IAAAA Policy Position
on
Pre-Admission Screening

Background

The purpose of the Pre-Admission Screening (PAS) program is to provide an assessment of all individuals seeking nursing home admission.  The goal is to assure that individuals entering a nursing home have an appropriate level of care and to divert individuals from nursing home placement who choose to be served in the community.

Area Agencies on Aging are the only entities who can conduct PAS under current Indiana statute.

Over the years, changes have affected the program resulting in increased nursing home placement of individuals who received Pre-Admission Screening.

• Changes to the Medicare program allowed many individuals that may have had protracted stays in hospitals for rehabilitative services to be admitted to nursing homes for receipt of those services.  This increased nursing home admission from hospitals nationally.

• Ggrowth in home and community based services has not kept pace with the growing number of older adults.  Indiana is engaged in an expansion of home and community based services, including the Aged and Disabled Waiver which now has 9500 slots available.

In 2008, the General Assembly passed and the Governor signed Senate Enrolled Act 315. The legislation included direction to promulgate rules regarding prior authorization for nursing home admission and the establishment of a long term care screening and counseling program.  The Senate Health and Provider Services Committee directed the Division of Aging to work with industry advocacy groups to write the rule.

IAAAA submitted suggested language for the long term care screening and counseling program in June 2008.

Indiana Statistics

In 2004, the Indiana State Department of Health's “Long Term Care 2004 County Statistical Profile and 2008 Bed Needs Assessment” desmonstrated that 67.3% of nursing home admissions came from hospitals. 17.5% of admissions were made by the individual or the family. 

That report also showed that 32.6% of those who were admitted were discharged to self care or family care, while 23.6% of those admitted died.  43.8% received long term placement.

According to data from the Kaiser Family Foundation, Indiana is 14th in nursing home admissions.

The National Association of State Units on Aging’s Project 2020 has defined a national goal of diverting 1% of individuals from nursing home placement to home.  Indiana has achieved a 5% diversion rate, one of the highest in the country, achieved in large part by integrating the Area Agencies’ Options Counseling program and Aged and Disabled Resource Center into the PAS process.

In 2004, Indiana announced priority access to Medicaid Waiver slots for individuals leaving or diverting from a nursing home. 

In 2008, Indiana fully opened the Aged and Disabled Medicaid Waiver.  This has effectively created increased access to all eligible persons who are appropriate for nursing home placement to be served at home and in their community.

Changes to Pre-Admission Screening

Indiana’s proposed rule should take into account:

• In 2006, Indiana data show that 84 per 1,000 admissions to nursing facilities were temporary Medicare skilled nursing placements and therefore no cost to the state of Indiana. Prior authorization for nursing home admissions would be an unnecessary expense to the state of Indiana.

• Early identification and follow along of individuals admitted to nursing home for skilled nursing/rehabilitative services should be part of the Long Term Care Screening and Counseling process, assuring a return to home as soon as possible, thus saving the state of Indiana money.

• The current system administered through the Area Agencies on Aging has already met and exceeded national standards with no additional cost to the State.  Addition of another level of oversight would place an unnecessary risk to the progress already demonstrated.

• We urge that any modifications to Indiana’s Pre-Admission Screen program take the above into account.

Last Updated April 2010