N.Y. Comp. Codes R. & Regs. tit. 10 § 85.8

Current through Register Vol. 46, No. 50, December 11, 2024

Section 85.8 - Alternate level of care placement

(a) During the process of making determinations of coverability as specified in sections 85.1 through 85.7 of this Part, if the person designated by the Commissioner of Health decides that the patient may require placement in an alternate level of medical care upon discharge from the hospital, the designated person shall refer such case to the discharge planning unit of the hospital for appropriate placement action.

(b) During the process of making determination of coverability under sections 85.1 through 85.7 of this Part, if the person designated by the Commissioner of Health determines that the patient no longer requires inpatient hospital care but cannot be discharged except to a lesser level of medical care, he shall make a determination of noncoverability unless the hospital demonstrates that it has made and is continuing to make every effort to place the patient but without success.

(c) For all patients for whom reimbursement is claimed under medical assistance for the needy who require placement in a nursing home or health-related facility at time of discharge from a hospital, patient review forms as required by the State Department of Health must be completed by the hospital as follows:

(1)

(i) The Hospital/Community Patient Review Instrument (Hospital/Community PRI), as contained in section 400.13 of this Title, shall be completed by a registered professional nurse who has successfully completed a training program in patient case mix assessment approved by the department to train individuals in the completion of the Patient Review form (PRI) or the Hospital/Community Patient Review form (Hospital/Community PRI). The SCREEN as contained in section 400.12 of this Title shall be completed by a professional with demonstrated skills in assessing psychosocial situations, including but not limited to social work and discharge planning professionals, who has successfully completed a training program in patient case mix screening approved by the department to train individuals in the completion of the patient screening form (SCREEN); or

(ii) each hospital shall have on staff one trained and qualified assessor, and one trained and qualified screener, each as described in subparagraph (i) of this paragraph, for every 70 medical surgical beds, who shall attest to the accuracy of the patient review forms, except that no more than nine trained and qualified assessors and nine trained and qualified screeners shall be required in a hospital.

(2) The Hospital/Community PRI, as contained in section 400.13 of this Title, shall have been completed prior to or within 24 hours of the patient's assignment to alternate level of care (ALC) status, and every 15 days for the first 30 days, and every 30 days thereafter, and within 24 hours prior to the time of discharge to a skilled nursing facility or a health-related facility, unless a different schedule is contained in 18 NYCRR 505.20.

(3) The SCREEN, as contained in section 400.12 of this Title, shall have been completed prior to or within 24 hours of the patient's assignment to ALC status, and every 30 days thereafter, unless a different schedule is contained in 18 NYCRR 505.20.

(4) The Hospital/Community PRI and SCREEN, as contained in sections 400.12 and 400.13 of this Title, shall also be completed when the patient's status changes, as evidenced by a change in the patient's assigned Resource Utilization Group (RUG-II). (See Appendix 13-A, infra, for RUG-II categories.)

(5) The patient and/or the patient's designated representative shall be given an explanation of the information contained on the SCREEN, including the determination of setting for care for that particular patient.

(6) Patients younger than 16 years of age shall be assessed at the frequency specified in paragraph (2) of this subdivision, using patient review forms as required by the facility(ies) to which the patient is referred for care upon discharge.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 85.8