LTCFS Instructions Module 11: Completion of the LTCFS

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

Contents

• 11.1 Overview
• 11.2 Screen Time Information
• 11.3 No Active Treatment (NAT)
• 11.4 Calculating Eligibility
• 11.5 Information Available on the Eligibility Results Page
• 11.6 Confirming the Functional Eligibility Results

11.1 Overview

Once the screener has entered the relevant information related to the needs of the individual in FSIA, there are some final steps to completing the LTCFS. Screeners must record the time spent working on the screen, complete the No Active Treatment (NAT) section if applicable, and calculate functional eligibility. It is important to understand target group definitions and level of care results to identify if the outcome is appropriate based on the needs of the individual.

11.2 Screen Time Information

All times are rounded to the nearest 15-minute increment.

Screen Completion Date (mm/dd/yyyy)
Refer to your agency policy regarding the date to enter in this field.

The screen completion date should not be changed when making an edit or when transferring a screen to another screening agency.

Face-to-Face Contact with Person
The amount of time the screener spent with the person being screened and any collateral contact(s) present during the in-person interview should be entered in this field.

Collateral Contacts
The amount of time the screener spent communicating with collateral contacts to gather information for the screen when the individual is not present should be entered in this field.

Paper Work
All other screen-related activity should be entered in this field. This may include:

• Communication with the person being screened outside of the in-person interview.
• Review of previous functional screens, assessments, plans, health records, and other written documentation.
• Consultation with the agency screen liaison, coworkers, or DHS staff regarding any aspect of an individual’s screen.
• Entering the LTCFS into FSIA.

Travel Time
The amount of time the screener spent traveling to gather information necessary to complete the LTCFS should be entered in this field.

11.3 No Active Treatment (NAT)

The NAT section will appear and must be completed for any individual who has at least one A1-A10 diagnosis selected on the Diagnoses Table.

A NAT determination is not the same as a Pre-Admission Screening and Annual Resident Review (PASARR) determination. When an individual has received a determination of NAT, they are not necessarily exempt from a PASARR determination.

NAT is a designation given to individuals with an intellectual/developmental disability who, for either health reasons or because of advanced age, no longer require treatment related to their intellectual/developmental disability. In addition, a person with an intellectual/developmental disability such as cerebral palsy, but with a normal IQ, could be appropriate for a NAT designation. An NAT designation can impact allowable residential settings for a person. Questions regarding NAT should be directed to the screening agency’s DHS oversight team.

Instructions
The NAT section contains two parts, A and B. Part A statements will have automatic default selections based on entries made on the Diagnosis Table. If a screener needs to change a default selection in Part A, they should include an explanatory note about why the default selection was changed.

Part A statements:

Statement 1: The person has a terminal illness.

Yes: Selected if K3 Terminal Illness is selected on the Diagnoses Table
No: Selected if K3 Terminal Illness is not selected on the Diagnoses Table

Statement 2: The person has an IQ greater than 75.

Yes: Selected if IQ score on the Diagnosis page is greater than 75
No: Selected if IQ score on the Diagnosis page is less than or equal to 75
N/A: Selected if IQ score on the Diagnosis page is selected as unknown.

Statement 3: The person is ventilator-dependent.

Yes: Selected if F4 Ventilator Dependent is selected on the Diagnoses Table
No: Selected if F4 Ventilator Dependent is not selected on the Diagnoses Table

After an individual enrolls in Family Care, PACE, Partnership, or IRIS, the program’s screener should complete Part B of the NAT section.

Part B Statements:

Statement 1: The person has physical or mental incapacitation, typically but not always due to advanced age, such that their needs are similar to those of geriatric nursing home residents.

Yes: Select Yes if person of any age has needs that are similar to those of geriatric nursing home residents
No: Select No if person of any age does not have needs similar to those of geriatric nursing home residents

Statement 2: The person is age 65 or older and would no longer benefit from active treatment.

Yes: Select Yes if person is age 65 or older and the program has determined the person would no longer benefit from active treatment
No: Select No if person is under age 65

Statement 3: The person has severe, chronic medical needs that require skilled nursing care.

Yes: Select Yes if person of any age has severe, chronic medical needs that require skilled nursing care
No: Select No if person of any age does not have severe, chronic medical needs that require skilled nursing care

11.4 Calculating Eligibility

The Calculate Eligibility button must be selected to complete a functional screen. Do not calculate eligibility until you have completed an in-person interview and have entered all information into the screen, including notes.

Eligibility must be calculated for a screen to be transferred. If the screen is complete, the screener does not need to recalculate eligibility before transferring a screen to another screening agency.

If a screener needs to change an individual’s name, Social Security number, or date of birth after eligibility has been calculated, the screener should reference the Basic Information for Screeners, P-01604 (PDF) for guidance.

11.5 Information Available on the Eligibility Results Page

Once the screener has selected Calculate Eligibility in FSIA, a new page will appear with target group and eligibility results. It will also include agency and screener information, target groups, level of care results and transfer of level of care results.

The results indicate that the individual meets or does not meet functional eligibility for adult LTC. HCBW Eligibility, HCBW LOC, and COP level 3 Eligibility are no longer recognized in adult LTC.

Target Groups

Target groups are defined in state statute and administrative code. Target group results and their definitions are listed below.

Frail Elder Target Group
“Frail elder” means an individual aged 65 or older who has a physical disability, or an irreversible dementia, that restricts the individual’s ability to perform normal daily tasks or that threatens the capacity of the individual to live independently. Wis. Admin. Code § DHS 10.13(25m).

Physical Disability Target Group
“Physical disability” means a physical condition, including an anatomical loss, or musculoskeletal, neurological, respiratory, or cardiovascular impairment, which results from injury, disease, or congenital disorder and which significantly interferes with or significantly limits at least one major life activity of a person. Wis. Stat. § 15.197(4)(a)2.

“Major life activity” means any of the following: A. Self-care, B. Performance of manual tasks unrelated to gainful employment, C. Walking, D. Receptive and expressive language, E. Breathing, F. Working, G. Participating in educational programs, H. Mobility, other than walking, I. Capacity for independent living. Wis. Stat. § 15.197(4)(a)1.

FEDERAL Definition of Intellectual/Developmental Disability Target Group
Under Federal law a person is considered to have an intellectual disability if they have: (i) A level of intellectual disability described in the American Association of Intellectual and Developmental Disabilities’ Manual on Classification in Intellectual Disability, or (ii) A related condition as defined C.F.R. § 435.1010 which states, “Person with related conditions” means individuals who have a severe, chronic disability that meets all of the following conditions:

(a) It is attributable to:

1. Cerebral palsy or epilepsy or
2. Any other condition, other than mental illness, found to be closely related to intellectual disability because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of intellectually disabled persons, and requires treatment or services similar to those required for these persons.

(b) It is manifested before the person reaches age 22.
(c) It is likely to continue indefinitely.
(d) It results in substantial functional limitations in three or more of the following areas of major life activity: self-care; understanding and use of language; learning; mobility; self-direction; or capacity for independent living.

Refer to the Guide for I/DD per Federal Definition, P-00935 (PDF) for more information.

STATE Definition of Developmental Disability Target Group
Wisconsin state law defines a developmental disability as a disability attributable to brain injury, cerebral palsy, epilepsy, autism, Prader-Willi syndrome, intellectual disability, or another neurological condition closely related to an intellectual disability or requiring treatment similar to that required for individuals with an intellectual disability, which has continued or can be expected to continue indefinitely and constitutes a substantial handicap to the afflicted individual. Developmental disability does not include senility which is primarily caused by the process of aging or the infirmities of aging. Wis. Stat. § 51.01(5)(a).

Wisconsin's definition of developmental disability is broader than the federal definition, in that it does not include the restrictive clauses “b” (onset before age 22) and “d” (substantial functional limitations) that are found within the federal definition.

Alzheimer’s Disease or Other Irreversible Dementia Target Group
Dementia means Alzheimer's disease and other related irreversible dementias involving a degenerative disease of the central nervous system characterized especially by premature senile mental deterioration and also includes any other irreversible deterioration of intellectual faculties with concomitant emotional disturbance resulting from organic brain disorder. Wis. Stat. § 46.87(1)(a).

Terminal Condition Target Group
Terminal condition is defined as a condition with which a person’s death is expected within one year from the date of the person’s screening.

Severe and Persistent Mental Illness Target Group
“Severe and persistent mental illness” is defined as a mental illness that is severe in degree and persistent in duration, that causes a substantially diminished level of functioning in the primary aspects of daily living and an inability to cope with the ordinary demands of life, that may lead to an inability to maintain stable adjustment and independent functioning without long-term treatment and support, and that may be of lifelong duration. “Serious and persistent mental illness" includes schizophrenia as well as a wide spectrum of psychotic and other severely disabling psychiatric diagnostic categories, but does not include degenerative brain disorder or a primary diagnosis of a developmental disability or of alcohol or drug dependence. Wis. Stat. § 51.01(14t).

No Target Group
Individuals who do not meet the definition of any adult LTC program target group, will not be found eligible.

Target Group General information

• An individual’s condition may meet the definitional requirements of more than one target group at a time.
• An individual may have a disability determination and NOT meet a target group definition.
• An individual will NOT meet a target group definition if they have a temporary condition.
• An individual meeting only the “No Target Group” definition will NOT be functionally eligible for a Wisconsin Medicaid funded LTC program.
• An individual may meet target group definition(s), but NOT be eligible for a Wisconsin Medicaid funded LTC program if they do NOT have a need for assistance with ADL, IADL, or HRS tasks.
• An individual may need assistance with an ADL, IADL, or HRS task, but NOT be eligible for a Wisconsin Medicaid funded LTC program if they do NOT meet one of the eligible target group definitions.
• An individual meeting ONLY the SPMI target group definition will NOT be functionally eligible for a Wisconsin Medicaid funded LTC program.
• An individual meeting ONLY the STATE definition of developmental disability target group will NOT be functionally eligible for IRIS.
• Except for diagnoses of Alzheimer’s disease, other irreversible dementias, and terminal illness, a diagnosis alone is not sufficient to qualify an individual to meet a target group definition.

Brain Injury Information
Traumatic brain injury is included with the physical disability or frail elder target group, even if the resulting symptoms are only cognitive or behavioral.

A person with brain injury may meet the FEDERAL definition of I/DD if their injury occurred before age 22. If the brain injury occurred at age 22 or after, the person’s condition may meet the STATE definition of I/DD, but not the federal definition.

Level of Care (LOC) Results

The following describes nursing home (NH) and intellectual/developmental disability (I/DD) levels of care and how these interact with functional eligibility for each Medicaid funded HCBS Waiver program.

Family Care and NH or I/DD Level of Care
To qualify for Family Care, a person must have a long-term care condition likely to last more than 90 days.

There are two levels of Family Care eligibility which are "Family Care Nursing Home LOC" and "Family Care Non-Nursing Home LOC."

• Family Care Nursing Home LOC includes all three nursing home levels of care and all four I/DD levels of care. Refer to Wis. Stat. § 46.286(1)(a)1m for complete definition.
• Family Care Non-Nursing Home LOC includes individuals who do not have a nursing home LOC or I/DD LOC but require minimal assistance in ADLs and/or IADLS. Refer to Wis. Stat. § 46.286(1)(a)2m for complete definition.

PACE/Partnership and NH or I/DD Level of Care
To qualify for PACE and/or Family Care Partnership, a person must have a long-term care condition likely to last more than 90 days and meet a NH or I/DD level of care.

IRIS and NH or I/DD Level of Care
To qualify for IRIS, a person must have a long-term care condition likely to last longer than 1 year and meet a NH or I/DD level of care.

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

• Intermediate care facility (ICF): Low to moderate needs
• Skilled nursing facility (SNF): High needs
• Intensive skilled nursing services (ISN): Highest needs

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

• Developmental Disability 1A (DD1A): People with significant medical support needs in addition to a cognitive disability
• Developmental Disability1B (DD1B): People with significant behavioral support needs in addition to a cognitive disability
• Developmental Disability 2 (DD2): People who have a cognitive disability and are neither DD1A nor DD1B level of care and need help with all or most ADLs and IADLs
• Developmental Disability 3 (DD3): People who have a cognitive disability and are more independent with most ADLs and IADLs

Level of Care General information

• An individual may meet target group definition(s) but may not meet a qualifying Level of Care.
• An individual meeting either a NH or I/DD Level of Care may qualify for a Wisconsin Medicaid funded LTC program.

Transfer Level of Care Results
This area will display if and when the LOC details were sent to CARES.

11.6 Confirming the Functional Eligibility Results

Expected Outcome
When a screener believes the target group and level of care results accurately reflect the individual’s needs, the screen is considered complete and accurate. The results may be different from prior screens, but if that change appears appropriate, then the results are not unexpected.

If the outcome is expected the screener can select the check box to immediately transfer the results to CARES, otherwise the results will transfer automatically on the 11th day after calculation.

Unexpected Outcome
If the target group and/or level of care result do not appear to be congruent with the individual’s needs, this is an unexpected outcome. A thorough review of the screen must be completed, and the screener should follow agency policy regarding the transfer of results to CARES.

If the results of the screen remain unexpected after that review, the agency screen liaison is to contact DHS at dhsltcfsdiagnosis@dhs.wisconsin.gov who will perform a full review of the screen and consult with the screen liaison until the screen results are considered complete and accurate. Once the screen is considered complete and accurate, the screener takes the action that is required of them by their screening agency based on the results of the screen.