Medical Eligibility is the cornerstone of Planning as well achieving ALTCS benefits. It does not matter what a client has or what they have done if they do not medically qualify. Right now the majority of denials from ALCTS (about 70%) are coming from clients failing to qualify medically for benefits.
The tool the state uses to determine medical eligibility is called a PAS (pre admission screening) and an applicant must score at least 60 points or higher in order to be considered medically eligible. The PAS is broken into two parts. The first part focuses on the applicant’s ability to do their activities of daily living. There are roughly 5 sections and the maximum score you can get from all five sections is 50 points (not enough on its own to qualify).
With the PAS being done telephonically and the assessor never meeting the potential ALCTS client, it is now more important than ever that the records accurately reflect all the assistance that a potential applicant requires. We have in the past worked directly with facilities to make sure their documentation encompasses all of what ALTCS is looking for so that the applicant gets all the points they should qualify for.
The second part of the PAS is a list of current diagnosis and list of medications to determine the severity of those diagnosis. An example of this is moderate to severe dementia will get 20 points on the PAS; but mild cognitive impairment or a diagnosis of just dementia gains zero points.
In order to pass the PAS a totality of points from each section is added together and if the points are 60 or higher then the applicant will medically qualify.