CHAPTER 12. HEALTH FACILITY PREADMISSION SCREENING
IC 12-10-12
Chapter 12. Health Facility Preadmission Screening
IC 12-10-12-1
"Agency" defined
Sec. 1. As used in this chapter, "agency" means the area agencyon aging designated by the division to carry out this chapter in theagency's established administrative region.
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.16;P.L.154-1995, SEC.5.
IC 12-10-12-2
"Designee" defined
Sec. 2. As used in this chapter, "designee" refers to an individualwho is designated by the director of the agency under section 27 ofthis chapter.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-3
"Health facility" defined
Sec. 3. As used in this chapter, "health facility" means a facility:
(1) that is licensed by the state department of health underIC 16-28; and
(2) that:
(A) provides comprehensive nursing care, room, food,laundry, administration of medications, special diets, andtreatments; and
(B) may provide rehabilitative and restorative therapies;
under the order of an attending physician.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-1993, SEC.82.
IC 12-10-12-4
"Office" defined
Sec. 4. As used in this chapter, "office" refers to the office ofMedicaid policy and planning established by IC 12-8-6-1.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-5
Admission to nursing facility; screening and approval; assessmentfor specialized services
Sec. 5. (a) Except as provided in sections 27 through 31 of thischapter, an individual who is admitted to a nursing facility must firsthave been screened and approved for placement under the nursingfacility preadmission screening program described in this chapter.
(b) An individual who is identified by the screening team undersection 16 of this chapter as an individual with a developmentaldisability or an individual who is mentally ill (as defined in 42U.S.C. 1396r(e)(7)) must be assessed to determine theappropriateness of nursing facility placement and the need forspecialized services.As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.2;P.L.1-1993, SEC.98; P.L.99-2007, SEC.66.
IC 12-10-12-6
Prior approval for nursing facility admission
Sec. 6. (a) This subsection does not apply after December 30,2008. If an individual who is discharged from a hospital licensedunder IC 16-21:
(1) is admitted to a nursing facility after the individual has beenscreened under the nursing facility preadmission programdescribed in this chapter; and
(2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facilitymay not be required by the office under IC 12-15-21-1 throughIC 12-15-21-3.
(b) This subsection applies beginning December 31, 2008. If anindividual:
(1) is admitted to a nursing facility after the individual has beenscreened under the nursing facility preadmission programdescribed in this chapter; and
(2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facilitymay be required by the office under IC 12-15-21-1 throughIC 12-15-21-3.
(c) The office shall adopt rules under IC 4-22-2 to implement:
(1) subsection (b);
(2) a screening and counseling program for individuals seekinglong term care services; and
(3) a biennial review of Medicaid waiver reimbursement rates.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.3;P.L.2-1993, SEC.83; P.L.50-2007, SEC.1; P.L.121-2008, SEC.3.
IC 12-10-12-7
Application; necessary information
Sec. 7. (a) An individual or the individual's parent or guardian, ifthe individual is not competent, who is required to be screened andapproved under this chapter shall apply to the agency serving thecounty of the individual's residence for participation in a nursingfacility preadmission screening program.
(b) The individual or the individual's parent or guardian if theindividual is not competent shall provide the agency with thefollowing:
(1) The individual's name.
(2) The address of the place where the screening team describedin section 14 of this chapter may contact the individual.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.4.
IC 12-10-12-8
Notification to applicant
Sec. 8. A nursing facility shall provide: (1) an individual who applies for admission to the nursingfacility; or
(2) the individual's parent or guardian if the individual is notcompetent;
a notification that meets the requirements of sections 9 and 10 of thischapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.5.
IC 12-10-12-9
Notification form
Sec. 9. The notification required under section 8 of this chaptermust be in writing on standardized forms prepared by the divisionand provided to the nursing facilities.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.6.
IC 12-10-12-10
Notification contents; acknowledgment by applicant; copies;violation
Sec. 10. (a) The notification required under section 8 of thischapter must notify the applicant of the following:
(1) That the applicant is required under state law to apply to theagency serving the county of the applicant's residence forparticipation in a nursing facility preadmission screeningprogram.
(2) That the applicant's failure to participate in the nursingfacility preadmission screening program could result in theapplicant's ineligibility for Medicaid reimbursement for perdiem in any nursing facility for not more than one (1) year.
(3) That the nursing facility preadmission screening programconsists of an assessment of the applicant's need for care in anursing facility made by a team of individuals familiar with theneeds of individuals seeking admission to nursing facilities.
(b) The notification must be signed by the applicant or theapplicant's parent or guardian if the applicant is not competent beforeadmission.
(c) If the applicant is admitted:
(1) the nursing facility shall retain one (1) signed copy of thenotification for one (1) year; and
(2) the nursing facility shall deliver one (1) signed copy to theagency serving the county in which the applicant resides.
(d) A person who violates this section commits a Class Ainfraction.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.7.
IC 12-10-12-11
Time limitations
Sec. 11. Each individual who is required to be screened andapproved before admission to a nursing facility shall be screened,within the time permitted under this chapter, by the screening teamdescribed in section 14 of this chapter.As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.8.
IC 12-10-12-12
Screening team; uniform rules
Sec. 12. (a) The activities of the screening team must beconducted under uniform rules adopted under IC 4-22-2 by thedirector of the division.
(b) The rules must be developed in cooperation with the divisionof mental health and addiction and the office.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.9;P.L.215-2001, SEC.38.
IC 12-10-12-13
Screening team; requirements
Sec. 13. The nursing facility preadmission screening programshall be conducted by a screening team that meets the requirementsof section 14 of this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.10.
IC 12-10-12-14
Screening team; membership; coordinator
Sec. 14. (a) A screening team must consist of two (2) members.
(b) An applicant's physician shall participate as a member of thescreening team.
(c) The agency that serves the county of the applicant's residenceshall, subject to the approval of the division, also appoint anindividual who:
(1) represents the agency serving the area in which theapplicant's residence is located; and
(2) is familiar with personal care assessment.
(d) The agency shall, subject to the approval of the division,appoint one (1) of the individuals under subsection (c) to be thecoordinator.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.11.
IC 12-10-12-15
Multiple screening teams
Sec. 15. More than one (1) screening team may be appointed.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.12.
IC 12-10-12-16
Screening program assessments
Sec. 16. (a) A screening team shall conduct a nursing facilitypreadmission screening program for each individual within the timepermitted under this chapter. The program must consist of anassessment of the following:
(1) The individual's medical needs.
(2) The availability of services, other than services provided ina nursing facility, that are appropriate to the individual's needs.
(3) The cost effectiveness of providing services appropriate to
the individual's needs that are provided outside of, rather thanwithin, a nursing facility.
(b) The assessment must be conducted in accordance with rulesadopted under IC 4-22-2 by the director of the division incooperation with the office.
(c) Communication among members of a screening team orbetween a screening team and the division, the office, or the agencyduring the prescreening process may be conducted by meansincluding any of the following:
(1) Standard mail.
(2) Express mail.
(3) Facsimile machine.
(4) Secured electronic communication.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.13;P.L.115-1997, SEC.1; P.L.121-2008, SEC.4.
IC 12-10-12-17
Findings; appropriateness of placement
Sec. 17. After an assessment is completed, the screening teamshall find, by both members of the team, whether the placement ofthe individual in a nursing facility is appropriate.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.14.
IC 12-10-12-18
Review of findings; final determinations
Sec. 18. The office shall do the following:
(1) Review a screening team's finding.
(2) Make the final determination only in the following cases:
(A) Where the individual is eligible for Medicaid.
(B) Members of the screening team disagree.
(C) A placement is denied.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.15.
IC 12-10-12-19
Mandatory placement; conditions
Sec. 19. Placement in a nursing facility may not be denied if anyof the following conditions exist:
(1) Community services that would be more appropriate thancare in a nursing facility are not actually available.
(2) The cost of appropriate community services would exceedthe cost of placement in a nursing facility.
(3) The applicant:
(A) has been determined to be eligible for assistance underthe federal Medicaid program (42 U.S.C. 1396 et seq.);
(B) needs a service that would make the applicant'splacement in a nursing facility inappropriate when theservice cannot be provided without the use of a new servicemade available under a home and community based serviceswaiver approved by the Secretary of Health and HumanServices under 42 U.S.C. 1396n; and (C) chooses not to receive the service described under clause(B).
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.16;P.L.150-1995, SEC.17; P.L.154-1995, SEC.6.
IC 12-10-12-20
Notice of determination; contents
Sec. 20. (a) The agency shall provide the applicant with a writtennotice of the office's determination made under section 18 of thischapter if the placement is appropriate. The office shall providewritten notice of a determination made under section 16 of thischapter when placement in a nursing facility is denied.
(b) If the office determines that an individual's placement in anursing facility is not appropriate, the written notice must contain thefollowing:
(1) The reasons for the office's determination.
(2) A detailed description of services available to the individualthat, if used by the individual, make the placement of theindividual in a nursing facility inappropriate.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.17.
IC 12-10-12-21
Administrative appeal of determination
Sec. 21. An applicant aggrieved by a determination of the officemay appeal the determination under rules concerning the appeal thatare adopted by the office under IC 4-22-2.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-22
Judicial appeal
Sec. 22. After exhausting all administrative remedies, theapplicant may obtain judicial review under IC 4-21.5-5.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-23
Waiver of sanctions; conditions; application
Sec. 23. An applicant may apply to the office for a waiver of thesanctions imposed by section 33 or 34 of this chapter if the followingconditions are met:
(1) The applicant has made an appropriate application undersection 7 of this chapter.
(2) The office has not provided the applicant with the noticerequired under section 20 of this chapter within twenty-five (25)days of the date the application was made under section 7 ofthis chapter.
(3) The applicant, the applicant's physician, and the applicant'scurrent custodian have cooperated with the screening team.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.18.
IC 12-10-12-24 Determination on application for waiver of sanctions
Sec. 24. If the office finds that an applicant has filed anapplication for a waiver and has met the three (3) conditions set outin section 23 of this chapter, the office shall, not later than thesecond working day following the receipt of the application for awaiver, either:
(1) issue the notice required by section 20 of this chapter; or
(2) waive the sanctions imposed by sections 33 and 34 of thischapter.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-25
Administrative rules for preadmission screening assessment
Sec. 25. The office shall adopt rules under IC 4-22-2 to permit anindividual who has not applied for admission to a nursing facility tobe assessed under section 16 of this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.19.
IC 12-10-12-26
Information gathering by division
Sec. 26. The division shall collect the information necessary to dothe following:
(1) Determine the effectiveness of the preadmission screeningprogram.
(2) Identify barriers to diversion of individuals to in-home care.
(3) Identify needs that may exist for additional in-homeservices.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-27
Designatory empowered to authorize unapproved temporaryadmissions
Sec. 27. (a) The agency shall, subject to the approval of thedivision, designate at least one (1) individual who may authorizetemporary admittance to a nursing facility under:
(1) subsection (b); and
(2) sections 28, 30, and 31 of this chapter;
without the approval required under this chapter.
(b) An individual designated under subsection (a) may authorizetemporary admittance to a nursing home for a resident of Indiana ifthe resident:
(1) has received treatment from and is being discharged from ahospital that is located in a state other than Indiana; and
(2) will be participating in preadmission screening under thischapter.
(c) Notwithstanding a rule adopted under section 12 of thischapter, a screening team appointed to screen a nonresident underthis section must:
(1) conduct its assessment under section 16 of this chapter; and
(2) report its findings;within ten (10) days after its appointment.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.20;P.L.278-1993(ss), SEC.25; P.L.115-1997, SEC.2.
IC 12-10-12-27.1
Temporary admissions of nonresidents
Sec. 27.1. An individual designated under section 27(a) of thischapter may authorize temporary admittance to a nursing home fora nonresident of Indiana if the nonresident:
(1) was admitted to the hospital immediately after receivingtreatment in the hospital's emergency department;
(2) has received treatment from and is being discharged from ahospital licensed under IC 16-21; and
(3) will be participating in preadmission screening under thischapter.
As added by P.L.115-1997, SEC.3.
IC 12-10-12-28
Temporary admissions; grounds; limitations; regular assessment
Sec. 28. (a) An individual may be admitted directly to a nursingfacility from an inpatient bed of a community mental health center,a managed care provider (as defined in IC 12-7-2-127(b)), a stateinstitution, or a hospital licensed under IC 16-21, subject to therequirements of 42 U.S.C. 1396r(e)(7), if, after the assessmentrequired by section 16 of this chapter is substantially complete, thedesignee makes a finding that services necessary to care for theindividual outside of the center or hospital are not at that timeavailable except in a nursing facility.
(b) The individual may remain in the nursing facility for thenumber of days designated by the designee without the approvalrequired by this chapter.
(c) The number of days designated by the designee may notexceed the lesser of:
(1) the individual's estimated recovery time, plus twenty-five(25) days; or
(2) one hundred twenty (120) days.
(d) During the period under subsection (c), the assessment shallbe modified and completed according to the individual's currentneeds and the determination of appropriate placement made undersections 16 and 17 of this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.21;P.L.2-1993, SEC.84; P.L.40-1994, SEC.20.
IC 12-10-12-28.5
List of long term care options provided to patients before dischargefrom hospitals
Sec. 28.5. Before discharging a patient who will be participatingin preadmission screening under this chapter, a hospital licensedunder IC 16-21 shall give the patient a list of all long term careoptions that: (1) may be available to the patient;
(2) are located within the hospital's service area; and
(3) are known to the hospital.
As added by P.L.115-1997, SEC.4.
IC 12-10-12-29
Repealed
(Repealed by P.L.78-1992, SEC.28.)
IC 12-10-12-30
Admission upon probability of early discharge; limitations onobtaining approval
Sec. 30. (a) An individual may be admitted to a nursing facility ifthe designee determines that it is probable that the individual will bedischarged from the nursing facility within thirty (30) days of theindividual's admission.
(b) If the individual:
(1) desires to remain in a nursing facility for more than thirty(30) days; and
(2) applies for approval under this chapter before the expirationof the thirty (30) days;
the individual has an additional twenty-five (25) days in which toobtain the approval.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.22.
IC 12-10-12-31
Preapproval admission; grounds
Sec. 31. An individual who has applied for approval under thischapter may be admitted before approval is granted if the designeedetermines that there will be serious harm to the physical or mentalhealth of the individual if the individual is required to wait forapproval.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-32
Stay following unapproved admission; duration
Sec. 32. An individual may remain in a nursing facility for notmore than twenty-five (25) days without approval under this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.23.
IC 12-10-12-33
Medicaid assistance predicated upon preadmission screening andapproval; intermediate care facility
Sec. 33. If an individual:
(1) does not participate in the health facility preadmissionscreening program described in this chapter; or
(2) participates in the health facility preadmission screeningprogram described in this chapter and is notified under section20 of this chapter that the individual's placement in a healthfacility is not appropriate;the individual is not eligible for assistance under the federalMedicaid program (42 U.S.C. 1396 et seq.) for the payment of anypart of the cost per diem provided to the individual in a part of ahealth facility certified as an intermediate care facility for one (1)year after the date of the individual's admission to the health facility.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-34
Medicaid assistance predicated upon preadmission screening andapproval; skilled health facility
Sec. 34. If an individual:
(1) refuses to participate in the health facility preadmissionscreening program described in this chapter; or
(2) participates in the health facility preadmission screeningprogram described in this chapter and is notified under section20 of this chapter that the individual's placement in a healthfacility is not appropriate;
the individual is not eligible for assistance under the federalMedicaid program (42 U.S.C. 1396 et seq.) for the payment of anypart of the cost per diem provided to the individual in a part of ahealth facility certified as a skilled health facility until the individualhas participated in the health facility preadmission screeningprogram and has been notified that placement in a health facilitycertified to provide skilled care is appropriate.
As added by P.L.2-1992, SEC.4.