Applying for Medicaid? Order the PAS early

“You have to get a PAS.” This is a cryptic statement frequently made to the families of patients who will be discharged from hospitals to sub-acute facilities for skilled nursing or rehabilitation care.  If someone is entering a sub-acute facility and may become financially eligible for Medicaid within 180 days, the receiving facility is obligated by state regulations to order a PAS for their patient. If a person is entering a nursing home directly from home, and may become Medicaid-eligible or is already financially eligible, the facility will typically require them to “get a PAS” before agreeing to provide a bed for them.

What is this mysterious thing? It refers to the clinical assessment called the Pre-Admission Screening that must be performed by a nurse from the Office of Community Choice Options (OCCO) to confirm that a potential Medicaid applicant meets the medical/clinical criteria to receive Medicaid services. Once the request is filed with OCCO, a “PAS-nurse” is assigned to go see the patient and perform the assessment to see if s/he is dependent in three or more Activities of Daily Living (ADL’s) and thus “meets nursing home level of care.” Once the PAS is issued, it is good for 6 months so that it will be applicable when the person becomes financially eligible for Medicaid. You can read the regulations at N.J.A.C.10:54-7.7 and N.J.A.C. 8:85-1.8: 105477 PASRR and PAS Screens – Necessity for nursing facility services 885-18 Pre-Admission Screening (PAS) admission and authorization

The law requires this assessment to be done within 30 days of receipt of the request. However, I was just informed by the business administrator of an Essex County nursing home that — at least in Essex — it is taking 3 to 4 months for the assessment to be done because there is an abundance of requests and perhaps a shortage of personnel. I have seen this problem in other counties as well.

The trap is that until a PAS is issued, a person cannot receive Medicaid benefits even if they are financially eligible.

So the legal news you can use is that you need to make sure that the PAS is ordered as early as possible if you anticipate Medicaid eligibility or nursing home placement within 6 months. Then stay on top of the process and do your best to advocate for the applicant’s medical & nursing needs so that the PAS is issued.

For legal advice on all aspects of clinical and financial Medicaid eligibility, preparation of applications and representation on appeals, call us at 732-382-6070.

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