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DSD MMIS Reference Guide

DSD MMIS Reference Guide


LTC screening ALT4 and ALT5 panels for SNBC

Page posted: 5/20/11

Page reviewed: 5/26/20

Page updated: 5/26/20

Overview

This guide explains how Special Needs BasicCare (SNBC) care coordinators enter health risk assessments into the Medicaid Management Information System (MMIS). SNBC uses Health Risk Assessment Screening Document – MSC+, MSHO and SNBC, DHS-3427H (PDF).

Some of the sections below do not apply to people on SNBC. For reference, these sections are included on LTC Screening Document, DHS-3427 (PDF).

Section D: Screening / assessment results on the ALT4 panel

Enter the appropriate code in the assessment results field:

  • · 35 – MSHO, MSC+ and SNBC health risk assessment (telephone call or face-to-face visit).
  • · 39 – Refusal of health risk assessment (person younger than age 65 refused the visit or phone call).
  • · 50 – Person is not located.
  • · 51 – Program change.
  • · 98 – Document change.

    • Effective date

    Enter the effective date in MMDDYY format.

    Relocation to the community

    Enter yes (Y) or no (N).

    This field is required if the current housing field is 02, 11 or 51. Do not complete this field for assessment results 39, 50 or 98.

    Section E: Professional conclusions on the ALT4 panel

    Do not complete fields in this section.

    Section F: Program type on the ALT4 panel

    Enter program type 28.

    Section G: Service plan summary on the ALT5 panel

    Do not complete fields in this section.

    Navigation

    Press a transmit/enter key two times to advance past the ALT5 panel to the comment panels.

    Additional resources

    DSD MMIS Reference Guide – LTC screening document for SNBC
    DSD MMIS Reference Guide – LTC screening document comments panel for SNBC

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