Section 240.1010  Nursing Facility Screening

a)         Nursing facility prescreening is the assessment of the need for long term care placement of all individuals age 60 and over, regardless of the payment source, prior to placement in a nursing facility.  Except as indicated in subsections (g) and (h) of this Section, any individual seeking admission to a nursing facility must be  screened to determine his or her need for nursing facility services pursuant to this Section.  For the purposes of this Section, "nursing facility" means a location licensed under the Nursing Home Care Act [210 ILCS 45], or a location certified to participate in the Medicare program under Title XVIII of the Social Security Act (42 USC 301 et seq.) or the Medicaid program under Title XIX of the Social Security Act.

b)         Prescreening shall be accomplished by the administration of the Community Care Program (CCP) Determination of Need, completion of the Illinois Department of Public Aid (DPA) Interagency Certification of Screening Results form, completion of the Illinois Department on Aging Nursing Facility Parolee Screen Notification form, and completion of an Illinois Department of Human Services (DHS) Level I ID Screen if the individual is determined appropriate for nursing facility placement.  Prescreening may occur:

1)         when hospital discharge planners have advised the CCU of the imminent risk of nursing facility placement of a patient who meets the above criteria and in advance of discharge of the patient; or

2)         when a CCU has been advised of the imminent risk of nursing facility placement of an individual in the community.

c)         A CCU must complete a DPA Interagency Certification of Screening Results form within two calendar days from the receipt of advice of imminent risk discharge from a hospital or admission from the community.

d)         Responsibility for prescreenings shall be vested in the CCUs.  However, CCUs may delegate authority to perform prescreenings to hospital discharge planners/social workers who have received training by the Department (refer to Section 240.740 of this Part), regularly attend required ongoing training, and who, in the professional judgement of the CCU, are qualified and approved to administer the CCP Determination of Need.

e)         The individual who is prescreened shall:

1)         be informed, of all appropriate options including nursing facility, in-home and community-based services; and

2)         be advised of his/her right to refuse nursing facility, in-home, community-based, or all services.

f)          Postscreening shall occur if an individual is admitted to a nursing facility without benefit of prescreening.  Postscreening may occur:

1)         after nursing facility placement in an emergency situation. The CCU shall conduct prescreening within 15 calendar days from the date of the request for postscreening;

2)         for nursing facility admissions from a hospital emergency room, outpatient services, or an out-of-state hospital.

g)         Nursing facility prescreening does not apply to the following:

1)         Transfers from one nursing facility to another.

2)         Admissions to a continuing care retirement community with which the individual has a Life Care contract.

3)         Admissions to hospice.

4)         Returns to a nursing facility from a hospital.

5)         Admissions to a nursing facility from the community for respite care for a period of no more than 15 days.

6)         Admissions to sheltered care facilities.

7)         Individuals who resided in a nursing facility on June 30, 1996.

8)         Individuals who 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.

h)         Any individual who has been admitted to a nursing facility that operates under the Hospital Licensing Act [210 ILCS 85], or provider licensed under Section 35 of the Alternative Health Care Delivery Act [210 ILCS 3/35], whose actual length of stay in the facility exceeds 21 days, shall be screened to determine the individual's need for continued services.

i)          Nursing facility conversion screening is the assessment of the appropriateness of in-home and community-based care for nursing facility residents age 60 and over who have applied for and been found eligible for Medicaid assistance.

1)         Conversion screens shall be initiated by a referral from the Illinois Department of Public Aid.

2)         Conversion screens shall be accomplished in accordance with deinstitutionalization (refer to Section 240.1960(g) of this Part).

3)         Conversion screens shall include the option of CCP transitional services for those individuals who are appropriate for in-home and community-based services.

(Source:  Amended at 26 Ill. Reg. 17358, effective November 25, 2002)