North Dakota Children's Treatment Services Level of Care Determinations
Maximus has been contracted by the state of North Dakota’s Health and Human Services (HHS) to implement and manage its Children’s Treatment Services Level of Care (LOC) Determinations. The role of Maximus in this partnership is to determine the use of residential and enhanced foster care services for eligible children and youth.
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North Dakota Children's Preadmission Screening and Resident Review (PASRR)
Maximus partners with the North Dakota Health and Human Services (ND HHS) Medical Services division to provide the online Preadmission Screening and Resident Review (PASRR) Level I screening, online Level of Care utilization review for long-term care populations, and onsite, independent PASRR Level II mental health and Level of Care evaluations.
The federally mandated PASRR screening and assessment are used to determine whether the nursing facility is the appropriate placement for individuals with mental illness, intellectual disabilities, or developmental disabilities. PASRR also works as a critical function to help match individuals with the care and services they need.
CMS requires safeguards to be in place to ensure appropriate use of Medicaid services in every state’s Medicaid program. In North Dakota, the Level of Care determination ensures that those with Medicaid and those in the PASRR population have Level of Care assessment completed to identify if the individuals meet the state criteria for Nursing Home Level of Care (also serving as the LOC criteria for the State’s waivers, as well as grant-funded and state funded home and community-based programs). The goal of the Level of Care determination is to ensure that those with Medicaid who are applying for waivers and nursing home care receive the most appropriate and least restrictive care, at the right time, for the right duration by verifying that they meet the state criteria.
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North Dakota Money Follows the Person
We partner with the DHS Medical Services Division to conduct the initial screening for eligibility (Level of Care) and makes determinations regarding denials for this transition program.
North Dakota Children with Medically Fragile Needs
This waiver covers children with high medical needs. Maximus reviews Level of Care screens and notification letters are sent to all parties.
North Dakota Program for All-Inclusive Care for the Elderly (PACE)
The PACE program offers services for individuals living in the community. We review Level of Care screens and send notification letters to all parties.
North Dakota Personal Care
Personal Care provides services associated with activities of daily living to individuals living in the community to help them maintain independence. We review screens to determine Level of Care needed and provide notification letters to all parties.
North Dakota Home and Community Based Services
This program offers services to provide an alternative to institutional placement for individuals with defined needs. We perform Level of Care screens and sends notification letters to all parties.
North Dakota Traumatic Brain Injury (TBI)
The TBI waiver provides services to individuals who have TBI and who would otherwise be eligible to be admitted to a nursing facility. We perform annual Level of Care screens and send notification letters to all parties.
North Dakota Medical Long Term Care Utilization Review
We perform Medical Long Term Care Utilization Review (admission and continued stay reviews) for several other services provided by the State of North Dakota.