42 C.F.R. 483, subpart C, 483.100 – 483.138, Minn. Stat. §256B.0911 (LTCC), Minn. Stat. §256B.092 subd. 7, 8 and 8a (Rule 185 case management)

OBRA Level I screening: There are two situations in which an OBRA Level I screening is completed:

1. An OBRA Level I screening is part of the preadmission screening (PAS) process used to determine if a person has a diagnosis or suspected diagnosis of developmental disabilities/related conditions or mental illness. It must happen before a person is admitted to a Medical Assistance (MA)-certified nursing facility (NF). This page provides information about OBRA Level I screenings that are part of the PAS process.

2. An OBRA Level I screening is part of the in-person MnCHOICES or long-term care consultation (LTCC) assessment. A person will receive an OBRA Level I screening as part of his/her annual reassessment if he/she is enrolled:

For information about the annual reassessment process, see CBSM – Assessment applicability and timelines.

A person must receive an OBRA Level I screening during the PAS process before he/she can be admitted to an MA-certified NF. (For additional information about the PAS process, see CBSM – PAS and OBRA.)

The Minnesota Board on Aging is responsible for statewide PAS activities, including OBRA Level I screenings, in partnership with the Area Agencies on Aging through the Senior LinkAge Line. A health care professional seeking NF admission for a person starts the process by submitting a referral.

The Senior LinkAge Line performs NF level of care determinations and OBRA Level I screenings for all people except those enrolled in:

If a person is enrolled in one of the above programs, the Senior LinkAge Line forwards information to the appropriate party responsible for the person’s NF level of care determination, OBRA Level I screening and other required activities for the program. For more information, see the follow sections on this page:

Senior LinkAge Line also does not perform NF level of care determinations and OBRA Level I screenings for people younger than 21 years old. The county/tribal nation of location receives a referral and is responsible to perform all activities for the person. For more information about this process, see CBSM – Screening for NF admission of people younger than 21 years old.

A referral for NF admission can only be made by one of the following qualified health care professionals:

Staff associated with the above health care professionals (e.g., administrative staff, nurses within the hospital or clinic where the physician works) may complete the PAS online referral after the health care professional has determined it is necessary.

Instructions

The health care professional or associated staff must:

Not enough information to complete the PAS online referral

If the health care professional does not have enough information to complete the PAS online referral, he/she should complete it to the best of his/her ability and submit it to the Senior LinkAge Line to determine if the amount of information is sufficient.

The Senior LinkAge Line may make a referral to the lead agency to gather additional information, if necessary. The health care professional who initiated the referral will receive a notification on the online form if the Senior LinkAge Line makes a referral to determine NF level of care.

Senior LinkAge Line determination

After receiving the PAS online referral, the Senior LinkAge Line will determine whether the person needs an in-person assessment from a lead agency.

The Senior LinkAge Line strives to complete or triage all requests within one business day, with the exception of state-recognized holidays.

If the lead agency is responsible to complete the PAS activities, it will make the determination and referrals as needed.

For people who only participate in MSC+, MSHO or SNBC, Senior LinkAge Line will forward the PAS online referral to the person’s MCO via secure email. Then, a qualified professional assigned by the MCO will take all necessary actions to complete the NF level of care determination and OBRA Level I screening. The qualified professional must follow the same OBRA Level I screening timelines, procedures and MMIS documentation requirements as outlined on this page.

Note

Senior LinkAge Line completes PAS activities, including OBRA Level I screenings, for people enrolled in any other managed care program (e.g., Families and Children).

Responsibilities

The MCO must:

Additional responsibilities for MSHO and MSC+

For people who receive services under MSHO or MSC+, the MCO is responsible to provide relocation assistance.

Contact information

To find contact information for each MCO, see DHS – Health plan member services phone numbers or use the MN-ITS eligibility system for NF providers.

An OBRA Level I screening is required for NF admission for people who currently receive home and community-based services (HCBS).

The Senior LinkAge Line does not complete the OBRA Level I screening for people enrolled in certain HCBS programs (for a complete list, see the overview section). For people on those programs, the Senior LinkAge Line forwards the information from the PAS online referral to the lead agency. The lead agency completes the required OBRA Level I screening activities.

If the person has already had a MnCHOICES/LTCC assessment and meets NF level of care as part of eligibility for his/her HCBS program, the lead agency does not need to complete another NF level of care determination. In this situation, the case manager must provide the NF with a copy of the person’s most recent OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness, DHS-3426 (PDF).

Admission to an NF from a hospital or clinic for people on AC, BI, CAC, CADI and EW

When a person is admitted to an NF from a hospital or clinic and the lead agency receives a PAS online referral from the Senior LinkAge Line, the lead agency must:

Admission to an NF for people on the DD Waiver

When a health care professional submits a PAS online referral for a person currently on the DD Waiver, the Senior LinkAge Line must:

Once the appropriate lead agency receives the PAS online referral information, the lead agency must follow the process on CBSM – OBRA Level II evaluative report.

Admission to an NF for people on the ECS program

When a health care professional submits a PAS online referral for a person currently on the ECS program, the Senior LinkAge Line must:

When the Senior LinkAge Line is not able to determine if the person meets NF level of care based on information in the PAS online referral, it will forward that information to the appropriate agency to complete an in-person MnCHOICES/LTCC assessment and other documentation activities. This assessment will gather the additional information needed to make a final determination of NF level of care.

Agency responsible to complete the assessment

People in MSHO or MSC+

Senior LinkAge Line will make a referral to the MCO to complete an in-person assessment to determine NF level of care.

People in SNBC only

Senior LinkAge Line will make a referral to the MCO. The MCO will make a referral to county/tribal nation of location (COL). The COL is responsible to complete an in-person assessment to determine NF level of care.

People in HCBS programs

Senior LinkAge Line will make a referral to the county, tribal nation or MCO responsible for the person’s HCBS program management/administration. That lead agency is responsible to complete an in-person assessment to determine NF level of care.

People not in MSHO, MSC+, SNBC or an HCBS program

Senior LinkAge Line will make a referral to the county/tribal nation where the hospital or clinic is located to complete an in-person assessment to determine NF level of care.

Process

The appropriate agency must complete the MnCHOICES/LTCC in-person assessment as soon as possible to support continuity in care for the person. The assessment must happen no later than 20 calendar days of referral and before NF admission.

If the person chooses facility-based services, the agency completing the assessment must: