36-2936

36-2936. Preadmission screening programs;
functional tests; screening review

A. The director shall adopt rules establishing a uniform statewide preadmission
screening program to determine if a person who has met the eligibility criteria
prescribed in section 36-2934 is eligible for institutional services pursuant to this
article. To be eligible for institutional services or home and community based services
as defined in section 36-2931, a person shall have a nonpsychiatric medical condition or
have a developmental disability as defined in section 36-551 that, by itself or in
combination with other medical conditions, necessitates the level of care which is
provided in a nursing facility or intermediate care facility for the mentally
retarded. These rules shall establish a uniform preadmission screening instrument that
assesses the functional, medical, nursing, social and developmental needs of the
applicant.

B. A person is not eligible to receive home and community based services unless
that person has been determined to need institutional services as determined by the
preadmission screening instrument pursuant to subsection C of this section. The
administration shall establish guidelines for the periodic reassessment of each member.

C. Preadmission screening conducted pursuant to subsection B of this section shall
be conducted by a registered nurse licensed pursuant to title 32, chapter 15 or a social
worker. The nurse or social worker shall have a physician licensed pursuant to title
32, chapter 13 or 17 available for consultation and may use the applicant's attending
physician's physical assessment form, if appropriate, in assessing needs for long-term
care services under this article. A physician who receives a referral from the nurse or
social worker may use the physician's medical judgment to determine the medical
eligibility of an applicant for the system or the continued medical eligibility of a
member or eligible person. In the medical referral, the physician shall use the
established combined thresholds for functional ability and medical condition as a guide
to determine the risk of institutionalization.

D. If a person who is eligible for services pursuant to this article, who is
enrolled with a program contractor pursuant to this article and who is enrolled with a
program contractor pursuant to section 36-2940 fails the preadmission screening for
institutional services pursuant to subsection A of this section at the time of a
reassessment, the administration may administer a second preadmission screening designed
to measure the functioning level of the person based on rules adopted by the
director. If the person meets the established thresholds of the functional preadmission
screening, the person is eligible for home and community based services pursuant to
section 36-2939, subsection A, paragraphs 2, 3 and 4, subsection B, paragraph 2 and
subsection C. If a person who is determined eligible pursuant to this subsection is
institutionalized pursuant to section 36-2939, including residence in an intermediate
care facility for the mentally retarded, institution for mental disease, inpatient
psychiatric facility or nursing facility, the person has a maximum of ninety days to
vacate the institutional setting and relocate to a home and community based setting
approved pursuant to section 36-2939.

E. If the person is determined not to need services pursuant to this section, the
administration shall provide the person with information on other available community
services.

F. The administration or its designee shall complete the preadmission screening
under subsection A of this section within eight days, excluding Saturdays and holidays,
and excluding the time period allowed to determine eligibility pursuant to section
36-2934.

G. If a provider who contracts with the administration pursuant to section 36-2904,
subsection A is dissatisfied with any action or decision of the administration regarding
the eligibility of a person for the system as prescribed in this article, that provider
may file a grievance in accordance with the provider grievance procedure prescribed in
section 36-2932, subsection I, paragraph 1. If the director determines pursuant to the
grievance process that the person should have been determined eligible pursuant to
section 36-2933, the director may reimburse the provider for the net cost of services
provided pursuant to this article after the cumulative time periods allowed pursuant to
section 36-2934 and this section.

H. In addition to those persons seeking services pursuant to this article, the
preadmission screening conducted pursuant to this section shall be made available to all
other persons applying for admission to a nursing care institution. The cost of
preadmission screenings conducted by the administration pursuant to this subsection shall
be borne by the state. The administration shall provide nursing care institutions and
the general public on request with detailed information about the preadmission screening
program and booklets that describe in clear and simple language the availability of
services and benefits from the system. The booklet shall:

1. Explain the availability of preadmission screening that will assess the
functional, medical, nursing and social needs of the patient and make recommendations on
services which meet the patient's needs as identified by the preadmission screening
assessment.

2. Describe the availability of public and private services appropriate to meet the
patient's needs in institutions and alternatives to institutions.

3. Explain financial eligibility standards for the Arizona long-term care system
and its effect on separate and community property.

I. In addition to the preadmission screening program established in this section,
the administration shall implement the preadmission screening program as set forth in
section 1919 of the social security act. For persons applying for admission to a title
XIX certified nursing care institution, an initial level I preadmission screening shall
be conducted by the administration on all nursing care institution applicants who are
applying for eligibility pursuant to section 36-2933 and by the nursing care institution
on all other nursing care institution applicants. The administration shall develop a
uniform identification screening instrument which shall be used by the nursing care
institution and the administration in conducting the initial level I screens. If the
identification screen indicates the applicant may be mentally ill, the applicant shall be
referred to the department of health services which shall conduct the level II
preadmission screening review using a level II screening instrument developed by the
department of health services. If the identification screen indicates the applicant may
be mentally retarded, the applicant shall be referred to the department which shall
conduct the level II preadmission screening review using a level II screening instrument
developed by the department.

J. Within ten working days a nursing care institution shall notify the department
of health services for a person who is mentally ill or the department of economic
security for a person with developmental disabilities about any significant change that
occurs in the physical or mental condition of a member who is residing in the nursing
care institution. The department of health services or the department of economic
security shall conduct a subsequent level II screening review of the member within the
time frame required by the administration after the notification by the nursing care
institution.