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TAR Discharge Planning Option for Long Term Care (tar dis ltc)

By Bill Jackson,2014-11-26 17:32
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TAR Discharge Planning Option for Long Term Care (tar dis ltc)

     tar dis ltc

    1 TAR Discharge Planning Option for Long Term Care

This section gives instructions on how to complete an authorization request using the Long Term Care

    Treatment Authorization Request (LTC TAR, 20-1).

Post-Discharge Nursing The Long Term Care Treatment Authorization Request (20-1)

    Facility Services is used to request initial authorization for post-discharge Nursing

    Facility (NF) services. The Medi-Cal consultant will write “DPT” in the

    upper left corner of the 20-1 form and in the comments section to

    differentiate the Discharge Planning TAR from a normal 20-1 TAR.

    For an example of a correctly completed 20-1 for NF care, see

    Figure 1 on a following page.

     Note: If the patient needs post-discharge community services, the

    discharge planner will fill out a Medi-Cal Managed Care

    Authorization form (55-1) instead of a 20-1. Refer to the

     TAR Discharge Planning Option section in this manual for

     instructions on completing the 55-1.

    Patients Discharged to If the patient is to be discharged to a NF, a 20-1 must be initiated a Nursing Facility by the acute care hospital discharge planner.

    The 20-1 is then presented to the Medi-Cal consultant who will review

    the medical record and, if appropriate, authorize the NF level of care.

    The consultant will also review the PASRR Screening Document and

    enter the following information in the Comments/Explanation section

    of the 20-1:

    ; Date the PASRR Screening Document was completed and the

    date of the referral to Level II, if appropriate

    ; Level of care authorized

    ; Indicate if a Medicare denial is needed

    ; Date and signature of Medi-Cal consultant

    The Medi-Cal consultant has the authority to approve a stay of up to

    one year in a NF. The consultant will make this determination based

    on the patient’s chart and the results of the PASRR Screening

    Document.

    Instructions on how to complete the screening document are in the

    Preadmission Screening Resident Review (PASRR) section in the

    appropriate Part 2 manual.

    A patient who is referred for Level II evaluation will only be approved

    for a four-month maximum NF stay.

2 TAR Discharge Planning Option for Long Term Care August 2002

tar dis ltc

    2

    Where to Submit The NF is responsible for completing the 20-1 and forwarding it to the 20-1 TAR Form the San Bernardino Medi-Cal Field Office.

     The 20-1 and PASRR Screening Document must accompany the

    patient to the NF. If post-discharge community services have been

    requested for the patient on a 55-1, and a post-discharge provider has

    not been found prior to admission to the NF, the authorized 55-1 must

    also accompany the patient to the NF. The NF is responsible for

    locating a willing post-discharge community provider and giving the

    provider the copy of the 55-1. The post-discharge provider completes

    the 55-1 and submits it to the field office. In this case, all timeliness

    guidelines have been met.

    Medicare/Medi-Cal For Medicare/Medi-Cal crossover patients admitted to an NF under Crossover Patients Medicare reimbursement, a 20-1 must be initiated by the acute care

    hospital, reviewed and authorized by the Medi-Cal consultant and

    sent with the patient to the NF along with a copy of the PASRR

    Screening Document. This allows NF providers to bill Medi-Cal as

    soon as the patient's Medicare benefits have exhausted without

    waiting for further TAR approval. In this case, NF providers must

    include a copy of the Medicare denial when submitting the 20-1 to the

    field office.

2 TAR Discharge Planning Option for Long Term Care July 2002

    tar dis ltc

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