Screening for Nursing Care, ICF-ID or HCBS Recipients 510-05-35-25

(Revised 10/1/13 ML #3390)

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(N.D.A.C. Section 75-02-02.1-04)

1. All applicants or recipients who seek nursing care services in nursing facilities, swing bed facilities, or intermediate care facilities for the intellectually disabled (ICF-ID), or who seek home and community-based services, must be screened to establish the medical necessity for these services.

2. This screening allows payment to providers for eligible recipients from the effective date of the screening. A new screening is required whenever there is a change in provider or a reentry into a facility following a discharge from that facility. A new screening is not required on a reapplication for Medicaid if there has been no change in the living arrangement of the applicant since the initial screening was completed and screening has not since ended. An annual rescreening is required only for recipients requiring care in an ICF-ID or through HCBS.

3. Applicants or recipients who seek nursing care services in the state hospital, the Prairie at St. John’s center, the Stadter Psychiatric Center, or any other institution for mental disease (IMD) and who are:
1. Age 65 or older are not required to be screened.
2. Age 22 to 65 are not eligible for Medicaid until January 1, 2014, when individuals 19 to 64 will be covered under the adult expansion group. Because this group will have insurance, these individuals will be subject to the requirements of the insurance plan.
3. Under age 22 who have obtained a certification of need may be eligible as described in 05-35-30.