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Clinical Assessment and Eligibility Program: Best Practices Guide and Appendix

The information contained within the guide is the be used by professionals working within the ASAP and is to serve as a guide and reference only. The information contained within the guide is only current as of November 2014. The most current regulations, program instructions, and information memorandums should be adhered to at all times Click the links below for the full Guide and Appendix respectively.

Download CAE Guide Version 1.02 11.4.14 FULL VERSION

Download CAE Guide Appendix 9.10.14

Requirements for Comprehensive Screening and Service Model Activities (CSSM)

The purpose of this Program Instruction is to issue requirements for Aging Services Access Points (ASAPs) in the performance of Comprhensive Screening and Services Model (CSSM) program related activities. This Program Instruction requires all ASAPs to adopt a specified management and staffing model and protocols to perform CSSM-related activities.

Review of Pre-Admission Screen & Record Review - PASRR Requirements prior to Authorization of MAssHealth Pmt. of NF Services

The purpose of this Program Instruction is to clearly delineate the practice for PASRR documentation review by ASAP Clinical Assessment Eligability (CAE) staff when approving pre-admission and post admission assessments in NF. This is being presented in order to improve NF compliance with PASRR to prevent inappropriate NF admissions for those indivduals with a diagnosis of mental illness (MI), intellectual disability/mental retardation (ID, intellectual disability is the current preferred terminology) and/or developmental disability (DD). For full detail please click the link below.

Download PI-12-04 Review of Pre-Admission Screen + Record Review - PASRR Requirements prior to Authorization of MAssHealth Pmt. of NF Services

Retrospective Cinical Eligibility Determinations for Discharged & Deceased MassHealth Members

The Executive Office of Elder Affairs is issuing this Program Instruction (PI) to modify requirements for clinical eligability determinations for authorization of MassHealth payment of nursing facility services. This PI modifies instructions contained in PI-09-02. All other requirements of PI-09-02 not referenced in this PI remain in effect. For full details please click on the link below.

Download PI-11-10 Retrospective Cinical Eligibility Determinations for Discharged + Deceased MassHealth Members

Conditions for Certain Nursing Facility Approvals

The Executive Office of Elder Affairs is issuing this Program Instruction (PI) to clarify requirements regarding the ASAP's role in performing clinical eligability determinations for authorization of MassHealth payment for nursing facility services. This PI modifies instructions previously issued in PI-07-18 and the ASAP RFR section 9.4.1.5.b. Please click on the link below for full details.

Download PI-11-03 Conditions for Certain Nursing Facility Approvals

Nursing Facility Clinical Eligibility Assessments, Short Term Approval and Noticing Procedures

The purpose of this Program Instruction is to clarify the ASAP's role and responsibility in tracking and conducting clinical eligability assessments for MassHealth members/applicants completed before and after nursing facility adminission, and to issue relevant notices to members/applicants. Any other previously issued instructuions, regardless of the format, are hereby rendered obsolete and replaced by the contents of this PI. Please click on the link below for the details.

Download PI-09-05 Nursing Facility Clinical Eligibility Assessments, Short Term Approval + Noticing Procedures

Retrospective and Conversions Requests Exceeding 90 Days

The purpose of this Program Instruction (PI) is to issue procedures for ASAPs when conducting retrospective clinical eligability assessments for authorization of MassHealth payment for nursing facility services. Any previously issued instructions, regardless of the format, are hereby rendered obsolete and replaced by the requirements in this PI. Please click on the link below for the details.

Download PI-09-02 Retrospective and Conversions Requests Exceeding 90 Days

Clinical Eligibility for Home and Community Based Frail Elder Waiver

This information Memorandoum is being issued to clarify the process for ASAPs when determining initial clinical eligibility for consumers identified through the Senior Care Organization (SCO) as potentially eligable for the Home and Community Based Frail Elder Waiver (FEW). Click on the link below for further details.

  Download IM-13-03 Clinical Eligibility for Home and Community Based Frail Elder Waiver

CDS-2 - training materials (SIMS assessments)

Document Abstract: (updated Dec 11, 2009) This zip file contains materials from the CDS-2 trainings presented on Oct 26 & 29, 2009. � It includes the following files: 2009 Revised SIMS Assessments for RNs - v103 final 10-23-09.ppt CDS-2-CM requirements - training document - v1.2- FINAL.doc CDS2 Change Log - 2009-10-02 - extra tab for RN version.xls Visio-CDS 2.0 diagrams - 2009-10-22.pdf Word - CDS 2.0 diagrams - 2009-10-22.doc

Author: EOEA

Source: SIMS Support

Keywords: SIMS

File: CDS-2 training materials - 2009-12-11.zip

Converted from ColdFusion Document Library, December 2010