To:	Interested Parties
From:	Christine Gianopoulos
Date:	January 2, 2004
Subject:	Long-term Care Assessment Protocols

 

After careful review of year-to-date spending for long-term care assessments, and the significant reduction in the waiting list for the state-funded Home Based Care program, the Department is pleased to be able to resume access to assessments as follows:

 

Home Based Care: Individuals seeking services will receive a telephone screening to determine if a face-to-face assessment is required. Consumers who are assessed and found eligible for HBC will be placed on the  waiting list.  As they come to the top of the list, and funds are available, EIM will contact them. If the consumer still desires services,  EIM will implement the plan of care. For those who do not receive a face-to-face assessment, Goold Health Systems will make referrals to other services, such as Homemaker, Alzheimer's Respite, Adult Day Services, or Family Caregiver; and provide the same written information that now is given at the face-to-face assessment.

 

Advisory Assessments: These will be available to individuals who are actively seeking nursing facility placement and have identified a facility; who are converting to private pay at the end of a SNF stay, or have been prescreened as potentially eligible for a MaineCare program or HBC.  Goold will continue to prescreen consumers to see if their needs and interests warrant a face-to-face assessment.

 

Hospital Assessments: Patients being discharged home who are eligible for HBC or MaineCare home care services will be assessed after discharge and, if applicable, when Home Health services end unless the prescreening determines that these skilled services are inadequate to meet the consumer’s expected needs.  We will continue to conduct the assessment in the home, unless discharge cannot occur without additional services being in place.  Consumers who previously received home care services that have lapsed due to the 30-day suspension will be reassessed.  Assessments for persons being discharged to residential care or assisted living are not required.

 

MaineCare Services: Requests for assessments for MaineCare nursing facility and home care will continue to be honored.

 

Nursing Facility Assessments: There will be no change in this process. MaineCare residents now receive an extended eligibility (24-month) date at the first nursing facility level of care re-assessment after admission, unless the assessor anticipates the resident's condition may change. MaineCare-eligible residents returning from a hospital stay no longer require an assessment, unless their bed-hold has expired.

 

Residential Care Facility Assessments: There will be no change in this process. Persons living in a residential care facility may have one assessment. Subsequent requests within the same fiscal year will be honored only if the facility is planning to discharge the resident to another care setting, or there is good cause to perform an additional assessment

 

If you have questions, please contact Mollie Baldwin at 287-9200, or by e-mail at Mollie.Baldwin@maine.gov.