member is admitted and discharged from services so that continuation of services for the member is effectively managed.

Prior to admission of any LTSS services (NF, PACE, CCC Plus Waiver) and SNF admissions, providers should understand their responsibility to check the member’s screening status in the DMAS Medicaid Enterprise System (MES) portal.

Failing to verify the screening status can result in denial of authorization requests and claim submissions.

Questions?

Providers can find more information about system training resources regarding the DMAS MES system and log in at Provider Training Resources | MES (virginia.gov).

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800‑901-0020.