The Executive Office of Elder Affairs and the Aging Services Access Point (ASAP) network have designed the Comprehensive Screening and Service Model (CSSM) to assist individuals to return to the community from a nursing facility in a more appropriate and timely manner. The face-to-face evaluation is designed to enhance the ASAPs ability to match consumers in need of long-term care support with care in the most appropriate and cost effective setting. In addition, this model should improve upon current methods of data collection, resulting in more precise information about the population served.

Effective June 1, 2004 hospitals will no longer be completing and submitting screening requests to ASAPs for nursing facility services for MassHealth Applicants or Dually Eligible Members. Hospitals will continue to conduct screenings for MassHealth only Members. Acute inpatient hospitals will authorize a duration of 45-days for short-term approvals. The authorization period for ASAPs is no longer limited to a period of up to 90 days.

The second major change will be the ASAP's presence in nursing facilities to identify residents for discharge potential, as well as to educate consumers and caregivers of the community options available to them. During the initial phase ASAPs will have direct contact with a statewide average of 253 nursing facility residents each month subsequent to a conversion request (a request for Medicaid reimbursement subsequent to a Medicare or private pay stay) from a nursing facility. Once target numbers are met each month, ASAPs may choose to identify additional residents with discharge potential, e.g. residents due for a Short Term Review Screening. The Interdisciplinary Evaluation Team consists of a core team and additional members who would be consulted as needed. The core team includes the Member/Applicant and family members/caregivers, the ASAP RN, the ASAP case manager and the nursing facility discharge planner.

-Adapted from Coordination of Care Program Update, from Diana Bratsos, MHC, RN, BC, Coordination of Care Program Director

05/2004