OBRA Level II evaluative report scenarios
Page posted: 6/27/19 | Page reviewed: 10/17/23 | Page updated: 10/17/23 | |
Overview | This page contains sequencing charts for: 1. OBRA Level II evaluative report for nursing facility (NF) admission or annual OBRA Level II review 4. OBRA Level II evaluative report – Person does not have a previous screening document in MMIS Extension of NF stayThe lead agency must pay close attention to the length of stay indicated. If the person’s stay extends beyond the dates originally indicated, the lead agency must replace the original document in MMIS. ProcessThe lead agency replaces the approved action type 11 document with a new document using the same data as the original OBRA Level II document, changing only the NF through date. The NF admission date should remain the same as the original submission. This document will automatically route to DHS to approve the new length of stay. If the lead agency does not update the through date, the NF will encounter billing issues. The lead agency should not: NF dischargeWhen planning with a person at the time of discharge, the lead agency should reference DD Screening Document Codebook – NF scenarios. Waiver exitsFor a person exiting the waiver, changes are allowed to the following fields only: MMIS will not accept changes to any other fields. | ||
Additional resources | DD Screening Document Codebook – Scenarios | ||
1. Scenario: OBRA Level II evaluative report for NF admission or annual OBRA Level II review
In this scenario, the person has screening document history in MMIS.
Lead agencies should use this scenario for a person who either:
County/tribal nation-entered fields | 1st sequence |
(23) Action date | In-person OBRA Level II evaluative report date |
(24) Action type | 11 |
(39) Level of care | 02 |
(41) Current services | 19 (if applicable), 30, other |
(42) Planned services | 19 (if applicable), 30, other |
(44) Waiver need index | 005 |
(46) Final action planned | Corresponds with field 42 planned services |
(47a) Assessment result | 16 – Facility stay |
(47b) Exit reason | N/A |
(48) Effective date | In-person OBRA Level II evaluative report date |
(49) Current Medical Assistance (MA) program | 05 |
NF short-term approval begin date | NF admission date |
NF through date | Anticipated NF discharge date, no more than 365 days from in-person OBRA Level II evaluative report (if staying in the NF) |
Time-limited payment | Y |
Payment authorized | 04 |
Case manager comments | Comments are needed when: |
Routing for approval | 1st sequence |
Automatically | Yes, to 570 |
2. Scenario: OBRA Level II evaluative report for a person on the DD Waiver who experiences an NF stay fewer than 30 days (historical scenario)
Effective May 1, 2022, this scenario is for historic rebuilding only.
In this scenario, the person has screening document history in MMIS.
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | Hospital/NF admission date or in-person OBRA Level II evaluative report date (if prior to hospitalization or NF admission) | In-person OBRA Level II evaluative report date |
(24) Action type | 03 | 11 |
(39) Level of care | 01 | 02 |
(41) Current services | 01, residential code, other | 19, 30, other |
(42) Planned services | 19, 30, other | 19, 30, other |
(44) Waiver need index | 004 | 005 |
(46) Final action planned | Corresponds with field 42 planned services | Corresponds with field 42 planned services |
(47a) Assessment result | 05 – Waiver out | 16 – Facility stay |
(47b) Exit reason | 16 – Facility stay | N/A |
(48) Effective date | Hospital/NF admission date | In-person OBRA Level II evaluative report date |
(49) Current MA program | 01 or 02 | 05 |
NF short-term approval begin date | N/A | NF admission date |
NF through date | N/A | Anticipated NF discharge date, no more than 365 days from in-person OBRA Level II evaluative report (if staying in the NF) |
Time-limited payment | N/A | Y |
Payment authorized | 01 | 04 |
Case manager comments | Comments as needed | Comments are needed when: |
Routing for approval | 1st sequence | 2nd sequence |
Automatically | N/A | Yes, to 570 |
3. Scenario: OBRA Level II evaluative report for a person on a DD Waiver who experiences an NF stay of fewer than 121 days
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | Hospital/NF admission date or in-person OBRA Level II evaluative report date (if prior to hospitalization) | In-person OBRA Level II evaluative report date |
(24) Action type | 03 | 11 |
(39) Level of care | 01 | 02 |
(41) Current services | 01, waiver service codes, residential code, other | 19, 30, other |
(42) Planned services | 19, 30, other | 19, 30, other |
Waiver need index | 004 | 005 |
(46) Final action planned | Corresponds with field 42 planned services | Corresponds with field 42 planned services |
(47a) Assessment result | 05 – Waiver out | 16 – Facility stay |
(47b) Exit reason | 17 – Temp waiver exit | N/A |
(48) Effective date | Hospital/NF admission date | In-person OBRA Level II evaluative report date |
(49) Current MA program | 01 or 02 | 05 |
NF short-term approval begin date | Delete date previously entered | Anticipated NF admission date |
NF through date | Delete date previously entered | Anticipated NF discharge date, no more than 365 days from in-person OBRA Level II evaluative report (if staying in the NF) |
Time-limited payment | N | Y |
Payment authorized | 01 | 04 |
Case manager comments | Comments as needed | Comments needed when: |
Routing for approval | 1st sequence | 2nd sequence |
Automatically | N/A | Yes, to 570 |
4. Scenario: OBRA Level II evaluative report – Person does not have a previous screening document in MMIS
County/tribal nation-entered fields | 1st sequence | 2nd sequence |
(23) Action date | In-person OBRA Level II evaluative report date | In-person OBRA Level II evaluative report date |
(24) Action type | 01 | 11 |
(39) Level of care | 02 | 02 |
(41) Current services | 19, residential code, other | 19, 30, other |
(42) Planned services | 19, 30, other | 19, 30, other |
(44) Waiver need index | 005 | 005 |
(46) Final action planned | Corresponds with field 42 planned services | Corresponds with field 42 planned services |
(47a) Assessment result | 16 – Facility stay | 16 – Facility stay |
(47b) Exit reason | N/A | N/A |
(48) Effective date | In-person OBRA Level II evaluative report date | In-person OBRA Level II evaluative report date |
(49) Current MA program | 00 | 05 |
NF short-term approval begin date | N/A | NF admission date |
NF through date | N/A | Anticipated NF discharge date, no more than 365 days from in-person OBRA Level II evaluative report (if staying in the NF) |
Time-limited payment | N | Y |
Payment authorized | 07 | 04 |
Case manager comments | Comments as needed | Comments are needed when: |
Routing for approval | 1st sequence | 2nd sequence |
Automatically | N/A | Yes, to 570 |
5. Scenario: OBRA Level II evaluative report – Community ICF/DD to NF
In this scenario, the person has screening document history in MMIS.
County/tribal nation-entered fields | 1st sequence |
(23) Action date | In-person OBRA Level II evaluative report date |
(24) Action type | 11 |
(39) Level of care | 02 |
(41) Current services | 19, 30, other |
(42) Planned services | 19, 30, other |
(44) Waiver need index | 005 |
(46) Final action planned | 08 |
(47a) Assessment result | 16 – Facility stay |
(47b) Exit reason | N/A |
(48) Effective date | In-person OBRA Level II evaluative report date |
(49) Current MA program | 05 |
NF short-term approval begin date | NF admission date |
NF through date | Anticipated NF discharge date, no more than 365 days from in-person OBRA Level II evaluative report (if staying in the NF) |
Time-limited payment | Y |
Payment authorized | 04 |
Case manager comments | Comments are needed when: |
Routing for approval | 1st sequence |
Automatically | Yes, to 570 |
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