Nursing Assessment 525-05-30-42

(New 7/1/18 ML #3543)

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Purpose

The purpose of Nursing Assessment is to identify needs of eligible individuals and ensuring successful transition from an institution or another provider-operated living arrangement (to include skilled nursing facility, adult residential, adult foster care, basic care, and assisted living) to a living arrangement in a private residence where the client is directly responsible for his/her own living expenses.

Service Eligibility, Criteria for

The individual receiving Nursing Assessment will meet the following criteria:

1. Must be on Medicaid;
2. Must be at least age 18;
3. Must be eligible for Community Transition Services through the Home and Community Based Services waiver;
4. The care needs of the client must fall within the scope of Nursing Assessment as described in this service chapter;
5. The client must be transitioning from an institution or another provider-operated living arrangement to a living arrangement in a private family dwelling where the client is directly responsible for his/her own living expenses; and
6. Prior approval from a HCBS Program Administrator is required before this service may be authorized.

Service Activities

Nursing Assessment includes identifying health care related needs of eligible individuals ensuring successful transition into the community by completing a nurse assessment and related narrative.

Preliminary Care Plan

Nursing Assessment Services may be authorized up to 180 consecutive days prior to admission to the waiver of an institutionalized person. A preliminary care plan must be completed by the HCBS Case Manager. The Person Centered Plan of Care (SFN 404) and Authorization to Provide Medicaid Waiver Services (SFN 410), must be completed and noted “preliminary” at the top. The HCBS Case Manager is responsible to send the completed documents to the HCBS line.

Services Activities, Authorized and Limits

1. Nursing Assessment may not duplicate the assessment completed by the HCBS Case Manager.
2. Nursing Assessment may be authorized up to 180 consecutive days prior to admission to the waiver of an institutionalized person.
3. Nursing Assessment is limited to more than 14 units (unit = 15 min) per recipient to complete the assessment tool. Any exceptions to this limit must be prior approved by an HCBS Administrator.
4. Nursing Assessment will require prior approval from the HCBC Program Administrator to prevent any duplication of services.
5. When Nursing Assessment Services are furnished to individuals returning to the community from a Medicaid institutional setting through entrance to the waiver, the costs of such services are considered to be incurred and billable when the assessment is completed
6. The Nursing Assessment may be shared with the HCBS Case Manager if an appropriate release of information has been completed.

Billing

Nursing Assessment Services may be billed directly to Aging Services using an SFN 78 Request for Reimbursement and cannot be billed through MMIS.

Authorization of Services

The service activities within the scope of this service chapter must be identified on the Authorization to Provide Medicaid Waiver Service, SFN 410.

Standards for Providers

Enrolled agency or individual QSPs, authorized to provide Extended Personal Care Services.

• Individual - N.D.C.C. 43-12.1: N.D.A.C. (54-02, 54-05)
• Agency - N.D.C.C. 43-12.1; N.D.A.C. (54-02, 54-05)

1. An applicant for licensure by examination to practice as a registered nurse or licensed practical nurse shall: Submit a completed application and appropriate fee as established by the board of nursing; submit an official transcript showing completion of an in-state nursing education program or a board-approved out-of-state nursing education program preparing for the level of licensure sought; pass an examination approved by the board of nursing.
   
   
2. An applicant for licensure by endorsement to practice as a registered nurse or licensed practical nurse shall: Submit a completed application and appropriate fee as established by the board; submit an official transcript showing completion of a nursing education program preparing for the level of licensure sought; submit proof of initial licensure by examination with the examination meeting North Dakota requirements for licensure examinations in effect at the time the applicant qualified for initial licensure; submit evidence of current unencumbered licensure in another state or meet continued competency requirements as established by the board.