2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Long-Term Carean individual provider employed by the IHS orTribal 638 facility that holds a current license topractice in the United States or its territories asmeeting licensure requirements.Community BenefitUnder Centennial Care, the state has created onecomprehensive Community Benefit that includesboth personal care and the HCBS previouslyprovided through the Coordination of Long-TermServices 1915(c) Waiver and the Mi Via 1915(c)Waiver. Individuals who are otherwise Medicaideligibleand who meet Nursing Facility Level ofCare (NF LOC) eligibility requirements have accessto HCBS and personal care services withoutwaiting for a slot to become available. Those whoare not otherwise Medicaid-eligible (including thoseelecting self-directed services) and who haveincomes below 300% of supplemental securityincome and who meet NF LOC eligibilityrequirements are able to access the CommunityBenefit if a slot is available. The state maintains acentral registry for persons waiting for theCommunity Benefit who are not otherwiseMedicaid-eligible. The central registry is managedon a statewide basis using a standardizedassessment tool and in accordance with criteriaestablished by the state.Nursing Facility Level of Care Assessment forLong-Term Care BeneficiariesA NF LOC eligibility assessment must beperformed for all applicants for whom there is areasonable indication that long-term care servicesmay be needed in the future. Presbyterian conductsthe NF LOC eligibility assessment for individualsenrolled in Presbyterian Centennial Care.Presbyterian uses state-developed LOC criteriaand a state-approved assessment tool fordetermining NF LOC eligibility for all long-term careservices (including facility placement and theCommunity Benefit). Elements of NF LOC eligibilitycriteria used to initially and periodically determinethe individual’s medical eligibility includeMedical risk factors, including but not limitedto medical diagnoses associated with BasicActivities of Daily Living (BADL), InstrumentalActivities of Daily Living (IADL), range ofmotion limitations, need for medicaltreatments, need for clinical monitoring by aregistered nurse, and hospitalization in thelast 90 daysAvailability of support and social resources,such as personal care assistancehousekeeping, home-delivered meals, livingarrangements, homebound status, anddurable medical equipmentEnvironmental conditions, including safety andaccessibility issuesNutritional challenges including eating issuessuch as swallowing problems, tube feeding,special diet, nausea, and tooth or mouthproblemsCommunication and cognition capabilityBehavioral/mental health statusHealth and safety risks, including susceptibilityto falling10-22014 Practitioner and Provider Manual - Ver. 3