Navigating the complexities of healthcare, especially when it involves long-term care and Medicaid, can be challenging. In North Carolina, the North Carolina Medicaid Fl2 Level Of Care Screening Tool plays a crucial role in ensuring individuals receive appropriate care in nursing facilities. This article provides a comprehensive overview of this essential tool, its purpose, process, and implications.
The North Carolina Medicaid FL2 Level of Care Screening Tool is rooted in federal law (42 CFR 483.128), which mandates Level I screens for all applicants seeking admission to Medicaid-certified nursing facilities. This screening process is designed to identify individuals who may have serious mental illness (SMI), intellectual or developmental disabilities (I/DD), or a related condition (RC). The responsibility falls upon the screener to initiate this Level I screen through the North Carolina Medicaid Uniform Screening Tool (NCMUST) system before an individual is admitted to a nursing facility.
For applicants who do not present any indications or prior diagnoses of SMI, I/DD, or RC, the initial Level I screen generally remains valid. However, it’s important to note that a significant change in the individual’s condition would necessitate a reassessment.
Delving Deeper into the Level I Identification Screen
The primary objective of a Level I identification screen is to pinpoint individuals who might be living with SMI, I/DD, or RC. This is achieved through a series of specific diagnostic and functional questions embedded within the screening tool. Both the Level I screen and, when deemed necessary, a subsequent Level II evaluation are conducted prior to admission to a nursing facility. This proactive approach ensures that individuals with these conditions are properly identified and that their needs can be adequately addressed.
Essential Documentation for Level I Screening
In situations where the NCMUST system flags a screen for manual review, the NC Medicaid PASRR (Preadmission Screening and Resident Review) nurse will request specific patient information to facilitate a thorough Level I manual review. The required documentation typically includes:
- Recent History and Physical (H & P): This provides a comprehensive overview of the individual’s medical history and current physical condition.
- Comprehensive Progress Notes: These notes, dated within the last 30 days, offer insights into the individual’s recent health status and any changes or ongoing issues.
- Detailed Drug History: A complete medication history, encompassing both current and immediately past medication use, is crucial for understanding potential medication-related factors.
- FL2 Form: Crucially, a copy of the FL2 form is required. This document must explicitly state the diagnosis, be dated within the last 30 days, and be signed by a physician (MD or DO). This form is a key component of the North Carolina Medicaid Level of Care Screening Tool process.
- Psychiatric Notes (if available): If the individual has a psychiatric history, any available psychiatric notes can provide valuable context and information.
Exemptions from Level I Screening
It’s important to understand that Level I screens are not universally required for all nursing facility admissions. Certain categories of individuals are exempt. These include:
- Readmissions Following Hospital Treatment: Individuals who have previously undergone a Level I screening and are being readmitted to a nursing facility after a hospital stay are generally exempt, unless there has been a significant change in their condition that suggests the presence or suspected presence of SMI, I/DD, or RC. In such cases, a new Level I screen via NCMUST is required upon readmission.
- Facility Transfers with Valid Level II Evaluations: Individuals who have already received a valid PASRR Level II evaluation and are transferring from one facility to another are also exempt. However, it is necessary to utilize the tracking module within NCMUST to report the transfer of these individuals for record-keeping purposes.
- Non-Medicaid Certified Facilities: Individuals being admitted to facilities or bed types that are not certified by the NC Medicaid program, such as swing beds, adult care home beds, or rest home beds that do not participate in NC Medicaid, are not subject to Level I screening.
Level I Screening Outcomes: Negative and Positive Findings
The manual review of a Level I screen can lead to distinct outcomes, categorized as either negative or positive findings.
Negative Finding: A negative finding is assigned when the manual review concludes that there is no indication of SMI, I/DD, or RC, and the individual is determined not to fall within the target population for further PASRR evaluation. In these cases, the PASRR review number will be appended with an “A” alpha character.
Positive Finding: Conversely, a positive finding is issued if the manual review raises suspicion of SMI, I/DD, or RC. A positive finding triggers a referral for a more in-depth Level II evaluation. Essentially, a submitted Level I screen that results in a positive finding suggests that the individual may have SMI, I/DD, or RC, warranting further assessment.
Time-Limited Admissions and the Level I Screen
The North Carolina Medicaid Level of Care Screening Tool also accommodates specific situations involving temporary, time-limited nursing facility admissions for individuals with diagnosed SMI, I/DD, and RC who meet specific federal and state criteria. These time-limited admissions are permitted following the submission of a Level I screen and the necessary medical documentation. NC Medicaid will then issue an authorization number with a defined end date for the temporary stay. If an individual’s stay is projected to extend beyond the initial timeframe, the receiving facility is obligated to update the Level I screen before the authorization expires. This update may lead to a referral for a Level II evaluation.
Several categories fall under time-limited admissions:
Convalescent Care Admissions (30-day limit): Federally permitted without a Level II screen under specific conditions:
- The admission to a skilled nursing facility (SNF) must be directly from a general hospital after receiving acute inpatient medical care.
- SNF services must be required specifically for the condition that was treated in the hospital.
- The hospital attending physician must certify that the required SNF care is unlikely to exceed 30 calendar days.
This physician certification must be provided to NC Medicaid at the time of the Level I screen. If it becomes apparent that the stay might exceed 30 days, the facility must submit an updated Level I screen to NC Medicaid no later than the 25th calendar day to determine if a Level II evaluation is necessary.
Provisional Admission (7-day limit): Allows for a brief, temporary admission when an individual’s delirium prevents an accurate diagnosis. Facilities utilizing provisional admissions must update the Level I screening procedures if the delirium clears, or at the latest, by the fifth calendar day following admission.
Emergency Admission (7-day limit): Applicable in emergency protective services situations for applicants with evidence of SMI, I/DD, or RC who require temporary nursing facility placement. This is intended for situations involving a sudden and unexpected need for immediate SNF placement due to the individual’s physical and/or environmental condition, where no other placement options are immediately available. Similar to other time-limited admissions, if the stay might exceed seven days, an updated Level I screen must be submitted to NC Medicaid by the fifth calendar day.
Respite (7-day limit): Provides temporary care to individuals with SMI, I/DD, or RC to offer respite for their primary caretaker. Again, if the stay is likely to extend beyond seven days, an updated Level I screen is required by the fifth calendar day.
The Time-Limited Request Process via NCMUST
The process for requesting a time-limited admission begins with the referral source submitting the North Carolina Level I Screening Form through NCMUST.
- For individuals with evidence of SMI, I/DD, or RC who require a 30-day or 7-day time-limited PASRR, NC Medicaid assigns a time-limited PASRR authorization number with an alpha character ending of “D” or “E”.
- If the individual is a Medicaid recipient, the screener must contact NCTracks to proceed with the Medicaid nursing facility prior approval process.
- Should the resident need to remain in the facility beyond the authorized time frame, the receiving facility is responsible for contacting NC Medicaid prior to the expiration date to update the Level I information. This contact should occur:
- Within five days for a seven-day authorization.
- Within 25 days for a 30-day authorization.
- Within 50 days for a 60-day authorization (if applicable, though not detailed in the original text, this is a logical extension of the timeframe structure).
- NC Medicaid may then refer the individual for a Level II evaluation based on the updated Level I screen.
- If the Level II evaluation is approved, the facility must contact NCTracks and submit a new prior authorization (PA) request.
Understanding the North Carolina Medicaid FL2 Level of Care Screening Tool is vital for healthcare providers, nursing facility staff, and individuals and families navigating the Medicaid system in North Carolina. This screening process ensures that individuals receive the appropriate level of care and that those with SMI, I/DD, or RC are identified and supported.
