CHAPTER 12. HEALTH FACILITY PREADMISSION SCREENING
IC 12-10-12
Chapter 12. Health Facility Preadmission Screening
IC 12-10-12-1
"Agency" defined
Sec. 1. As used in this chapter, "agency" means the area agency
on aging designated by the division to carry out this chapter in the
agency's established administrative region.
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.16;
P.L.154-1995, SEC.5.
IC 12-10-12-2
"Designee" defined
Sec. 2. As used in this chapter, "designee" refers to an individual
who is designated by the director of the agency under section 27 of
this chapter.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-3
"Health facility" defined
Sec. 3. As used in this chapter, "health facility" means a facility:
(1) that is licensed by the state department of health under
IC 16-28; and
(2) that:
(A) provides comprehensive nursing care, room, food,
laundry, administration of medications, special diets, and
treatments; and
(B) may provide rehabilitative and restorative therapies;
under the order of an attending physician.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-1993, SEC.82.
IC 12-10-12-4
"Office" defined
Sec. 4. As used in this chapter, "office" refers to the office of
Medicaid policy and planning established by IC 12-8-6-1.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-5
Admission to nursing facility; screening and approval; assessment
for specialized services
Sec. 5. (a) Except as provided in sections 27 through 31 of this
chapter, an individual who is admitted to a nursing facility must first
have been screened and approved for placement under the nursing
facility preadmission screening program described in this chapter.
(b) An individual who is identified by the screening team under
section 16 of this chapter as an individual with a developmental
disability or an individual who is mentally ill (as defined in 42
U.S.C. 1396r(e)(7)) must be assessed to determine the
appropriateness of nursing facility placement and the need for
specialized services.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.2;
P.L.1-1993, SEC.98; P.L.99-2007, SEC.66.
IC 12-10-12-6
Prior approval for nursing facility admission
Sec. 6. (a) This subsection does not apply after December 30,
2008. If an individual who is discharged from a hospital licensed
under IC 16-21:
(1) is admitted to a nursing facility after the individual has been
screened under the nursing facility preadmission program
described in this chapter; and
(2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facility
may not be required by the office under IC 12-15-21-1 through
IC 12-15-21-3.
(b) This subsection applies beginning December 31, 2008. If an
individual:
(1) is admitted to a nursing facility after the individual has been
screened under the nursing facility preadmission program
described in this chapter; and
(2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facility
may be required by the office under IC 12-15-21-1 through
IC 12-15-21-3.
(c) The office shall adopt rules under IC 4-22-2 to implement:
(1) subsection (b);
(2) a screening and counseling program for individuals seeking
long term care services; and
(3) a biennial review of Medicaid waiver reimbursement rates.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.3;
P.L.2-1993, SEC.83; P.L.50-2007, SEC.1; P.L.121-2008, SEC.3.
IC 12-10-12-7
Application; necessary information
Sec. 7. (a) An individual or the individual's parent or guardian, if
the individual is not competent, who is required to be screened and
approved under this chapter shall apply to the agency serving the
county of the individual's residence for participation in a nursing
facility preadmission screening program.
(b) The individual or the individual's parent or guardian if the
individual is not competent shall provide the agency with the
following:
(1) The individual's name.
(2) The address of the place where the screening team described
in section 14 of this chapter may contact the individual.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.4.
IC 12-10-12-8
Notification to applicant
Sec. 8. A nursing facility shall provide:
(1) an individual who applies for admission to the nursing
facility; or
(2) the individual's parent or guardian if the individual is not
competent;
a notification that meets the requirements of sections 9 and 10 of this
chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.5.
IC 12-10-12-9
Notification form
Sec. 9. The notification required under section 8 of this chapter
must be in writing on standardized forms prepared by the division
and provided to the nursing facilities.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.6.
IC 12-10-12-10
Notification contents; acknowledgment by applicant; copies;
violation
Sec. 10. (a) The notification required under section 8 of this
chapter must notify the applicant of the following:
(1) That the applicant is required under state law to apply to the
agency serving the county of the applicant's residence for
participation in a nursing facility preadmission screening
program.
(2) That the applicant's failure to participate in the nursing
facility preadmission screening program could result in the
applicant's ineligibility for Medicaid reimbursement for per
diem in any nursing facility for not more than one (1) year.
(3) That the nursing facility preadmission screening program
consists of an assessment of the applicant's need for care in a
nursing facility made by a team of individuals familiar with the
needs of individuals seeking admission to nursing facilities.
(b) The notification must be signed by the applicant or the
applicant's parent or guardian if the applicant is not competent before
admission.
(c) If the applicant is admitted:
(1) the nursing facility shall retain one (1) signed copy of the
notification for one (1) year; and
(2) the nursing facility shall deliver one (1) signed copy to the
agency serving the county in which the applicant resides.
(d) A person who violates this section commits a Class A
infraction.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.7.
IC 12-10-12-11
Time limitations
Sec. 11. Each individual who is required to be screened and
approved before admission to a nursing facility shall be screened,
within the time permitted under this chapter, by the screening team
described in section 14 of this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.8.
IC 12-10-12-12
Screening team; uniform rules
Sec. 12. (a) The activities of the screening team must be
conducted under uniform rules adopted under IC 4-22-2 by the
director of the division.
(b) The rules must be developed in cooperation with the division
of mental health and addiction and the office.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.9;
P.L.215-2001, SEC.38.
IC 12-10-12-13
Screening team; requirements
Sec. 13. The nursing facility preadmission screening program
shall be conducted by a screening team that meets the requirements
of section 14 of this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.10.
IC 12-10-12-14
Screening team; membership; coordinator
Sec. 14. (a) A screening team must consist of two (2) members.
(b) An applicant's physician shall participate as a member of the
screening team.
(c) The agency that serves the county of the applicant's residence
shall, subject to the approval of the division, also appoint an
individual who:
(1) represents the agency serving the area in which the
applicant's residence is located; and
(2) is familiar with personal care assessment.
(d) The agency shall, subject to the approval of the division,
appoint one (1) of the individuals under subsection (c) to be the
coordinator.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.11.
IC 12-10-12-15
Multiple screening teams
Sec. 15. More than one (1) screening team may be appointed.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.12.
IC 12-10-12-16
Screening program assessments
Sec. 16. (a) A screening team shall conduct a nursing facility
preadmission screening program for each individual within the time
permitted under this chapter. The program must consist of an
assessment of the following:
(1) The individual's medical needs.
(2) The availability of services, other than services provided in
a nursing facility, that are appropriate to the individual's needs.
(3) The cost effectiveness of providing services appropriate to
the individual's needs that are provided outside of, rather than
within, a nursing facility.
(b) The assessment must be conducted in accordance with rules
adopted under IC 4-22-2 by the director of the division in
cooperation with the office.
(c) Communication among members of a screening team or
between a screening team and the division, the office, or the agency
during the prescreening process may be conducted by means
including any of the following:
(1) Standard mail.
(2) Express mail.
(3) Facsimile machine.
(4) Secured electronic communication.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.13;
P.L.115-1997, SEC.1; P.L.121-2008, SEC.4.
IC 12-10-12-17
Findings; appropriateness of placement
Sec. 17. After an assessment is completed, the screening team
shall find, by both members of the team, whether the placement of
the individual in a nursing facility is appropriate.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.14.
IC 12-10-12-18
Review of findings; final determinations
Sec. 18. The office shall do the following:
(1) Review a screening team's finding.
(2) Make the final determination only in the following cases:
(A) Where the individual is eligible for Medicaid.
(B) Members of the screening team disagree.
(C) A placement is denied.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.15.
IC 12-10-12-19
Mandatory placement; conditions
Sec. 19. Placement in a nursing facility may not be denied if any
of the following conditions exist:
(1) Community services that would be more appropriate than
care in a nursing facility are not actually available.
(2) The cost of appropriate community services would exceed
the cost of placement in a nursing facility.
(3) The applicant:
(A) has been determined to be eligible for assistance under
the federal Medicaid program (42 U.S.C. 1396 et seq.);
(B) needs a service that would make the applicant's
placement in a nursing facility inappropriate when the
service cannot be provided without the use of a new service
made available under a home and community based services
waiver approved by the Secretary of Health and Human
Services under 42 U.S.C. 1396n; and
(C) chooses not to receive the service described under clause
(B).
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.16;
P.L.150-1995, SEC.17; P.L.154-1995, SEC.6.
IC 12-10-12-20
Notice of determination; contents
Sec. 20. (a) The agency shall provide the applicant with a written
notice of the office's determination made under section 18 of this
chapter if the placement is appropriate. The office shall provide
written notice of a determination made under section 16 of this
chapter when placement in a nursing facility is denied.
(b) If the office determines that an individual's placement in a
nursing facility is not appropriate, the written notice must contain the
following:
(1) The reasons for the office's determination.
(2) A detailed description of services available to the individual
that, if used by the individual, make the placement of the
individual in a nursing facility inappropriate.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.17.
IC 12-10-12-21
Administrative appeal of determination
Sec. 21. An applicant aggrieved by a determination of the office
may appeal the determination under rules concerning the appeal that
are adopted by the office under IC 4-22-2.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-22
Judicial appeal
Sec. 22. After exhausting all administrative remedies, the
applicant may obtain judicial review under IC 4-21.5-5.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-23
Waiver of sanctions; conditions; application
Sec. 23. An applicant may apply to the office for a waiver of the
sanctions imposed by section 33 or 34 of this chapter if the following
conditions are met:
(1) The applicant has made an appropriate application under
section 7 of this chapter.
(2) The office has not provided the applicant with the notice
required under section 20 of this chapter within twenty-five (25)
days of the date the application was made under section 7 of
this chapter.
(3) The applicant, the applicant's physician, and the applicant's
current custodian have cooperated with the screening team.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.18.
IC 12-10-12-24
Determination on application for waiver of sanctions
Sec. 24. If the office finds that an applicant has filed an
application for a waiver and has met the three (3) conditions set out
in section 23 of this chapter, the office shall, not later than the
second working day following the receipt of the application for a
waiver, either:
(1) issue the notice required by section 20 of this chapter; or
(2) waive the sanctions imposed by sections 33 and 34 of this
chapter.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-25
Administrative rules for preadmission screening assessment
Sec. 25. The office shall adopt rules under IC 4-22-2 to permit an
individual who has not applied for admission to a nursing facility to
be assessed under section 16 of this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.19.
IC 12-10-12-26
Information gathering by division
Sec. 26. The division shall collect the information necessary to do
the following:
(1) Determine the effectiveness of the preadmission screening
program.
(2) Identify barriers to diversion of individuals to in-home care.
(3) Identify needs that may exist for additional in-home
services.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-27
Designatory empowered to authorize unapproved temporary
admissions
Sec. 27. (a) The agency shall, subject to the approval of the
division, designate at least one (1) individual who may authorize
temporary admittance to a nursing facility under:
(1) subsection (b); and
(2) sections 28, 30, and 31 of this chapter;
without the approval required under this chapter.
(b) An individual designated under subsection (a) may authorize
temporary admittance to a nursing home for a resident of Indiana if
the resident:
(1) has received treatment from and is being discharged from a
hospital that is located in a state other than Indiana; and
(2) will be participating in preadmission screening under this
chapter.
(c) Notwithstanding a rule adopted under section 12 of this
chapter, a screening team appointed to screen a nonresident under
this section must:
(1) conduct its assessment under section 16 of this chapter; and
(2) report its findings;
within ten (10) days after its appointment.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.20;
P.L.278-1993(ss), SEC.25; P.L.115-1997, SEC.2.
IC 12-10-12-27.1
Temporary admissions of nonresidents
Sec. 27.1. An individual designated under section 27(a) of this
chapter may authorize temporary admittance to a nursing home for
a nonresident of Indiana if the nonresident:
(1) was admitted to the hospital immediately after receiving
treatment in the hospital's emergency department;
(2) has received treatment from and is being discharged from a
hospital licensed under IC 16-21; and
(3) will be participating in preadmission screening under this
chapter.
As added by P.L.115-1997, SEC.3.
IC 12-10-12-28
Temporary admissions; grounds; limitations; regular assessment
Sec. 28. (a) An individual may be admitted directly to a nursing
facility from an inpatient bed of a community mental health center,
a managed care provider (as defined in IC 12-7-2-127(b)), a state
institution, or a hospital licensed under IC 16-21, subject to the
requirements of 42 U.S.C. 1396r(e)(7), if, after the assessment
required by section 16 of this chapter is substantially complete, the
designee makes a finding that services necessary to care for the
individual outside of the center or hospital are not at that time
available except in a nursing facility.
(b) The individual may remain in the nursing facility for the
number of days designated by the designee without the approval
required by this chapter.
(c) The number of days designated by the designee may not
exceed the lesser of:
(1) the individual's estimated recovery time, plus twenty-five
(25) days; or
(2) one hundred twenty (120) days.
(d) During the period under subsection (c), the assessment shall
be modified and completed according to the individual's current
needs and the determination of appropriate placement made under
sections 16 and 17 of this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.21;
P.L.2-1993, SEC.84; P.L.40-1994, SEC.20.
IC 12-10-12-28.5
List of long term care options provided to patients before discharge
from hospitals
Sec. 28.5. Before discharging a patient who will be participating
in preadmission screening under this chapter, a hospital licensed
under IC 16-21 shall give the patient a list of all long term care
options that:
(1) may be available to the patient;
(2) are located within the hospital's service area; and
(3) are known to the hospital.
As added by P.L.115-1997, SEC.4.
IC 12-10-12-29
Repealed
(Repealed by P.L.78-1992, SEC.28.)
IC 12-10-12-30
Admission upon probability of early discharge; limitations on
obtaining approval
Sec. 30. (a) An individual may be admitted to a nursing facility if
the designee determines that it is probable that the individual will be
discharged from the nursing facility within thirty (30) days of the
individual's admission.
(b) If the individual:
(1) desires to remain in a nursing facility for more than thirty
(30) days; and
(2) applies for approval under this chapter before the expiration
of the thirty (30) days;
the individual has an additional twenty-five (25) days in which to
obtain the approval.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.22.
IC 12-10-12-31
Preapproval admission; grounds
Sec. 31. An individual who has applied for approval under this
chapter may be admitted before approval is granted if the designee
determines that there will be serious harm to the physical or mental
health of the individual if the individual is required to wait for
approval.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-32
Stay following unapproved admission; duration
Sec. 32. An individual may remain in a nursing facility for not
more than twenty-five (25) days without approval under this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.78-1992, SEC.23.
IC 12-10-12-33
Medicaid assistance predicated upon preadmission screening and
approval; intermediate care facility
Sec. 33. If an individual:
(1) does not participate in the health facility preadmission
screening program described in this chapter; or
(2) participates in the health facility preadmission screening
program described in this chapter and is notified under section
20 of this chapter that the individual's placement in a health
facility is not appropriate;
the individual is not eligible for assistance under the federal
Medicaid program (42 U.S.C. 1396 et seq.) for the payment of any
part of the cost per diem provided to the individual in a part of a
health facility certified as an intermediate care facility for one (1)
year after the date of the individual's admission to the health facility.
As added by P.L.2-1992, SEC.4.
IC 12-10-12-34
Medicaid assistance predicated upon preadmission screening and
approval; skilled health facility
Sec. 34. If an individual:
(1) refuses to participate in the health facility preadmission
screening program described in this chapter; or
(2) participates in the health facility preadmission screening
program described in this chapter and is notified under section
20 of this chapter that the individual's placement in a health
facility is not appropriate;
the individual is not eligible for assistance under the federal
Medicaid program (42 U.S.C. 1396 et seq.) for the payment of any
part of the cost per diem provided to the individual in a part of a
health facility certified as a skilled health facility until the individual
has participated in the health facility preadmission screening
program and has been notified that placement in a health facility
certified to provide skilled care is appropriate.
As added by P.L.2-1992, SEC.4.