Download 2015 Long Term Care Nursing Facility/Hospice

LTC Nursing Facility/Hospice User Guide
Expedited Admission Process
Expedited Admission Process
Does
individual
fit into a Category for
Expedited
Admission?
RE performs PL1
Yes
NF submits PL1 on
Portal immediately
on receipt
RE sends PL1 to NF
with individual
No
When is PE
required?
RE follows Preadmission or
Exempted Hospital Discharge Process
1, 2, or 3
4 or 5
6
7
Portal alerts LA/LMHA to
perform PE once PL1 is
submitted
Portal alerts LA/LMHA to
perform PE 7 days after
NF admission date
Portal alerts LA/LMHA to
perform PE 14 days after
NF admission date
Portal alerts LA/LMHA to
perform PE once MDS
indicates individual is no
longer comatose
LA/LMHA performs PE
within 72 hours of
notification
*LA/LMHA submits PE
within 7 days of
notification
*Payment for PE
NF conducts IDT with required
participants. NF certifies on
the PL1 Able or Unable to
serve the individual
LA/LMHA coordinates
placement if NF is unable
to serve
1. The Expedited Admission process starts when an RE performs the PL1 Screening and screens for Expedited
Admission using the following categories. (These categories are known by their numbers as well as their names):
Category # Category Name
Description
1
Convalescent Care
Individual is admitted from an acute care hospital to an NF for convalescent care with
an acute physical illness or injury which required hospitalization and is expected to
remain in the NF for greater than 30 days.
2
Terminal Illness
Individual has a medical prognosis that his or her life expectancy is 6 months or less if
the illness runs its normal course. An individual’s medical prognosis is documented by
a physician’s certification, which is kept in the individual’s medical record maintained
by the NF.
3
Severe Physical
Illness
An illness resulting in ventilator dependence or diagnosis such as chronic obstructive
pulmonary disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral
sclerosis, congestive heart failure, which result in a level of impairment so server that
the individual could not be expected to benefit from specialized services.
4
Delirium
Provisional admission pending further assessment in case of delirium where an accurate diagnosis cannot be made until the delirium clears.
5
Emergency
Protective Services
Provisional admission pending further assessment in emergency situations requiring
protective services, with placement in the NF not to exceed seven days.
6
Respite
Very brief and finite stay of up to a fixed number of days to provided respite to inhome caregivers to whom the individual with MI or IDD is expected to return following the brief NF stay.
7
Coma
Severe illness or injury resulting in inability to respond to external communication or
stimuli, such as coma or functioning at brain stem level.
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