Re: LEVELS OF CARE

[sheppard70057rn]

This is what we have been told, REsident uses 100 days Medicare  For example a tube feeder.  Well, in our state the resident would remain at a skilled level of care.  Resident falls breaks a hip goes to hospital comes back.  We would not give this resident another 100 days because they remain at a skilled level of care under Medicaid.  (Even though we do not send anything to medicaid office saying they are a skilled level of care)  We have been told that these instances we have to find a tracking system for our building.   Dawn Sheppard, RN, CRNAC ----- Original Message ----- From: carol maher To: [EMAIL PROTECTED] Sent: Wednesday, January 14, 2004 9:59 AM Subject: RE: LEVELS OF CARE I agree with Carolyn's answer.  The Medicaid level of care designations are different from the Medicare level of care.  The resident needs to be SNF level of care (or whatever they are calling it in your state) in order to qualify for nursing home placement.  The medicare questions are different.  To qualify for a break in skilled services and start the 60 day break in spell of illness, the resident has to be no longer receiving daily skilled services under Medicare A.  You are to determine whether the resident had 60 consecutive days when they did not receive either daily skilled services in your facility under Medicare A nor require admission to an acute care hospital.  (The facility is responsible for sending a bill to the FI noting the end of daily skilled services for its residents). -----Original Message----- From: Debbie Settle <[EMAIL PROTECTED]> Sent: Jan 14, 2004 6:39 AM To: [EMAIL PROTECTED] Subject: RE: LEVELS OF CARE Thanks..... But I still don't understand how we can determine if there has been a 60 day period of wellness if we don't have ICF or SNF levels. For example, a resident w/ new CVA uses 100 days, continues to reside in facility, and 65 days after Med A was exhausted sustains a hip fx and is hospitalized for 3 days. She returns w/ orders for PT 5x week.Even if she had been recieving some skilled service would she still qualify for another Med A stay?.... Normally I'd say no, but since there is only Nursing Home Level and no more SNF or ICF I DON'T KNOW ANYMORE. (auggggg)          -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of claudia farrell Sent: Tuesday, January 13, 2004 6:18 PM To: [EMAIL PROTECTED] Subject: RE: LEVELS OF CARE From my understanding in N.C., everything is in motion to be either skilled or nursing home period. No one should ever keep anyone that doesn't qualifiy for nursing home anyway.We make sure these people have always been d/c to an assisted living, unless they are private pay. Medicaid is not putting out the money yet. You and I are going through the motions right now. For example, we really don't need to have UR anymore; Fl2's on what use to be ICF level;you have to transmit on the last day of q qtr to the state anyone that their rate is diffirent, a significant change/getting therapies etc; your long term tube feeds, stage IV's all of these different type of issues; will bring you a higher rates, instead of the ICF 1.00 a day & ICF skilled 1.29  a day(joking) on the money. Let me know if I am off base, but this is what I have been doing, and reviewing. Q thing I transmited to the state on the last day in sept of 03, was nerve racking because it is suppose to reflect new "prposed rates". No one in the facility is allowed to recieve Med B therapy until it is reviewed and approved by myself, don, adon or if necessary our administrator. This has cut out about 90% of unnecessary therapy's. Claudia >From: "Debbie Settle" <[EMAIL PROTECTED]> >Reply-To: [EMAIL PROTECTED] >To: <[EMAIL PROTECTED]> >Subject: LEVELS OF CARE >Date: Tue, 13 Jan 2004 16:36:14 -0500 > >I have a questiion that I've not seen addressed here yet. I am in NC where >we recently went  Case-Mix on Medicaide. We no longer have "Skilled" or >"ICF" levels of care. We have "Nursing Home" and "Domicilary." If someone is >Domiciliary, we have to get them into a Rest Home or Assisted Living >Facility. However, my question is.... If we no longer have "SNF" level, how >do we determine if someone has had a 60 day period of wellness? Currently we >are allowing residents to have another 100 Med A days if they haven't been >in hospital in 60 days. I'm not comfortable with this, but I'm told it >dosen't matter since there are no more levels. Can someone shed some light >on this??? > >/---------------------------------------------------------- >The Case Mix Discussion Group is a free service of the >  American Association of Nurse Assessment Coordinators >       "Committed to the Assessment Professional" >Be sure to visit the AANAC website. Accurate answers to your >          questions posted to NAC News and FAQs. >     For more info visit us at http://www.aanac.org >-----------------------------------------------------------/ Find out everything you need to know about Las Vegas here for that getaway. /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/