LTCFS Instructions Module 2: Screening Process and Quality Assurance

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

Contents

• 2.1 Screener Qualifications
• 2.2 The LTCFS is Voluntary and Confidential
• 2.3 In-Person Interview
• 2.4 Interviewing Strategies
• 2.5 Screening Strategies
• 2.6 Abilities Fluctuate
• 2.7 Notes
• 2.8 Screening and Rescreening Requirements
• 2.9 Quality Assurance

2.1 Screener Qualifications

Screeners must meet the following qualifications:

• Meet all education and experience requirements as specified below:
  • Bachelor of Arts or Science degree, preferably in a health or human services related field or have a license to practice as a registered nurse in Wisconsin pursuant to Wis. Stat. § 441.06.
  • At least one year of experience working with at least one of the target populations (frail elder, physical disability, or intellectual/developmental disability).
• Meet all training requirements as specified by DHS. This includes successfully completing the certification course, quizzes, refresher courses, and continuing skills testing.

2.2 The LTCFS is Voluntary and Confidential

The LTCFS is voluntary. The person being screened or their legal guardian must consent to the LTCFS being completed.

All information collected for the screening process is confidential.

• Gathering information to complete the screen: Screening agencies must comply with confidentiality rules and requirements and must obtain a signed release of information from the person being screened, or their legal guardian, where applicable, to collect health care records and other records needed to complete the screening process.
• Releasing the LTCFS between screening entities: When an aging and disability resource center (ADRC) or Tribal Aging & Disability Resource Specialist (ADRS) refers a person for enrollment in a long-term care program, the person’s functional screen may be shared with that program without separate written authorization. An individual’s LTCFS can be transferred to the new agency without the individual’s informed consent under Wis. Stat. § 46.284(7). Refer to DHS publication Transition of Care Between Medicaid Programs or Between Agencies Within a Medicaid Program, P-02364 (PDF).
• Releasing the LTCFS to all other individuals and/or entities: Release of a functional screen to another person or any other entity requires written authorization by the person screened, or their legal guardian, where applicable.

2.3 In-Person Interview

• The screening process requires in person, face to face contact with the individual. The whole interview does not need to be completed in person.
• The in-person interview may take place in any setting. However, best practice is to perform the interview in the individual’s residence.

Waiving the In-Person Interview Requirement

In rare instances, there may be a need to complete a screen for an individual who is not able to be seen in person.

In situations where the screener did not complete an in-person interview, the agency must inform the individual that functional eligibility may change after the in-person interview is completed.

Waiving the In-Person Interview Requirement for the Initial Screen for an Applicant Temporarily Out of State

There may be a need for ADRCs or Tribal ADRS to complete an initial screen for an applicant who is currently located in a state other than Wisconsin. In these instances, the screening agency may conduct the screen via telephone or video meeting without requesting a waiver from DHS. The screening agency must document in the notes section why the in-person interview was not completed.

Waiving the In-Person Interview Requirement for an Applicant in a Department of Corrections (DOC) or DHS Institution or Treatment Center

There may be a need for ADRCs or Tribal ADRS to complete a screen for an individual who is currently located in:

• The Department of Correction’s (DOC) institutions and centers (PDF).
• The Department of Health Services (DHS) secure treatment centers of Sand Ridge and Wisconsin Resource Center.
• DHS’s institutes for mental disease (IMD) Mendota and Winnebago Mental Health Institutes.

In these instances, the ADRC or Tribal ADRS may conduct the screen via telephone or video meeting without requesting a waiver from DHS. The screener must document in the notes section why the in-person interview was not completed.

Waiving the In-Person Interview Requirement for Other Reasons

Requests from a screening agency to waive the in-person interview requirement for reasons other than listed above will be considered on a case-by-case basis. In these instances, the screening agency must obtain approval from the DHS LTCFS team to conduct a screen without an in-person interview. It may be appropriate to request a waiver when one or more of the following criteria are met:

• Traveling to conduct the in-person interview is a hardship to the agency. Hardships might include the need for air travel, overnight stay, excessive loss of work time.
• The ADRC or Tribal ADRS has attempted to arrange for an in-person interview to be performed by another ADRC or Tribal ADRS located closer to the individual (courtesy screen) but the request was denied or is unreasonable.

To request a waiver:

• The screening agency’s LTCFS liaison will email the request to dhsltcfsteam@dhs.wisconsin.gov. The submission must include:
  • The individual’s date of birth and initials.
  • The reason(s) for the request.
  • The plan for when a subsequent in-person interview is to occur
  • Compelling information to support the need for the waiver.
• Within 10 working days of the request, the screening agency’s liaison will be notified of DHS’ approval or denial.
• A waiver must be requested for each occurrence.

If DHS waives the in-person interview requirement, the screening process must be followed, but information may be gathered from the individual through telephone or video call. The Notes section of the Screen Information page must include the information from the waiver request and the date DHS granted the waiver.

2.4 Interviewing Strategies

The LTCFS is not an interview tool. Information may be gathered in any order. It may take more than one contact with the individual and/or collateral contacts to complete the screen.

Screeners should use their professional interview skills to gather information in a way that is appropriate and respectful to best capture the needs of the individual being interviewed.

• Ask questions in a variety of ways.
• Use open-ended questions.
• Use varying communication methods.
• Consider multi-cultural interviewing strategies.
• Look for visual clues, facial expressions, and interactions between the individual and others present.
• Take a tour of the individual’s home and observe them as they perform everyday activities.

2.5 Screening Strategies

Individuals being screened and/or their collateral contacts may provide inaccurate or conflicting information. They may overrate or underrate the individual’s abilities. To maintain screen accuracy and reliability, screeners should:

• Seek more details from the individual being screened.
  • Ask for clarifying information. For example, if the individual tells you they bathe themselves independently but cannot dress their lower body, ask additional questions to help determine the individual’s needs.
  • If possible, ask the individual to demonstrate tasks. For example, ask the individual to demonstrate transferring in and out of their bathtub.
• Seek additional information from collateral contacts who are familiar with the individual and involved in their direct care. Collateral contacts may include, but are not limited to, an individual’s guardian, family members, friends, health care providers, an authorized representative, and service providers.
• Use professional judgment to make the most accurate selections.
  • Follow the LTCFS definitions and instructions as outlined in this document.
  • Be as objective as possible when making selections.
  • Consider inter-rater reliability as defined in Module 1.1.
• Review the individual's previous screens for information and historical perspective.
• Seek guidance from the agency’s screen liaison as needed.

2.6 Abilities Fluctuate

Many individuals have conditions and abilities that fluctuate over time. When addressing fluctuating needs, use the following guidelines:

• If the individual's functional abilities vary day to day, then make selections that most accurately describe their needs on a "bad" day.
• If the individual's functional abilities vary week to week, make selections that reflect the assistance needed from another person to maintain the individual’s health and safety.
• If the individual's functional abilities vary over months or years, then make selections that are closest to the average frequency of help needed.

2.7 Notes

Screeners are strongly encouraged to use the Notes sections to support all selections.

Best practice attributes of quality notes should:

• Include date and screener initials or name.
• Be written professionally in a style that is:
  • Individual-specific, factual, objective, unbiased, and concise.
  • Easily read and understood by others.
  • Grammatically correct and free of spelling errors.
• Be current.
  • Notes that are no longer accurate or relevant should be deleted. These notes are saved in screen history.
  • It is not considered plagiarism for screeners to edit or use a note previously written by another screener. When a screener adds their initials or name and dates a note previously written by another screener, they are signing off that the information in the note is accurate.
• Indicate:
  • Why selections have been made.
  • The source of referenced information.

Examples of Quality Notes

• 1/2/2023: Diagnoses: All diagnoses were confirmed from medical records received 12/2022 from Dr. Jones at Healthy Clinic. -Sally Screener, Care Manager, Caring Faces Inc.
• May 2023: Meal Preparation: Ruth needs help to monitor for food spoilage and grocery shop due to cognitive impairments from vascular dementia. She is able to independently prepare sandwiches, salads, and reheat foods in her microwave. -SS
• 6/23: Behaviors: Participant has a history of kicking and hitting caregivers while in the shower. There is a plan in place with preventative interventions that are understood amongst caregivers. These interventions are provided every evening before and during participant’s shower. With these interventions provided, participant has not attempted to hit or kick their caregivers in over three months. -S. Screener
• June 1, 2023: Risk: Individual meets the criteria for Risk Box B2 as they need help from another person with 4 ADLs and has had 2 falls resulting injury in the past month. They would be at imminent risk of institutionalization in a nursing home if supports are not provided. -SS, CM

2.8 Screening and Rescreening Requirements

Initial Screen

An initial screen, including an in-person interview, is only completed by the ADRC or Tribal ADRS to determine functional eligibility for individuals who are not enrolled in Medicaid funded LTC programs. ADRC and Tribal ADRS screeners should refer to their guidelines for when to perform a new initial screen for a person who has had a screen performed in the past.

Rescreen

Rescreens, including an in-person interview, must be completed by screeners for the following reasons:

• Annual Rescreen: An annual rescreen must be completed by a screener at the agency where an individual is enrolled to re-determine functional eligibility. The screen must be calculated by midnight on the 365th day (which in most years would be the day before the previous screen).
• Change in Condition Rescreen: A change in condition rescreen must be completed by a screener at the agency who owns the screen if a person experiences a substantial change in condition. This could be a decline or an improvement in the person’s condition. The change may be short term or long term. It is best practice to include an explanation of why a change of condition rescreen was completed in the Notes section.

Rescreens may be completed for other reasons as outlined in the screening agency’s guidelines and policies.

Screening When Impending Discharge

When screening a person who is actively preparing for discharge from a hospital, skilled health care facility, correctional facility, institute for mental disease (IMD), or other facility, complete the LTCFS based on how the person is expected to function upon their discharge. Examples may include:

• A person is using oxygen and intravenous (IV) medication in a nursing home but is expected to stop these treatments upon discharge, the screener would not make selections for these treatments.
• A person is using a mechanical lift in a hospital, but family members are learning to perform a two-person pivot transfer, the screener would not select this adaptive equipment.

The screener may need to review discharge planning documentation and gather additional information from facility staff and the individual’s supports to get the most accurate picture of their needs after discharge.

Edits

In some situations, a screen that has already been calculated may be edited to ensure the screen is accurate. An additional in-person interview is not required. It is best practice to include an explanation of why an edit was completed in the Notes section.

If there has been a change identified in an individual’s condition or service an edit is not appropriate.

Edits may be completed:

• If inaccurate information or an error is identified in selections or notes. The information being changed in this circumstance should be changed to what was true at the time the screen was completed.
• If an individual only needs the Basic Information and/or Demographic Information updated.

2.9 Quality Assurance

Quality assurance activities promote the consistency and accuracy of administration of the screen by screening agencies. Components of functional screen quality assurance include:

• Individual Screener Quality Assurance
  It is the screener's responsibility to be objective, accurate, informed of the instructions, and to verify information gathered regarding the person. Screeners should contact their screen liaison to address questions or unexpected outcomes.
• Agency-Level Quality Assurance
  Agencies are responsible for the accuracy of all screens completed by their staff. Each screening agency must identify a liaison to DHS to oversee screening activities performed by the agency. The duties and responsibilities of this person are defined in contracts between DHS and screening agencies. For additional guidance on the role of the Screen Liaison, refer to the Screen Liaison Toolkit document, Role of the Screen Liaison, P-02783 (PDF).
• State-Level Quality Assurance
  DHS reviews screens and uses quality assurance methods to monitor screener performance, screen accuracy and completeness, and appropriate use of FSIA by staff at all screening agencies. Screening agencies may be required to perform corrective action to improve or remediate DHS findings.

The LTCFS results issue a determination of functional eligibility for Medicaid waiver programs. Therefore, individuals being screened, their collateral contacts, screeners, and the screening agency, should be aware that unethical or fraudulent activity during the screening process may be referred to the DHS Office of the Inspector General for investigation.