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SLL triage tip sheet for PAS referrals

During the preadmission screening (PAS) process, the Senior LinkAge Line (SLL) makes referrals to counties, tribal nations and managed care organizations (MCOs) responsible for completing specific tasks.

This page provides information about referrals when:

· SLL does not conduct PAS, nor OBRA Level I screening

· SLL conducts PAS, including the OBRA Level I screening, and makes a referral.

For additional policy and procedural information, see:

· CBSM – PAS and OBRA (overview)

· CBSM – OBRA Level I screening

· CBSM – OBRA Level II evaluative report for people with developmental disabilities

· CBSM – Screening for NF admission of people younger than 21 years old

· OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness, DHS-3426 (PDF)

· OBRA Level II evaluative report for people with developmental disabilities or related conditions, DHS-4248 (PDF).

When SLL does not conduct PAS, nor OBRA Level I screening

Situation	Who receives referral	Purpose of referral/next steps
Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+), including Elderly Waiver (EW)	SLL sends referral to MCO	The MCO will: · Conduct the OBRA Level I screening, nursing facility (NF) level of care determination and MMIS data entry · Provide documentation to the NF about NF level of care and OBRA Level I screening using DHS-3426 · Make an OBRA Level II evaluative report referral to the county/tribal nation, as appropriate · Provide relocation assistance, as appropriate · Conduct appropriate waiver activities for people on EW.
MSHO or MSC+ with one of the following waivers: · Brain Injury (BI) · Community Alternative Care (CAC) · Community Access for Disability Inclusion (CADI)	SLL sends referral to both: · MCO · County of financial responsibility (CFR)/tribal nation	The MCO must be aware of the admission. The CFR/tribal nation will: · Conduct appropriate waiver activities, including the OBRA Level I screening · Provide documentation to the NF about NF level of care and OBRA Level I screening using DHS-3426 · Conduct or make a referral for an OBRA Level II evaluative report, as appropriate · Make a referral for a MnCHOICES assessment, as appropriate · Enter the LTC screening document into MMIS · Forward the results of the OBRA Level II evaluative report to the MCO, county/tribal case manager and NF.
MSHO or MSC+ with Developmental Disabilities (DD) Waiver	SLL sends referral to both: · MCO · CFR/tribal nation	The MCO will: · Conduct the OBRA Level I screening and NF level of care determination · Enter the PAS information into MMIS · Provide documentation to the NF for NF level of care and OBRA Level I screening using DHS-3426. The CFR/tribal nation will: · Conduct appropriate waiver activities · Conduct the in-person OBRA Level II evaluative report · Enter the DD screening document into MMIS · Make a referral for a MnCHOICES assessment, as appropriate · Forward the results of the OBRA Level II evaluative report to the MCO, county/tribal case manager and NF.
Special Needs BasicCare (SNBC) only	SLL sends referral to both: · MCO · County/tribal nation of NF location	The MCO will: · Conduct the OBRA Level I screening, NF level of care determination and MMIS data entry · Provide documentation to the NF for NF level of care and OBRA Level I screening using DHS-3426 · Make an OBRA Level II evaluative report referral to the county/tribal nation, as appropriate · Forward the OBRA Level I screening to the CFR/tribal nation for relocation assistance and access to home and community-based programs and services · Make a referral to the county/tribal nation of location for a MnCHOICES assessment prior to NF admission if the person is younger than 21 years old, or if NF level of care cannot be determined (Note: The county/tribal nation that conducts the MnCHOICES assessment must communicate the level of care determination to the MCO) · Forward the results of the OBRA Level II evaluative report to the MCO, county/tribal case manager and NF. The county/tribal nation of NF location will conduct a MnCHOICES assessment within 80 days of admission.
SNBC with one of the following waivers: · BI · CAC · CADI · DD	SLL sends referral to all of the following: · MCO · CFR/tribal nation · County/tribal nation of NF location	The MCO must be aware of the admission. The CFR/tribal nation will: · Conduct appropriate waiver activities, including the OBRA Level I screening · Provide documentation to the NF for NF level of care and OBRA Level I screening using DHS-3426 · Make an OBRA Level II evaluative report referral, as appropriate · Enter the LTC screening document into MMIS · Forward the results of the OBRA Level II evaluative report to the MCO, county/tribal case manager and NF. The county/tribal nation of NF location will conduct a MnCHOICES assessment within 80 days of admission.
BI, CAC or CADI fee-for service and person is younger than age 65	SLL sends referral to both: · CFR/tribal nation · County/tribal nation of NF location	The CFR/tribal nation will: · Conduct appropriate waiver activities, including the OBRA Level I screening · Provide documentation to the NF for NF level of care and OBRA Level I screening using DHS-3426 · Conduct the OBRA Level II evaluative report, as appropriate · Forward the results of the OBRA Level II evaluative report to the county/tribal case manager and NF. The county/tribal nation of NF location will conduct a MnCHOICES assessment within 80 days of admission.
BI, CAC or CADI fee-for-service and person is 65 years or older	SLL sends referral to CFR/tribal nation	The CFR/tribal nation will: · Conduct appropriate waiver activities, including the OBRA Level I screening · Provide documentation to the NF for NF level of care and OBRA Level I screening using DHS-3426 · Conduct an OBRA Level II evaluative report, as appropriate · Enter the LTC screening document into MMIS · Forward the results of the OBRA Level II evaluative report to the county/tribal case manager and NF. The county/tribal nation of NF location will conduct a MnCHOICES assessment, as appropriate.
EW fee-for-service or Alternative Care (AC)	SLL sends referral to county/tribal nation of residence	The county/tribal nation of residence will: · Conduct appropriate waiver activities, including the OBRA Level I screening · Provide documentation to the NF for NF level of care and OBRA Level I screening using DHS-3426 · Conduct the OBRA Level II evaluative report, as appropriate · Enter the LTC screening document into MMIS · Forward the results of the OBRA Level II evaluative report to the county/tribal case manager and NF · Conduct a MnCHOICES assessment, as appropriate.
Younger than 21 years old, or DD Waiver and younger than 21 years old (Note: Does not include people enrolled in SNBC; see rows about SNBC)	SLL sends referral to county/tribal nation of location	The county/tribal nation of location will: · Conduct an in-person MnCHOICES assessment · Conduct the OBRA Level I screening · Provide documentation to the NF for NF level of care and OBRA Level I screening using DHS-3426 · Conduct the OBRA Level II evaluative report, as appropriate · Request DHS approval for NF admission · Make a referral to the CFR/tribal nation for relocation service coordination, as appropriate · Forward the results of the OBRA Level II evaluative report to the county/tribal case manager and NF.

When SLL conducts the OBRA Level I screening (PAS) and makes a referral

Situation	Who receives referral	Purpose of referral/next steps
Younger than 65 without managed care or waiver/AC enrollment	SLL sends referral to county/tribal nation of NF location	The county/tribal nation of NF location will conduct a MnCHOICES assessment within 80 days of admission.
Requires OBRA Level II evaluative report for a developmental disability or related condition	SLL sends referral to CFR/tribal nation	The CFR/tribal nation will conduct applicable OBRA Level II evaluative report activities.
Requires OBRA Level II evaluative report for a mental illness	SLL sends referral to county/tribal nation of location	The county/tribal nation of location will conduct applicable OBRA Level II evaluative report activities.
Requires OBRA Level II evaluative report for both developmental disability and mental illness	SLL sends referral to CFR/tribal nation	The CFR/tribal nation will conduct applicable OBRA Level II evaluative report activities.
Requires OBRA Level II evaluative report for developmental disability or mental illness and will be admitted to an NF in another state	SLL sends referral to out-of-state NF	The state in which the NF is located will conduct applicable OBRA Level II evaluative report activities.
Requires OBRA Level II evaluative report for developmental disability or mental illness and will be admitted to a Minnesota NF from another state	SLL sends referral to either: · Minnesota CFR/tribal nation (for people with developmental disabilities) · Minnesota county/tribal nation of NF location (for people with mental illness)	The state in which the NF is located will conduct applicable OBRA Level II evaluative report activities. The county/tribal nation will conduct applicable OBRA Level II evaluative report activities.
DD Waiver, younger than 65 years old and not on SNBC	SLL sends referral to both: · CFR/tribal nation · County/tribal nation of NF location	The CFR/tribal nation will: · Conduct appropriate waiver activities · Conduct the OBRA Level II evaluative report · Request DHS approval for NF admission. The county/tribal nation of NF location will conduct a MnCHOICES assessment within 80 days of admission.
DD Waiver, 65 years or older and not on MSC+ or MSHO	SLL sends referral to CFR/tribal nation	The CFR/tribal nation will: · Conduct appropriate waiver activities · Conduct the OBRA Level II evaluative report · Request DHS approval for NF admission.
SLL cannot determine NF level of care, and person is not in enrolled in managed care or a waiver/AC	SLL sends referral to county/tribal nation of person’s location	The county/tribal nation of the person’s location will conduct an in-person MnCHOICES assessment to determine level of care.
Essential Community Supports (ECS)	SLL sends referral to lead agency providing case management	The lead agency will exit the person from ECS and notify SLL once completed, within one day of receiving the request to exit.

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Community-Based Services Manual (CBSM)