Gov. Ralph Northam’s Executive Order 58 suspended the Long Term Services and Supports (LTSS) screening requirements for all hospital discharges directly to a nursing facility for both skilled and long term care services retroactive to March 12, 2020 and for the duration of the COVID-19 emergency. Hospitals do not need to screen these individuals prior to discharge nor do nursing facilities need to obtain a screening prior to admission. 

The governor’s action does not supersede federal regulations for the Pre-Admission Screening and Resident Review (PASRR) process, but recall that on March 30, 2020, CMS issued a blanket waiver covering PASRR. This waiver allows “states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should receive the assessment as soon as resources become available.”

DMAS is finalizing formal guidance but asked that we communicate the process to the membership. 

If the post March 12 hospital to nursing facility admission with no screening is direct for long term care services, or if a skilled admission subsequently needs long-term care services:

1. Nursing facilities should still check determine if one of the six “special circumstances” for non-screening exist and if so, select “no” for the screening question and then check the appropriate circumstance on the DMAS-80; or
2. If no special circumstance exists, the nursing facility should select “yes” to the question asking if a pre-admission screening was reviewed.
   • When appropriately selecting “yes” per this guidance, we strongly recommend that you make a note on the DMAS-80 for the record that this admission is under the COVID-19 suspension period
3. At the appropriate time, transmit the DMAS-80 to the MCO (if CCC plus) or enter the DMAS-80 into the LTC Portal with the relevant answers from above

We have been told that the LTC Portal will not validate whether a completed LTSS Screening has occurred for nursing facility admissions on and after March 12 until this public health emergency has subsided. Obviously, the provision of skilled or long term care services depends on the needs of the patient. Documentation (MDS and Physician Certification) of the proper level of care for billing purposes is still needed.

DMAS has requested that nursing facilities notify the managed care organizations (MCOs) when their CCC Plus patients are admitted (despite requirements that the hospitals notify the MCOs upon admission to the hospital and discharge to nursing facility post hospitalization.)  For a long term care admit, this would be accomplished through the DMAS-80; for a skilled admit, we suggest you attempt to contact a care coordinator from the plan the individual is enrolled.

This only applies for admissions directly from hospitals, not the community. VHCA-VCAL has requested guidance on how the transition from a nursing facility to the community for home and community-based long term care services will work for unscreened individuals and will provide updates when that is addressed.

Please contact April Payne or Steve Ford if you have any questions.