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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

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    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

     3 LONG TERM CARE TREATMENT AUTHORIZATION REQUEST STATE OF CONFIDENTIAL 1 FOR FI USE ONLY CALIFORNIA DEPARTMENSTATE PATIENT HEALTH SERVICES T PLEASE TYPE USE INFORMATION 5 REQUIRE ALLINFORMATION ONLY CCN Elite Elite Pic DPT aTypewriter SERVICE PicaCATEGORY SKILLECHECK ONLY ONE BOX REAUTHOR- INTERMEDIATE SPECIAL PROGRAM I.C.F.AlignmentCARE FORM LIC 231 ATTACHED NURSING CARE D.D. D IZATION TRANSFER INITIALX

    .. REQUEST IS PROVIDER PHONE NO. 18 PROVIDER; YOUR REQUEST IS: VERBAL CONTROL NO. RETROACTIVE? . 2 1 APPROVED AS ( ) APPROVED 213 555-1234 X MODIFIED AS AREA NO YES SEE COMMENTS BELOW REQUESTED PROVIDER NAME AND ADDRESS FI USE ONLY 4DEFERRED 3 DENIED 2 PROVIDER NUMBER REASON AND ALTER- 3 4 NATE TREATMENT LTC45678G PLAN RECOMMENDED ; BELOW HAPPY HOME ; 5 JACKSON VS RANK 6 5 123 CARE ROAD ; PARAGRAPH CODE HOLLYWOOD, CA 90012 ; ; BY: (MEDI-CAL CONSULTANT) X 01 01 MEDICAL RECORD NUMBER I D NO DATE REVIEW MEDI-CAL IDENTIFICATION NO. PEND. FIRST, M.I.) 19 20 COMMENTS PATIENT NAME (LAST, 8 7 INDICATOR 6 333445555 SMITH, DOROTHY D. ADMIT SOCIAL SECURITY CLAIM NO. DATE OF BIRTH MEDICARE ADMIT DATE. DATE SEX COMMENTS/EXPLANATION 9 12 13 14 15 10 11 01 12 09 12 21 99 333445555 DPT F FROM THIS SERVICE STATUS BENEFITS EXHAUSTED

    (FROM) DATE (T0) DATE PRIM. DX CODE PASRR COMPLETED 01/07/00, PERIOD OF CARE 16 REQUESTED NO REFERRAL MADE. APPROVED CURRENT DIAGNOSES A. (PRIMARY):FOR N.F. LEVEL B FOR ONE YEAR. (SECONDARY) PLEASE ATTACH APPROPRIATE NAME OF FORMER FACILITY FACILITY Joyce Johnson MEDICARE DENIAL. B. DAILY MEDICATIONS (NAME, DOSAGE, FREQUENCYJOYCE JOHNSON MEDI-CAL NURSE C. PATIENT'S GENERAL CONDITION, LIMITATIONS AND NURSING PROCEDURES REQUIRED: TOTALLY AMBULATORY CONFINED TO BEDRIDDEN SPOON FED AMBULATORY INCONTINENT W. ASSISTANCE WHEELCHAIR SPECIFY M D M D N0 SPECIAL SNF ICF ICF DD SOB REHAB PROGRAM 4 FOCUS REVIEW 23 FROM (Y/N) D. DIET E. ATTENDING PHYSICIAN'S LAST VISIT (DATE): (DATE) CHART REVIEWED 24. THRU (Y/N) (DATE) PHYSICIAN NAME & PHONE NO. PATIENT'S AUTHORIZED REPRESENTATIVE (IF ANY) PROLONGED ADMIN. DAYS ENTER NAME AND ADDRESS: CARE (BED NOT AVAILABLE) PENDING (REQUEST FOR ; FAIR HEARING) Y N ; ; PHYSICIAN MEDI-CAL 17 25 ; RETROACTIVE AUTHORIZATION GRANTED IN ACCORDANCE IDENTIFICATION NO. WITH SECTION 51003(8) TO THE BEST OF MY KNOWLEDGE THE ABOVE INFORMATION IS TRUE, ACCURATE, AND COMPLETE AND THE REQUESTED SERVICES ARE MEDICALLY INDICATED AND NECESSARY TO THE HEALTH OF THE PATIENT. OFFICE SEQUENCE DATE SIGNATURE OF PHYSICIAN 20-IZ 12/87 NOTE: AUTHORIZATION DOES NOT GUARANTEE PAYMENT. PAYMENT IS SUBJECT TO PATIENT'S ELIGIBILITY. BE SURE THE IDENTIFICATION CARD IS CURRENT BEFORE RENDERING SERVICE.

    Figure 1. Sample completed Long Term Care Authorization Request (20-1) for Discharge Planning.2 TAR Discharge Planning Option for Long Term Care August 2000

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    This list outlines the steps involved when requesting and authorizing Nursing Facility (NF) level of care for Medi-Cal patients under Discharge Planning Option. Providers may wish to photocopy this page and post it in the office.

    Discharge Planning Option Instructions

    Patient Discharged From a Delegated Acute Hospital to a Nursing Facility

    Long Term Care Discharge Planning Treatment Authorization Request (20-1)

    1. The patient is admitted to an acute care hospital participating in the Discharge Planning Option

    program.

2. The Medi-Cal Consultant approves the Treatment Authorization Request (TAR) for the initial

    admission if criteria are met.

    3. The patient appears to need NF care. The discharge planner initiates communication with the

    Medi-Cal Consultant.

    4. The attending physician orders NF care. The physician's order is placed in the patient's chart.

5. A representative of the acute care hospital completes the PASRR Screening Document and

    refers the patient to Level II, if appropriate. (Refer to the Preadmission Screening Resident

    Review [PASRR] section in the appropriate Part 2 manual.)

    6. The discharge planner completes the patient name and Medi-Cal number fields (Boxes 6 and 7)

    on a Long Term Care Treatment Authorization Request (20-1).

7. The Medi-Cal Consultant reviews the 20-1, the PASRR Screening Document and the patient's

    chart to verify the information and determine medical necessity for the requested level of care,

    and approves the 20-1 if criteria are met.

8. The discharge planner locates a NF provider willing to accept the patient.

9. The 20-1 and PASRR Screening Document are sent to the NF with the patient.

    10. The NF completes the 20-1 and sends it to the San Bernardino Medi-Cal Field Office.

2 TAR Discharge Planning Option for Long Term Care August 2000

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