Section 681.10  Who Must be Prescreened

 

Per Department of Public Aid (DPA) rules found at 89 Ill. Adm. Code 140.642, certain individuals ages 18 through 59 who are not determined to be developmentally disabled or classified with severe mental illness as determined through completion of the Level I ID Screen (OBRA:1), who seek nursing facility placement, must be prescreened.  For the purpose of this Part, "nursing facility" means a location licensed under the Nursing Home Care Act [210 ILCS 45] as a skilled or intermediate nursing facility, or a location certified to participate in the Medicare program under Title XVIII of the Social Security Act (42 U.S.C. 301, et seq.), or the Medicaid program under Title XIX of the Social Security Act.

 

(Source:  Amended at 20 Ill. Reg. 10366, effective July 19, 1996)

 

Section 681.20  DHS Prescreening Responsibilities

 

a)         Pursuant to Section 2-201.5 of the Nursing Home Care Act [210 ILCS 45], DHS must prescreen any individual, as described in Section 681.10, who seeks admission to a nursing facility.

 

b)         DHS Home Services Program does not prescreen individuals who:

 

1)         are less than 18 years of age, or 60 years of age or older;

 

2)         are transferred from one nursing facility to another nursing facility;

 

3)         resided in a nursing facility for a period of at least 60 calendar days who are returning to a nursing facility after an absence of not more than 60 calendar days;

 

4)         are returning to a nursing facility after an absence for medical care, regardless of the duration of the absence;

 

5)         have a diagnosis of developmental disability or severe mental illness, regardless of age;

 

6)         are admitted to a facility that is part of a Life Care Contract;

 

7)         are admitted to a hospice;

 

8)         are admitted to a nursing facility for respite care from the community for a period of no more than 15 calendar days;

 

9)         are admitted to a sheltered care facility;

 

10)         are admitted to a facility operated under the Hospital Licensing Act [210 ILCS 85] whose actual length of stay in such a facility is less than 21 calendar days.  If an individual's stay extends to 21 days or beyond, he/she must be prescreened;

 

11)         are admitted to a facility operated by a provider licensed under the Alternative Care Delivery Act [210 ILCS 3/35] whose actual length of stay in such a facility is less than 21 calendar days.  If an individual's stay extends to 21 days or beyond, he/she must be prescreened; or

 

12)         were residents of a nursing facility on June 30, 1996.

 

(Source:  Amended at 23 Ill. Reg. 3989, effective March 19, 1999)

 

Section 681.30  Prescreening Process

 

The Prescreening process is the completion of the DON and reporting of the results.  The DON, completed by the counselor or appropriate representative of a cooperating social service agency/hospital who has been trained by DHS or DoA, measures the level of impairment of an individual and the individual's unmet need for care. Determination of eligibility for institutional care and eligibility for HSP services is based on the points earned in both of these categories and their totals.  The results of the Prescreening are reported via the Inter-Agency Certification of Screening Results For Long Term Care (DPA:2536).

 

(Source:  Amended at 23 Ill. Reg. 3989, effective March 19, 1999)

 

Section 681.35  Assessment Validity Period and Customer Rights

 

A prescreening shall be valid for a period of 90 calendar days from the date of completion.  The individual who is prescreened shall be informed of:

 

a)         the availability of services through the Home Services Program, if such services are appropriate; and

 

b)         his/her right to refuse nursing facility placement, Home Services, or both.

 

(Source:  Added at 20 Ill. Reg. 10366, effective July 19, 1996)

 

Section 681.40  Time Frames

 

a)         If a request for a prescreening is received by DHS from a social service agency/hospital which is providing DHS with customer information including a DON score, the counselor must act on the request within 2 working days.

 

b)         If a request for prescreening is received by DHS from a social services agency/hospital or the community which includes only basic customer information (i.e., name, address, etc.), the counselor must act on the request within 5 working days.

 

(Source:  Amended at 20 Ill. Reg. 10366, effective July 19, 1996)

 

Section 681.50  Outcome of Prescreening Process

 

As a result of the Prescreening, the individual will be determined as:

 

a)         eligible for nursing facility placement and therefore eligible to consider HSP as an alternative to institutional care; or

 

b)         ineligible for nursing facility placement or to receive HSP services.

 

(Source:  Amended at 20 Ill. Reg. 10366, effective July 19, 1996)

 

Section 681.60  Certification of Prescreening Results

 

a)         After the prescreening is completed, if the customer has chosen institutional placement, the counselor must complete an Inter-Agency Certification of Screening Results For Long Term Care (DPA:2536) form and an OBRA 1 ID Screen form and forward the results to the nursing facility. A partial HSP Eligibility Summary (IL 488-0325) is required from the case file.

 

b)         Further, if the individual is eligible and has chosen institutional placement over HSP services, the customer must sign and date the appropriate form, indicating nursing home preference and that the customer has been informed of the availability of HSP services as an alternative to institutionalization and has chosen the institutional care.

 

c)         Results must be certified, as per subsection (a) above, regardless of whether the individual is eligible.

 

(Source:  Amended at 23 Ill. Reg. 3989, effective March 19, 1999)

 

Section 681.70  Necessity of Prescreening

 

It is not required that an individual undergo prescreening to apply for HSP services.  Prescreening is only required when institutionalization is being considered as a placement for the individual.