What is Must What is MUST? Minimize

The Medicaid Uniform Screening Tool (MUST) is a web-based tool that will evaluate the applicant's medical, functional, and psycho-social needs for Long Term Care Services and Support. MUST will make a recommendation as to the services or level of care that best fit the applicant needs. It may also provide possible alternatives that could meet their needs.

Authorized and trained screeners will enter health information into the MUST system. The tool will then perform a review based on policies set by the Division of Medical Assistance and Federal regulations.

After determinations are made, MUST will mail a screening outcome letter to the applicant explaining the screening results.

Upon full implementation, MUST will screen for the following eight Medicaid programs:

  • Nursing Facility Services (NF)
  • Adult Care Home Services (ACH)
  • Personal Care Services (PCS)
  • Personal Care Services Plus (PCS Plus)
  • Community Alternatives Program for Children (CAP/C)
  • Community Alternatives Program for Disabled Adults (CAP/DA)
  • Community Alternatives Program for Disabled Adults Choice (CAP/Choice)
  • Private Duty Nursing (PDN)

MUST will also screen for the federally mandated Preadmission Screening and Annual Resident Review (PASRR) program that is required for all applicants entering a Nursing Facility.

The roll out of MUST will be implemented in stages. The first stage will be the release of the Level I PASRR Screening function scheduled for release on September 12, 2008.

The roll out of the eight other long term care programs listed above have not been scheduled; however, there will be information available on this site as well as the provider bulletins when the decision is made.

Until the roll out occurs, please continue to utilize existing policy and procedure as documented within the each program.

For more information on the Uniform Screening Program or other Medicaid programs, call the toll free CARE-LINE at 1-800-662-703 or visit them online at http://www.ncdhhs.gov/ocs/careline.htm
How Does Must Work How does MUST work? Minimize

Referring organizations will be required to complete a medical/psycho/social screening via a Web-enabled, automated screening tool. The screening tool will be accompanied by decision rules that translates eligibility criteria for covered services and applies these rules to submitted screens to determine what service(s) the applicant may be eligible for.

To facilitate transition to uniform screening, the initial decision rules and logic are based on existing eligibility criteria for all covered programs. In the months ahead, DMA may wish to refine the eligibility criteria in light of the insights gained reviewing the initial logic of the uniform screening process.

The screening tool is based on several features and concepts:

  • Provides an automated and comprehensive review of applicant needs/circumstances necessary to determine the best program(s) or setting of care.
  • Provides automated Prior Approval for Nursing Facility.
  • Organized around major assessment domains and designed to be complementary to a proposed integrated assessment tool also being developed by DMA.
  • Includes the calculation of certain scores that in turn are used as a screening criterion. (for example, calculation of a cognitive performance score, or a home safety score.)
  • Relies heavily on fixed response codes and little on narrative.
  • Attempts to integrate required information and eliminate redundancy arising when screening for multiple programs.
  • Allows for additional questions to be prompted based on answers to a core question.
  • Incorporates questions from current screening tools.
  • Is compatible with RAI-MDS on important screening questions, ADLs, CPS, etc.
  • Incorporates the use of skip logic to simplify and speed up completion of the screen.
  • Will provide built-in explanation of terms and help guides accessible to the screener as they complete the screen.
  • Takes into account growing interest in screening for Self-Directed Care capacities of informal caregivers and the interest of applicants in remaining at home to the extent possible.
  • There is no cost to use the tool and it will be available 24 hours a day, 7 days a week.

The information collected in the MUST instrument is considered to be confidential personal health information. This data is considered sensitive and all necessary protections will be employed to keep the data secure and confidential. All screening Organizations and respective employees are expected to uphold DMA HIPAA guidelines and their own Agency HIPAA policies. Any breach in confidentiality needs to be reported. Please note: The MUST tool is not signed by a physician and must not be viewed as Physician orders - the information is for screening purposes ONLY.