Indiana’s Pre-Admission Screening IPAS Program

Indiana’s Pre-Admission Screening (PAS) started in 1983.  It’s primary purpose is to assure that, before an individual is placed in a Nursing Facility (NF), alternatives (in-home and community services) have been explored.

The State Legislature was concerned about rising Medicaid costs for NF care and the increasing number of elderly people.  The IPAS program monitors NF admissions to insure that placements are appropriate.  Individuals are helped to stay at home by finding and assisting them to access in-home and community services that are necessary to avoid or delay NF placement.  Nursing facility beds are then available for those who need them most.

What Is Pre-Admission Screening (PAS)?

IPAS is a process which consists of an application, a comprehensive assessment of needs, a plan of care, and a finding or decision concerning the most appropriate placement for an individual.

The application will initiate an appointment with the case manager of the IPAS team.  Your doctor is also a member of the team.

AT HOME APPLICANT:

The case manager will meet with you and your family to discuss your medical problems, how much help you need with activities of daily living, and the kind of help you may receive in your home.  Based on the assessment and knowledge of alternative services available in your area, the IPAS team recommends either NF care or continued living at home.  The final determination for an individual eligible for Medicaid is made by a professional team at the Office of Medicaid Policy and Planning.

Do I Have To Participate In IPAS?

By state law, ALL persons, regardless of income or resources, must participate in IPAS to be admitted to a NF in Indiana.  You may choose to agree or refuse to participate.  However, if you refuse and are admitted to a NF, you will incur a penalty of non-payment by Medicaid of per diem costs for up to one (1) year.

It is the responsibility of every NF in Indiana to inform each individual seeking admission that there is an IPAS program, what it is, and the penalty for non-participation.

How Do I Apply For IPAS?

Application is usually made through the NF to which you are seeking admission.  It may also be made at a hospital in which you are a patient or at your local Area Agency on Aging.

The NF must assure that the IPAS application is immediately sent to the IPAS agency.  A NF which admits an individual without following IPAS program requirements commits a Class A infraction.  Federal law also requires the NF to provide answers to a series of questions call a Level 1 screen.   The answers to these questions will indicate whether a specialized assessment (Level ll) should be done to identify additional services your may need for a condition of mental illness or developmental disability.

NURSING HOME INFORMATION WEB SITES
www.medicare.gov/NHCompare/Home.asp
http://www.in.gov/isdh/reports/QAMIS/index.htm

How Long Does The IPAS Decision Take?

The time limit for the IPAS process varies according to the situation.  It should be completed within the following time frames:

  • At home:  As soon as possible, but no later than 25 days
  • In the nursing facility:  Within the time limits specified under the designee authorization for admission
  • Emergency / APS:  Within 25 days from the date of admission
  • Short-Term (30-Day):  If discharged within the 30-day limit, no assessment is completed.  If longer stay is needed, complete assessment within an additional 25 days
  • Direct-from-Hospital:   Doctor’s estimated recovery time (ERT) plus 25 days, not to exceed 120 days (Medicaid eligible's limited to 25 days)   

When Level II assessment is needed, a determination should be made within 7-9 working days. When IPAS assessment is completed, you will receive the decision on a PAS Form 4B.

Must I Enter A Nursing Facility If IPAS Find That Placement Is Appropriate?

No.  The IPAS finding that placement is appropriate means that you have needs which NF care is designed to meet and that community support services to meet those needs were not available.  You may choose to use services which have been identified and remain at home or in the community.  However, if you enter a NF after an IPAS finding that placement is NOT appropriate, you will incur the penalty of non-payment of per diem by Medicaid for up to one year from the date of admission.

What If The IPAS Screening Is Not Completed On Time?

If everyone (including your doctor, the NF and others as appropriate) cooperated promptly to provide necessary information, but the IPAS decision was not rendered in time, you may request a waiver of the IPAS penalty from the State.  If the waiver is granted, you may enter the NF without incurring the IPAS penalty.  Contact your local IPAS agency for information and assistance.  NOTE:  If Medicaid per diem is needed, all other Medicaid eligibility requirements still apply.  If you seek Medicaid for your NF care, you will need to provide information to OMPP concerning your IPAS participation status.

What If I Do Not Agree With The IPAS Finding?

You may appeal any decision if you do not agree.  Directions on how to appeal are printed on the back of the IPAS determination form (PAS Form 4B) which you will receive.