Applicants for MLTSS/Medicaid need to be clinically eligible as well as financially eligible in order to receive payment for services. Financial eligibility is within the applicant’s control — usually — but to get the proof of clinical eligibility that’s required by the program, a “Pre-Admission Screening” or “PAS” must be issued by Medicaid’s Regional Office of Community Choice Options or “OCCO.” This is a multi-step process. If the applicant resides in a nursing home, the facility has to submit a request for the PAS evaluation to be done. These requests are typically being done via email this year. Somebody at OCCO has to assign the request to a “PAS Nurse.” The case goes in line behind hundreds of similar requests. Eventually the PAS nurse evaluates the applicant and/or the applicant’s medical records to determine whether the applicant is dependent in three or more of the Activities of Daily Living (ADL’s). If yes, the PAS is issued and is entered into the MLTSS computer system. A written approval is supposed to be sent over to the facility.
If the applicant resides in the community, they have to contact the Aging and Disability Resource Center in the applicant’s county to initiate the PAS request.
The PAS is sometimes backdated to the time it was ordered or shortly thereafter, because the regulations require that the evaluation be completed within thirty days of request and personnel may simply be too overwhelmed with requests. The system can break down at any point along the way and this year was particularly troublesome. There is no way for an applicant or a facility to speed the process along. Under the COVID-19 emergency rules issued by the Governor and the Department of Health and Human Services, MLTSS cannot be denied to an other-wise eligible applicant just because the PAS wasn’t secured. This is helpful as far as it goes, but very old pending applicants may encounter problems if the PAS wasn’t requested or issued in a timely way.
Vigilance and follow-up are needed, although there is a real limit to what the applicants and their advocates can do.
Call us for advice on any aspect of MLTSS eligibility, applications and appeals