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LTCFS Instructions Module 1: Overview of the Long Term Care Functional Screen (LTCFS)

Glossary of Acronyms, P-01010 (PDF) | LTCFS Paper Form, F-00366 (PDF)

Contents

1.1 Introduction

The Wisconsin Adult LTCFS determines functional eligibility for Wisconsin’s Medicaid funded long-term care (LTC) programs for persons who are frail elders or have physical disabilities, dementia, a terminal illness, and/or intellectual/developmental disabilities. In particular, the LTCFS includes eligibility for all three federal Medicaid target groups: frail elders, adults with physical disabilities, and adults with intellectual/developmental disabilities (I/DD). Functional eligibility is the combination of target group(s) and level(s) of care (LOC) determined by the screen after it has been completed and calculated.

The LTCFS has been used by screeners, in paper or electronic format, since 1997. Currently, the LTCFS is completed in Functional Screen Information Access (FSIA), a web-based application, which contains logic that interprets information entered by screeners to determine an adult’s eligibility for LTC programs. The LTCFS has been designed, operated, evaluated, and improved through a rigorous quality management system. To maintain a high level of validity and reliability, Department of Health Services (DHS) staff address screener questions, review functional eligibility results, provide training and support to screeners, and notify screeners of updates to the written instructions and FSIA.

Principles used to develop and maintain the quality and accuracy LTCFS include the following:

  • Clarity: Screeners must clearly understand definitions and answer choices.
  • Objectivity and Reliability: The LTCFS is designed to be as objective as possible to achieve the highest inter-rater reliability (two screeners would answer the same way for an individual), to ensure fair and proper functional eligibility determinations, and provide statewide consistency.
  • Brevity: The LTCFS is a functional eligibility tool, not a comprehensive assessment.
  • Inclusivity: Regardless of age, race, gender, culture, diagnoses, and other life conditions, every individual can be accurately screened with given choices for each question on the screen.

The LTCFS captures the needs of individuals, regardless of their living situation, and the assistance they may need from another person as a result of their diagnosis(es) in the following areas:

  • Activities of Daily Living (ADLs)
  • Instrumental Activities of Daily Living (IADLs)
  • Additional Supports
  • Health-Related Services (HRS)
  • Communication and Cognition
  • Behavioral Health including mental health and substance use
  • Risk

Individuals must be 18 years of age or older to participate in a Medicaid funded LTC program for which the LTCFS determines eligibility. DHS policy allows for early screening of individuals who are 17 years 6 months or older to assist in planning for transition to adult LTC services.

Other Functions of LTCFS

  • Serves as a foundation for the comprehensive assessment performed by the LTC program selected by a person. 
  • Provides data for quality assurance and improvement studies for DHS and LTC programs utilizing the LTCFS.
  • Indicates the need for referrals to adult protective services, mental health services, substance use services, or other community resources.
  • Provides actuarial information for rate setting and monthly allocations within LTC programs.

1.2 Wisconsin’s Medicaid Home and Community-Based Services (HCBS) Waiver Programs

Wisconsin’s Medicaid funded LTC programs are part of the Medicaid HCBS Waivers. The programs that the LTCFS determines functional eligibility for include:

To be eligible for a Wisconsin Medicaid funded LTC program an individual must meet ALL the following criteria:

  • Have a LTC condition or have a condition that is expected to result in death within one year
  • Have a condition that meets one or more of the eligible target group definitions for Medicaid funded LTC programs in Wisconsin.
  • Have a need for assistance from another person to complete ADLs, IADLs, or HRS tasks that are directly related to the conditions(s) that qualified the individual for a target group.
  • Have a need for assistance that meets one or more of the level(s) of care that are eligible for Medicaid funded LTC programs in Wisconsin.
  • Meet any other Wisconsin Medicaid funded LTC program eligibility requirements.

More information related to program eligibility is in Module 11.

1.3 Target Groups

There are three federal Medicaid target groups for HCBS waiver program participation:

  • Frail elder (FE)
  • Physical disability (PD)
  • FEDERAL definition of intellectual/developmental disability (I/DD per FEDERAL definition)

Wisconsin has more expansive definitions of the above target groups which include:

  • STATE definition of developmental disability (I/DD per STATE definition).
  • Alzheimer’s disease or other irreversible dementia (onset any age).
  • A terminal condition with death expected within one year from the date of this screening.

Additionally, there is a severe and persistent mental illness (SPMI) target group. Target groups are defined in state statute or administrative code, these definitions and more information is in Module 11.

1.4 Level of Care (LOC)

Wisconsin's Medicaid HCBS waiver programs require that an individual has at least one qualifying level of care. Qualifying levels of care include:

  • Nursing home (NH)
  • Intellectual/developmental disability (I/DD)
  • Non-nursing home (NNH)

Wisconsin’s NH levels of care for adults with disabilities and frail elders include:

  • Intermediate care facility (ICF)
  • Skilled nursing facility (SNF) 
  • Intensive skilled nursing services (ISN)

Wisconsin’s I/DD levels of care for adults meeting the FEDERAL definition of intellectual/developmental disability include: 

  • Developmental Disability 1A (DD1A)
  • Developmental Disability 1B (DD1B)
  • Developmental Disability 2 (DD2)
  • Developmental Disability 3 (DD3)

More information related to LOC is in Module 11.

Glossary

 
Last revised July 3, 2024