The following is an excerpt from my book, New Jersey Elder Law: A Resource and Planning Guide. The book is published by ALM Media. ALM is the publisher of the New Jersey Law Journal¸ the leading New Jersey legal periodical. If I do say so myself, the book contains a great deal of information for those individuals who are generally interested in the articles that I write in this paper.
If you are interested in obtaining my book, you can contact the New Jersey Law Journal at 973-642-0075 or contact Doug Brown at dabrown@alm.com.
8:7-2 The Pre-Admission Screen (PAS)
In addition to the financial criteria (resources and income), an applicant for institutional level care services must have a need for care from a health perspective. The law that imposes this criterion is the Pre-Admission Screen Act. A Pre-Admission Screen is called a PAS (pronounced Pass).
8:7-2.a. Activities of Daily Living
A PAS is issued to an applicant if the applicant either requires hands-on assistance with three or more activities of daily living (ADLs) or has cognitive impairments that affect his ability to perform independently three or more ADLs. There are six ADLs: clothing, bathing, toileting, eating, transferring, and mobility. These are the only activities of daily living that matter when making the PAS assessment.
There are also instrumental activities of daily living (IADLs). IADLs are activities such as meal preparation and medication administration. Most people believe that if a person cannot prepare their own meals or cannot take their medications properly they need help, but the inability to perform IADLs does not get an applicant for Medicaid a PAS.
The Office of Community Choice Options (OCCO)—which is an office of the Division of Aging Services, part of the Department of Health and Senior Services—employs nurses who make the assessment as to whether or not an applicant for Medicaid benefits qualifies for a PAS. From a practical standpoint, OCCO believes that it is the only entity that can make such an assessment. In other words, even if the applicant’s physician attested to the fact that the applicant required hands-on assistance with 3 or more ADLs, OCCO believes that it is the one and only entity that can make that determination and if that office does not believe that the applicant requires hands-on assistance with 3 ADLs, then the applicant does not qualify for Medicaid benefits.
This can be confusing because the county board of social services will ask the applicant to have his physician complete a medical assessment form called a PA-4. Essentially, the PA-4 is just a preliminary screening tool. The physician is attesting to the fact that the applicant may require care in a nursing facility or assisted living residence within the next 30 days.
The PA-4, though, is really an elimination tool, not an eligibility tool. If the physician attests that the applicant will not require care in a nursing home or assisted living residence in the next 30 days, then his application will be denied; however, if the physician attests to the fact that the applicant may need such care in the next 30 days, then the application can proceed, and OCCO will make its own assessment.
If you or someone you love is interested in the Medicaid program or the administration of a deceased individual’s estate or in drafting a proper Will, power of attorney, or living will, then my book is a must read for you. These areas of the law are fraught with pitfalls. In my book, I provide you with an understanding of these areas of the laws and helpful tips for navigating your way through the legal issues affecting the elderly and disabled.