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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 87 Chapter 24 Long Term Care

• To return the original form, with the review determination, to the originating provider. The possible review results are: o A = Nursing care needed o B = Personal care needed o C = No services needed • To forward the original PAS to the appropriate agency for the Level II evaluation when the presence of mental illness or intellectual disability is indicated. See below. 24.12.2.E.4 Responsibilities of the Worker Responsibilities of the Worker include: • To forward the original PAS to the level of care evaluator when the PAS completer sends to the county office instead of the level of care evaluator. • To obtain a signed copy of the current, approved PAS as verification of medical necessity at application and redetermination. A new PAS is only required in the situations described above. A new PAS is not required at each redetermination. However, the Worker must verify that the client remains medically-eligible by obtaining a copy of the current PAS on file with the nursing facility. PAS Example: Mrs. Ginger completes a redetermination in June 2017. The Worker obtains a copy of the current approved PAS on file with the nursing facility. The PAS is dated May 21, 2016, approved for over six months and Mrs. Ginger has not left the facility since admission. The Worker has verified medical necessity at redetermination. 24.12.2.E.5 Level II Pre-Admission Screening and Annual Resident Review (PASARR) Any client who applies for nursing facility services in a Medicaid-certified facility must be evaluated for the presence of mental illness, intellectual disability, or related conditions, as well as for the need for specialized services to address the individual’s mental health needs or developmental disability. The level of care evaluator, after making the Level I decision of medical necessity, forwards the PAS to the mental health evaluator, if appropriate. The date of the Level II evaluation has no bearing on the date that medical necessity for nursing care is established.