Revised September 1, 2000
July 25, 2000
TO: Area Agency on Aging (AAA) Directors
Home and Community Services (HCS) Division Regional Administrators
SUBJECT: HOSPITAL ASSESSMENTS (REVISION OF MB-AASA/AAA-
This MB has been revised to clarify nursing facility authorization and payment procedures (see
the fifth and sixth paragraph).
WAC 388-97-027 is currently being amended to reflect a policy change for hospital assessments.
The purpose of this MB is to provide interim policies for staff until the WAC and LTC manual
Are hospital assessments required for individuals being discharged to the nursing facility?
Hospital assessments are no longer required for individuals being discharged to nursing
facilities. In order to more efficiently use staff resources, Home and Community Services (HCS)
staff will complete assessments of these individuals after they have been placed in nursing
What about individuals who have been screened as likely to meet the PASRR criteria?
Federal pre-admission screening and resident review (PASRR) regulations require that HCS
continue to do brief assessments on those individuals who are likely to have a serious mental
illness or developmental disability (and not otherwise exempted) prior to discharge to a nursing
facility. For more instructions, refer to Chapter 10 of the Long Term Care Manual.
Who is responsible for seeing hospital patients going home or to a residential facility?
HCS will continue to complete comprehensive assessments and authorize service plans for:
Any applicants of long-term care services.
Existing clients returning to or AAA clients going to a residential setting (AFH, BH, or
July 25, 2000 Revised September 1, 2000
AAA and their case management subcontractors will continue to:
Case manage their current state core and regular case management clients for the time
they are in the hospital and provide reassessments/service plan changes around the time
of discharge if they are expected to return home.
Transfer files if their clients’ length of stay in the hospital/or other setting (outside of
home) is expected to exceed 30 days.
When will HCS need to complete assessments for individuals placed in the nursing facility
Once HCS receives a referral from the hospital or the nursing facility (NF), they will need to
complete the brief Comprehensive Assessment within seven (7) working days of admit.
Regardless of when an assessment is done, staff must base eligibility on the functional needs of
the individual on the first day of admit.
What if HCS determines the person is functionally not eligible for nursing facility care?
If the social worker determines that the client does not meet functional eligibility criteria, the
client does not meet the eligibility requirement of "institutional status". The client must meet
institutional medical rules, both functional and financial, in order for us to authorize Medicaid
payment for nursing facility care. If someone is functionally not eligible for NF care, but is
financially eligible, HCS must follow RCW 74.42.450, which requires that HCS staff provide
30-day written notice before discharging the resident, which states the reasons for denial and the
right to a fair hearing. In this case, staff may authorize payment for 30 days or until the client is
discharged, whichever is earlier. Payment is made from state-funds only through the A-19
process described below.
If the client does not meet functional eligibility for nursing facility level of care, but is SSI
related, HCS financial staff would still look at other medical programs the client may be eligible
for. Financial staff will determine eligibility for other medical programs as if the client were
living at home since they do not meet "institutional status" criteria. If the client meets
categorical and financial eligibility requirements for regular MN medical (as if they were living
at home), Financial staff may authorize regular MN, but will not use the nursing facility cost as a
medical expense. The HCS social worker will authorize payment for nursing facility care
separately using state funds only, per the instructions below.
What if HCS determines the person is financially not eligible for nursing facility care?
If the client's income and resources are over the standards, the client does not meet the financial
eligibility requirement. If the client is not financially eligible, we will not authorize payment for
nursing facility care. This is not a change from current policy.
How are nursing facilities paid?
Payment is contingent on the date a request is received or the date services begin, whichever is
later. Staff should coordinate with hospitals and nursing facilities to ensure that HCS
immediately receives notification of NF placements.
If the client is determined functionally not eligible (but is financially eligible), as described
above, payment will be made to the nursing facility on an A19- Invoice Voucher. A blank A19,
July 25, 2000 Revised September 1, 2000
instructions, and a W9 form are attached. The nursing facility must complete the A19 and W9
forms when the client is discharged from the nursing facility. To approve the A19, the social
worker must verify the number of days the client received service and the daily rate of the
nursing facility. The approved A19 and completed W9 should be forwarded to the address listed
Address questions to:
Brooke Buckingham, Program Manager
Home and Community Programs
Phone: (360) 725-2530
Penny Black, Acting Director
Home and Community Services Division
Hospital requests an assessment for:
NF Placement (AFH, ARC, EARC, In-home
HCS completes HCS completes HCS completes AAA completes HCS completes
assessment within assessment in the assessment in the reassessment for current assessment for
7 days. hospital for hospital. clients. new clients.