8114 CARE Assessment Process and Eligibility

All individuals applying for admission to a nursing facility, either as private pay or under medical assistance must have a needs assessment completed to determine if nursing facility level of care is appropriate. The assessment will also determine if the individual has mental illness or an intellectual disability (or related condition) and is in need of specialized services. KDADS is responsible for management of the assessment process. The current screening instrument, the Client Assessment, Referral and Evaluation (CARE) is completed by assessors through the local ADRC. The CARE process also incorporates federal Pre-admission Screening and Resident Review (PASRR) requirements. The CARE includes a Level I assessment, which is completed for all persons. A Level II evaluation is completed if mental illness or an intellectual disability is indicated through the Level I.

For most persons seeking medical assistance in a nursing facility or nursing facility for mental health, a level of care (LOC) threshold must be met. The threshold, determined by KDADS, is commonly referred to as functional eligibility. The need for a functional eligibility determination must be evaluated for all individuals requesting medical assistance reimbursement of facility expenses. The CARE is the primary instrument used for making a functional eligibility determination, along with the Uniform Assessment Instrument (UAI) and the Multiple Data Set (MDS) in limited situations LOC information is obtained through KDADS using the ES-3164 on the online CARE inquiry system.

Individuals who are determined to be exempt from a CARE assessment, as described in 8114.1 and 8114.2 , do not require a LOC determination, nor are they negatively impacted by a LOC score below the threshold.

NOTE : The CARE assessment requirements in this section do not apply to ICF/IID admissions. See 8112.2 for ICF/IID prior approval requirements.