|Community-Based Services Manual|
|CBSM - OBRA||General|
Page posted: 10/01/03
Page updated: 06/24/10
Omnibus Budget Reconciliation Act (OBRA) 1987 is the federal law, which mandates the screening and review of all persons with a diagnosis or suspected diagnosis of developmental disability who seek admission to a nursing facility regardless of the source of payment for the NF services.
Note: Federal language uses the term developmental disability. Where referenced, this page will use the term developmental disability.
The Omnibus Budget Reconciliation Act 1987 requires states to determine the appropriateness of MA-certified NF placement for persons with mental illness or developmental disabilities.
Minnesota legislation expanded preadmission screening (PAS) activities to all persons that apply for admission to NFs certified by MA. In 2001, the Minnesota Legislature incorporated Minnesota guidelines regarding admission decisions for persons seeking services in a NF and county concurrence into the Long-Term Care Consultation (LTCC) Services.
PAS determines the need of a NF level of care. PAS activities also consist of :
For persons who have a diagnosis of developmental disability, specialized services are the services specified in the Individual Service Plan that, when combined with services provided by the NF, result in treatment that meets the requirements in 42 C.F.R. 483.440 Active Treatment Services.
All NF residents who have primary or secondary diagnosis of developmental disability whose needs are such that continuous supervision, treatment and training by a qualified developmental disability professional is necessary must receive specialized services.
The evaluation and determination of the need for specialized services, when using the categorical determinations to determine NF needs, must be completed by a QDDP.
Throughout this page, specialized services and active treatment are used interchangeably.
The DD screening team is responsible to:
1. Review all needs of the person.
NOTE: OBRA exemptions do not apply to persons age 20 years or younger.
Exempted hospital discharge (Does not apply to persons on the DD Waiver)
A person age 21 years or older, with any diagnosis, may be exempt from the screening process when all of the following criteria are met:
NOTE: If the nursing facility stay exceeds 30 days, a preadmission screening, level I determination, level II evaluation and full-team screening must be conducted within 40 days of the admission.
Interfacility transfers and re-admissions
A person age 21 years or older with or without a diagnosis of developmental disability is exempt from OBRA activities related to NF admissions when the person:
CAC, CADI, TBI and Elderly Waiver respite
Specialized service needs do not have to be assessed when NF admissions are based on county contracted respite stay as a waiver service.
Counties must use forms and criteria developed by DHS to identify persons who require referral for further evaluation and determination of the need for specialized services.
Evaluative Report: Level II Preadmission Screening for Persons with Developmental disability (DHS-4248)
Adult Mental Health PASRR and Level I and II Screenings Bulletin #O8-53-02 (For information on OBRA for persons who have mental illness and seek admission to a NF)
Process and Procedure
If the person does not meet the 30-day exemption, the county must perform PAS (including OBRA level I and OBRA level II evaluations) for all Minnesota residents seeking NF admission to an out-of-state facility funded by Minnesota Medical Assistance.
For persons seeking admission to NFs located outside of Minnesota when the admission is not paid for by Minnesota Medical Assistance, admission activities must be guided by the rules in the state in which placement is being sought.
People being admitted to Minnesota NFs from other states should have their preadmission screenings performed by the state from which they come when that state is paying for the stay.
Assessment / OBRA Process
1. Determine the need for NF level of care.
Level II Evaluation
1. Conduct a full team screening within seven to nine working days of receiving the Level I referral from the PAS team.
Keep a copy of the Level I and Level II forms in the persons lead agency case file and forward a copy of each to the NF.
When a person is transferred from a NF to a hospital or another NF, the transferring NF is responsible to send copies of the most recent Level II evaluative report along with the person.
Screening documents with incomplete information will not be approved. NFs cannot bill MMIS for services without an approved MMIS screening document. DHS reviewers will approve the document in MMIS and note any communication to the screening teams via the DHS comments page.
Contact DHS if the information cannot be entered into MMIS within the required timelines.
1. Enter a full team screening document (01) in MMIS.
2. Enter Level II evaluation information on the case manager comment screen. All of the following documentation must be provided in order for the document to be approved. DHS form 4248, the Level II Evaluative Report, may be used as the template for this documentation.
Level II information must include:
For people who were on the DD Waiver prior to admission to the NF, the waiver out date must be the same or earlier than the date of NF admission.
Federal regulations require that persons with a diagnosis of developmental disability who reside in NFs receive a review of the continued appropriateness of their NF stay and the need for active treatment services not less than annually.
Counties may document this information in a number of ways, depending on other screening requirements for the individual. For any person with a developmental disability diagnosis, a county may elect to perform an annual full-team screening and enter the information as a 01 screening document in MMIS.
Persons who receive Rule 185 case management services
Persons not receiving Rule 185 case management services
Persons who declined both Rule 185 case management and annual LTCC visits or aged out of the LTCC annual visit requirement