PART ONE PART ONE What I s PASRR? History and Process What I s - - PDF document

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Rick Sc Scott,

• tt, Governor
• r

Charles T les T . Corley ey, S Secret etar ary

Pre Pre-

• Admission Screening and

Admission Screening and Resident Review (PASRR) Training Resident Review (PASRR) Training

PART ONE PART ONE

• What I s PASRR? History and Process

What I s PASRR? History and Process

• PASRR and Level of Care

PASRR and Level of Care

• I mplementation of New PASRR Forms

I mplementation of New PASRR Forms

• PASRR Training and Contact I nformation

PASRR Training and Contact I nformation

Presented by the Comprehensive Assessment and Review Presented by the Comprehensive Assessment and Review for Long for Long-

• Term Care Services Program (CARES)

Term Care Services Program (CARES)

November 2011 November 2011

Acronym Legend

AHCA: Agency for Health Care Administration APD: Agency for Persons with Disabilities CARES: Comprehensive Assessment and Review for Long-Term Care Services CFR: Code of Federal Regulations CIRTS: Client Information and Registration Tracking System-DOEA g g y CMAT: Children’s Multidisciplinary Assessment Team DOEA: Department of Elder Affairs HIPAA: Health Information Portability and Accountability Act LOC: Level of Care MDS: Minimum Data Set MH: Mental Health MI: Mental Illness MR: Mental Retardation

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NF: Nursing Facility PASRR: Pre-Admission Screening and Resident Review SAMH: Substance Abuse and Mental Health SMHA: State Mental Health Authority SMA: State Medicaid Agency SMRA: State Mental Retardation Authority SMI: Serious Mental Illness SS: Specialized Services

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What is PASRR?

PASRR or Pre-Admission Screening and Resident Review is a screening and evaluation process to ensure all nursing facility applicants and residents ensure all nursing facility applicants and residents with Serious Mental Illness (SMI) and/or Mental Retardation (MR) are:

Identified Placed appropriately in the least restrictive environment Admitted or allowed to remain in a nursing facility only if they are appropriately served Provided with the MI/MR services they need including Provided with the MI/MR services they need, including specialized services.

The PASRR process is mandated by 42 Code of Federal Regulations (CFR) 483.100-483.138.

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What is PASRR?

Two part PASRR process: Level I Pre-Admission Screen and Determination

Applies to all new admissions into a Medicaid certified nursing facility, regardless of payer source. Identifies possible presence (indication) of SMI or MR and does not require a diagnosis.

Level II Request for Evaluation or Resident Review

Required when Level I PASRR Screen identifies SMI or MR or Minimum Data Set reveals a significant change in the resident’s mental or physical condition. Determines if nursing facility placement is appropriate and diverts from NF g y p pp p if needs cannot be met. Identifies supports for community living; finds most independent placement possible. Reports all levels of services needed, to guide care plan and recommend specialized services if necessary. Resident review process assures that services are delivered and effective.

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General PASRR Process

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SS = Specialized Services RR= Resident Review NF = Nursing Facility

Overview of State PASRR Programs

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Overview of State PASRR Programs Continued

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Federal Caveat on Suspected Indications of MI/MR

Suspected means that the role of the Level I screen is to look behind existing diagnoses to identify any clues that look behind existing diagnoses to identify any clues that suggest an undiagnosed person might have a Level II condition. “It is clear to us that reliance on known diagnosis would cause the process to miss individuals whose mental illness or mental retardation had not been specifically identified either through lack of physican care (when the individual is proposed for admission by his or her family individual is proposed for admission by his or her family without prior consultation with a physician or mental health professional) or when a physician has avoided articulating the diagnosis out of consideration of the individual or the family.”

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PASRR Regulations - History

OBRA 87-Covered anyone who was mentally ill OBRA 87 Covered anyone who was mentally ill. OBRA 89- Covered anyone who had a Serious Mental Illness AND anyone with indicators such as psychoactive medications. OBRA 90- Covered 3Ds (duration, disability and diagnosis) and anyone with indicators such as psychoactive medications (“look behind”).

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PASRR in the Positive

PASRR is designed to prevent inappropriate placement of individuals in nursing facilities. Rather than PASRR restricting entrance to nursing facilities, the required PASRR process can be a gateway to community services. Ensuring appropriate PASRR screening and g pp p g evaluation is done prior to nursing facility admission ensures client needs can be met.

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PASRR and Level of Care (LOC)

Per state and federal regulations, issuing a LOC determination requires CARES to have:

1. All the necessary PASRR paperwork on file; 2. Verified the PASRR documentation was completed in an accurate and timely manner; and 3. Confirmed PASRR determined the applicant appropriate for the nursing home setting.

CARES is required to withhold the requested LOC when PASRR is not done or incomplete. Refer to Page 7-8 of the Summer 2011 Medicaid Provider Bulletin for more information.

http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/BULLETI NS/2455%20Summer%202011%20Provider%20Bulletin%2009.pdf

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Implementation of New PASRR Forms

Effective date for new PASRR forms is November 14 2011 November 14, 2011. Prior PASRR forms will be accepted until AHCA rule promulgation is complete. However, the use of new forms is recommended to improve accuracy and completeness of PASRR screens and determinations now

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screens and determinations now. Watch Part Two and Part Three of this training to review form changes and instructions for Level I Screeners to complete the PASRR process.

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Training

PASRR training materials, forms, and form instructions can be found on the DOEA CARES instructions can be found on the DOEA CARES PASRR Website.

http://elderaffairs.state.fl.us/english/cares_pasrr.php

Local PASRR training and technical assistance

• n the new PASRR forms and the PASRR

process is available by contacting your local

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CARES Program Office.

CARES Local Contacts for PASRR Training or Technical Assistance

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DOEA CARES State Office

Kathi Chisolm, PASRR Point of Contact, (850) 414-2343

Additional Contact Information

CARES Regional Program Supervisors (RPS)

Carol Klauer, Region 1 RPS, klauerc@elderaffairs.org Mark Young, Region 2 RPS, youngjm@elderaffairs.org Sheila Mitchell, Region 3 RPS, mitchells@elderaffairs.org

PASRR Compliance Questions

Local AHCA Health Quality Assurance Field Office http://ahca.myflorida.com/mchq/index.shtml#6 Kim Smoak, AHCA Health Quality Assurance Kimberly.Smoak@ahca.myflorida.com

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Thank you for watching Part Thank you for watching Part Thank you for watching Part Thank you for watching Part One of One of Pre Pre-

• Admission

Admission Screening and Screening and Resident Review (PASRR) Resident Review (PASRR) Training Training

17

Training. Training.

Rick Sc Scott,

• tt, Governor
• r

Charles T les T . Corley ey, S Secret etar ary

Pre Pre-

• Admission Screening and

Admission Screening and Resident Review (PASRR) Training Resident Review (PASRR) Training

PART TWO PART TWO

• Level I Screening and Determination Process

Level I Screening and Determination Process

• Categorical and Advance Determinations

Categorical and Advance Determinations

• Categorical and Advance Determinations

Categorical and Advance Determinations

• Hospital Exemptions

Hospital Exemptions

• Completing the Level I Screen and Determination

Completing the Level I Screen and Determination

Presented by the Comprehensive Assessment and Review Presented by the Comprehensive Assessment and Review for Long for Long-

• Term Care Services Program (CARES)

Term Care Services Program (CARES)

November 2011 November 2011

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Purpose of the Level I

Pre-Screen prior to admission. Method of identifying NF applicants and residents with known or suspected mental illness, mental retardation, and related conditions. Level I applies to all new admissions into a Medicaid certified nursing facility, regardless of payer source payer source. Level I identifies possible presence of MI or MR and does not require a diagnosis.

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Level I (continued)

Level I involves the participation with: Level I involves the participation with:

The individual The individual’s representative (if applicable) The individual’s family (if available and agreed to by the individual or legal representative) representative)

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Level I PASRR, to fulfill its purpose:

ALL SUSPECTED MI/MR is evaluated at Level II. ALL SUSPECTED MI/MR is evaluated at Level II. Judgments about MI/MR made only by qualified professionals, including:

Level II evaluators and determiners, or Level I screeners with professional qualifications and/or centralized guidance.

Categorical Determinations are real Categorical Determinations are real determinations, with reports (not “exemptions”).

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Level I PASRR, to fulfill its purpose:

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Look Behind

The Level I evaluator should not just rely The Level I evaluator should not just rely

• n “known diagnosis” but should “use

discretion in reviewing client data and look behind diagnostic labels…for any presenting evidence of MI.”

• Federal Register

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Types of Determinations

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Advance Group Determinations

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Advance Group Determinations (continued)

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Hospital Exemption

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Completing the Level I PASRR Screen and Determination

Please refer to Level I PASRR Screen and Determination Form provided.

(AHCA MedServ Form 004, Part A, November, 2011)

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PASRR Level I Screen Covers the Following Areas:

Section I: Guide For Determining An Indication Of Or A Section I: Guide For Determining An Indication Of, Or A Diagnosis of, A Serious Mental Illness (MI), Mental Retardation (MR), Or Related Condition Section II: MI/MR Section III: Categorical Determination of Dementia/ Related Disorder Section IV: Exempted Hospital Discharge Section V: Advance Group Determinations Section VI: Individualized Evaluation Determination

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Fill in Fill in Name, Date

• f Birth,

Address. Answer Yes or No to first d i i

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admission question and fill in admitting diagnoses.

First look for MI/MR indicators by reviewing 3008 form, 701B form and all and all pertinent medical information. Then complete all Section I questions (1A 1B 2

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(1A , 1B, 2 can be seen

• here. 3 and 4

are on the next slide).

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Complete Section I and then you must continue to Section II.

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For Part A and Part B, check Yes if the guide indicates MI/MR. Check No if there is no indication

• f MI/MR.

If No, you can

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sign and date. If Yes, you must continue to Section III.

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Answer each question by checking either Yes or No. Always follow instructions before and after the signature lines to see whether you must proceed to

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must proceed to next question or section.

Answer by checking Yes or No based on physician certification of expected length of NF sta NF stay. If Yes, and if upon admission individual is likely to require more than 30 NF days, a resident review is required. Follow Follow instructions before and after the signature lines to see whether you must proceed to Section V.

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Answer each question by checking either Yes or No. If any answer is Yes and if upon Yes, and if upon provisional admission individual is determined to need a longer stay, a Level II evaluation and determination is required. Follow instructions before and after the signature lines to see whether you must proceed to Section VI.

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Answer each question by checking either Yes or No. Complete the date, signature

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signature, and Level II referral information at bottom of page.

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Thank you for watching Part Thank you for watching Part Thank you for watching Part Thank you for watching Part Two of Two of Pre Pre-

• Admission

Admission Screening and Screening and Resident Review (PASRR) Resident Review (PASRR) Training Training

40

Training. Training.

21

Rick Sc Scott,

• tt, Governor
• r

Charles T les T . Corley ey, S Secret etar ary

Pre Pre Admission Screening and Admission Screening and Pre Pre-Admission Screening and Admission Screening and Resident Review (PASRR) Training Resident Review (PASRR) Training PART THREE PART THREE

• Level

Level I I Process I I Process

• Serious Mental I llness and Mental Retardation

Serious Mental I llness and Mental Retardation C l ti th N R t f L l I I E l ti d C l ti th N R t f L l I I E l ti d

• Completing the New Request for Level I I Evaluation and

Completing the New Request for Level I I Evaluation and Determination or Resident Review Determination or Resident Review

• Determination of Need and Examples of Specialized Services

Determination of Need and Examples of Specialized Services

Presented by the Comprehensive Assessment and Review Presented by the Comprehensive Assessment and Review for Long for Long-

• Term Care Services Program (CARES)

Term Care Services Program (CARES)

November 2011 November 2011

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Completing the Request for Level II Evaluation and Determination

• r Resident Review

Please refer to PASRR Request for Level II Evaluation and Determination or Resident Review Form provided. (AHCA MedServ Form 004, Part B, November 2011)

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Enter date

• f request and

check the type

• f request
• f request.

Enter your name, agency and phone number. Complete PASRR Level II reviewer’s II reviewer s name, agency and phone number.

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Enter Name, Date of Birth d C t Check and Current Location of individual to be evaluated by the Level II reviewer.

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Check appropriate MI/MR Indicator(s).

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Gather the required documents listed here for either Initial Level II evaluation and determination or for Resident Review of existing nursing facility resident. Required documents must be submitted with the Request for Level II Form. Check all

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Check all appropriate boxes for documents submitted to Level II Reviewer.

The Level II

Reviewer will complete, sign, and date Section IV. Questions 1-7 will provide the disposition of the disposition of the Level II Evaluation and Determination. When specialized services are needed, a care plan of required services will be provided. The date of

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The date of distribution of the Level II Evaluation and Determination and to whom it is distributed is also found here.

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Thank you for watching Part Thank you for watching Part Thank you for watching Part Thank you for watching Part Three of Three of Pre Pre-

• Admission

Admission Screening and Screening and Resident Review (PASRR) Resident Review (PASRR) Training Training

68

Training. Training.