CALIFORNIA DEPARTMENT OF AGINGDEPARTMENT OF HEALTH CARE

SERVICES MSSP SITE ASSOCIATION (MSA)

MULTIPURPOSE SENIOR SERVICES PROGRAM(MSSP)

MODULE TWOELIGIBILITY DETERMINATION AND

ASSESSMENT1

October 24, 2013

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Keep questions brief and clear – it will be helpful if you indicate the subject of your questions first. For example: “Feedback – Where do I send suggestion's for waiver amendments?”

Many questions will be answered at the end of the presentation as time permits

Questions not answered today will be answered and posted on CDA’s website in the following weeks.

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OBJECTIVES

o Eligibility Determination

o Level of Care Determination

o Assessment Process

o Reassessment Process

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MSSP PRE-SCREENING

o Can be completed in person or by telephone.

o Potential MSSP applicants are Pre-Screened for the basic requirements of age, Medi-Cal eligibility, and residence in site service area. A Medi-Cal Fair Hearing notice is not required for individuals screened out at this point. These individuals are usually referred to other community resources.

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MSSP SCREENING

o Can be completed in person or by telephone.

o Following Pre-Screening, potential MSSP applicants are screened for probable level of care eligibility and need for MSSP services. Screened MSSP applicants likely to meet level of care are placed on a wait list. Individuals not likely to meet the level of care criteria have a right to request a Medi-Cal Fair Hearing.

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ELIGIBILITY DETERMINATION

o Eligible for placement in a nursing facility.

o Age 65 or older.

o Receiving Medi-Cal under a qualifying aid code.

o Able to be served within MSSP’s cost limitations.

o Appropriate for care management services.

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DOCUMENTATION TIMELINE

o On or Prior to Enrollment• Complete Application• Complete Level of Care Certification

o Within Two Weeks of Enrollment• The Initial Psychosocial Assessment (IPSA) and the

Initial Health Assessment (IHA) must be completed within two weeks of each other.

o Reassessment• On anniversary of enrollment (one month grace period

before or after).

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MSSP APPLICATION

o The application must be completed prior to enrollment in the MSSP.

o The Care Manager and Waiver Participant are required to sign and date the application prior to or on enrollment date.

o Enrollment determination must occur within 30 days of application.

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INFORMATION EXCHANGE

o The application informs the Waiver Participant that personal information is shared among MSSP staff, governmental regulatory agencies, consultants, service vendors, and health care plans to facilitate services.

o Beyond these parameters sharing and obtaining information requires the specific consent of the Waiver Participant (see next slide).

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AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH

INFORMATION (AUDPHI)

o An AUDPHI form must be completed in order to exchange information with, but not limited to the following:

• Family Members• Caregivers• Physician• Home Health Agency• In-Home Supportive Services• Adult Protective Services

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LEVEL OF CARE (LOC) CERTIFICATION

o Required for enrollment.

o Completed and signed by a nurse care manager (NCM) on or before the date of enrollment.

o May be completed in person or by record review.

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LOC CERTIFICATION-CONTINUED

o NCM uses Title 22 Criteria (Sections 51334 & 51335) to determine LOC, including the following components:

• Cognitive and/or sensory deficits

• Activities of Daily Living

• Instrumental Activities of Daily Living

• The above information is used to substantiate Nursing Facility (NF) Level of Care

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LOC CERTIFICATION - CONTINUED

o NCM may use the following sources of information to complete the LOC certification:

• Initial health assessment• Initial psychosocial assessment• Functional needs assessment grid• Waiver Participant• Physician records• Family input• Caregiver input• Waiver Participant Medical Record

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LEVEL OF CARE EXAMPLE

o Client is alert and oriented to person and place. Client has poor endurance due to congestive heart failure and requires hands on assistance for all ADLs, except can feed self if caregiver sets up meals. Client ambulates with a four-wheel walker in the house and uses wheelchair for outdoor mobility. Caregiver manages medications due to memory deficits. Client needs total assistance for all IADLs except can use the telephone independently.

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LOC RECERTIFICATION

o LOC must be completed (at a minimum) within 365 days of the last LOC

o A new LOC may be completed more frequently when there is a significant change of condition for a Waiver Participant.

This may include significant changes to:• health condition/status• cognitive or mental health status• living situation• support systems• functional status 15

ASSESSMENT

o Initial Health Assessment (IHA)• Completed by the NCM• Conducted in the Waiver Participant’s home

o The comprehensive IHA includes:• Diagnoses/medical history• Medications• Nutritional Assessment• Health Habits• Review of Systems• Problem List• Assessment Summary

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ASSESSMENT - CONTINUED

o Initial Psychosocial Assessment (IPSA)• Completed by the Social Work Care Manager (SWCM)• Conducted in the Waiver Participant’s home

o The comprehensive IPSA includes:• Living arrangements• Finances• Family and social network• Environmental safety• Formal services received within the past month

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ASSESSMENT - CONTINUED

o The comprehensive IPSA includes:• Psychological functioning

• Environmental Safety

• Functional Needs Assessment Grid

• Problem List

• Assessment Summary

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ASSESSMENT - CONTINUED

o MSSP Sites can choose to use a cognitive screening tool from the list below:

o CDA Approved Cognitive Screening Tools• Folstein Mini Mental State Examination (MMSE)• Saint Lewis University Mental Status Examination

(SLUMS)• Short Portable Mental Status Questionnaire (SPMSQ)• Montreal Cognitive Assessment (MoCA)

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REASSESSMENT

o The reassessment is a formalized method of documenting and analyzing changes in the Waiver Participant’s health and psychosocial status since the previous assessment.

o The reassessment must be completed in the Waiver Participant’s home.

o The multidisciplinary team, in collaboration with the Waiver Participant, reviews the Reassessment to update the Care Plan.

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REASSESSMENT COMPONENTS

o The comprehensive reassessment, at a minimum, includes:

• Functional needs assessment grid

• CDA-Approved Cognitive Screening Tool

• Medication List

• Problem List

• Reassessment Summary

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QUESTIONS

Thank you for your participation

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