New Physician Certification for Long Term Care Services (450B) Policies

The Division of Aging has announced two new policies regarding the Physician Certification for Long Term Care Services (450B). Beginning January 1, 2013, the current 450B document will no longer be limited to only the physician's signature. The physician may now delegate, within his or her scope of practice, that responsibility to either a Physician Assistant (PA) or Nurse Practitioner (NP) for whom the physician has supervisory responsibilities. 

This change in policy and practice affects the following:
• Pre-Admission Screening (PAS)
• Pre-Admission Screen Resident Review (PASRR)
• Nursing facility requests for continued stays
• Nursing facility transfers
• New Medicaid pay status
• Clients transition from Medicaid Waiver program to nursing facility admissions
• Nursing facilities must develop a policy regarding their process for assuring compliance with the delegation of the Physicians authority to the PA and/or NP 

As a result of the expansion of 450B signatory responsibility, the State is requesting that completed documents be submitted to the AAA/PAS office within 14 days of the NF admission date for those that require AAA/PAS processing.

Also effective on January 1, the Division of Aging (DA) and the Office of Medicaid Policy and Planning (OMPP) is expanding statewide a piloted electronic 450B (e-450B) process. The new e-450B form utilizes an online "check-off" system that thoroughly describes the resident's condition. It is a summary of the MDS, the "old" 450B, and the eligibility screen used by the AAA/PAS team in determining nursing facility level of care. Required additional documents include the 4B, medication sheets, and the nurse's clinical summary, which includes a narrative of the resident's current condition. No more than 10 pages of documentation including the nurse's clinical summary will be accepted along with the submission of the e-450B. Please also be aware that e-450Bs submitted to the DA without all required documentation will be rejected, denied or returned to the NF for additional information.

With the new web-based process, NF staff completes the e-450B online, saves and prints it, obtains the approved signature (physician, PA, or NP) and then uploads the completed e-450B along with the required documentation. The DA receives the information electronically, reviews and processes it, data-enters Medicaid information as appropriate, and returns the reviewed e-450B electronically to the NF.

The Division will host e-450B trainings at the Indiana Government Center South Auditorium on the following dates and times:

Thursday, January 10, 10:00 am - 12:00 pm
Wednesday, January 16, 1:00 pm - 3:00 pm
Wednesday, January 23, 10:00 am - 12:00 pm
Thursday, January 24, 1:00 pm - 3:00 pm

Please note the above-listed trainings are repeats session. You may attend any training that fits in your schedule. Please bring a copy of the User Guide and the PowerPoint presentation slides to the training (Which may be accessed at https://myweb.in.gov/FSSA/aging/form450b/ as of December 10), as the DA will not have printed copies.

Full implementation will be effective February 1, 2013. After that date, the DA will no longer accept mailed documents.

The Division of Aging has clarified that the request for the completed 450B to be submitted to the PreAdmission Screening agency within 14 days does NOT replace the requirement in IAC 455 1-1-8 requiring that the signed application and Level 1 be submitted to the PAS agency within 5 working days of the date of admission.

Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 with any questions about these new policies.