PASRR M A R K F R A N C I S , M S , L N H A LT C L E A D E R S H - PowerPoint PPT Presentation

PASRR M A R K F R A N C I S , M S , L N H A LT C L E A D E R S H I P C O A C H M U M D S A N D Q U A L I T Y R E S E A R C H T E A M S I N C L A I R S C H O O L O F N U R S I N G U N I V E R S I T Y O F M I S S O U R I C O L U M B I A

PASRR H I STORY AND O VERVI EW In 1840 Dorothea Dix activist, lobbied for better living conditions for the mentally ill and created the institutional care model.

PASRR H I STORY AND O VERVI EW • By the mid-1950s, a push for deinstitutionalization and outpatient treatment began in many countries, facilitated by the development of a variety of antipsychotic drugs. • 1970s and 1980s, states moved individuals with mental illness out of state-funded institutions (including psychiatric hospitals) and into the community. • Housing was not always available so individuals were admitted to nursing homes, as default housing.

PASRR H I STORY AND O VERVI EW • In 1987 Congress enacted legislation directed to long-term care facilities. • The primary goal of this law, known as the Nursing Home Reform Act , was to establish uniform standards for nursing homes and ensure the protection and safety of patients.

PASRR H I STORY AND O VERVI EW • Nursing homes participating in Medicare and Medicaid were required to “provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care”. • The Nursing Home Reform Act also established a bill of rights for nursing home residents.

PASRR H I STORY AND O VERVI EW o live in a caring environment free from abuse, mistreatment and neglect Th e r i g h t t live without the fear of enduring physical restraint Th e r i g h t t o privacy Th e r i g h t t o receive personal care that accommodates physical, medical, emotional, social needs Th e r i g h t t o a social contact/interaction with fellow residents and family members Th e r i g h t t o be treated with dignity Th e r i g h t t o exercise self-determination Th e r i g h t t o exercise freedom of speech and communicate freely Th e r i g h t t o participate in the creation and review of one’s individualized care plan Th e r i g h t t o be fully informed in advance of changes to care plan or status of the nursing home Th e r i g h t t o voice grievances without discrimination or reprisal Th e r i g h t t o

PASRR H I STORY AND O VERVI EW OBRA 1987 did not include a mandated process for States to implement for PASRR. The 1990 and 1992 regulations also granted states enormous flexibility in implementing PASRR.

PASRR H I STORY AND O VERVI EW • On September 28, 2016, the Centers for Medicare & Medicaid Services (CMS) issued updated federal nursing home regulations. This was the first comprehensive revision to the regulations since they were issued in 1991 despite significant changes in the industry. • The updated rule (also referred to as the “ final rule ”) was implemented in three phases: Phase 1- November 28, 2016; Phase 2 - November 28, 2017; and Phase 3 - November 28, 2019.

PASRR H I STORY AND O VERVI EW • The new rules were designed to meet the needs of a broader resident population with a wide variety of diagnosis and a wider age range and ensure that the regulatory environment stays relevant to the population seen in nursing facility. • The requirements require integration of the PASRR assessment into the NF plan of care and new requirements related to the behavioral health needs of individuals.

PASRR H I STORY AND O VERVI EW • Protect individuals with serious mental illness (SMI) or intellectual disability (ID) or a related condition from inappropriate placement in nursing facilities. • Ensure that individuals receive all specialized services necessary to meet the individual's unique MI/ID needs if admitted to a NF. • Provide the opportunity to identify alternative community supports.

N URSI NG F ACI LI TY L EVEL OF C ARE The Department of Health and Senior Services (DHSS) utilizes the Initial Assessment-Social and Medical forms (DA124 A/B) to initiate the process for admission to a Nursing Facility. DHSS determines the need for nursing facility services through established NF level of care criteria (24 points). The Medicaid level of care criteria can be found in DHSS regulation 19 CSR 30-81.030 PDF Document . A special admission category must be granted/approved by DHSS to admit an individual to a SNF before a PASRR assessment is completed.

PASRR H I STORY AND O VERVI EW PASRR has t wo core components: t w 1) The Level I screen (DA 124C) given to all NF applicants is reviewed by DHSS Central Office Medical Review Unit (COMRU) after completion of the LOC. The Level 1 is also used for a significant change of condition. 2) The Department of Mental Health is responsible for the Level II evaluation. DMH contracts with Bock Associates to complete the evaluations.

PASRR H I STORY AND O VERVI EW The Level I screen must: • Capture all persons with suspected or known SMI, ID, or RC/DD. • Be sensitive (identify everybody it was meant to identify). • Be specific (include few people who did not need to be targeted).

PASRR H I STORY AND O VERVI EW Individuals are referred to DMH for Level II Evaluations by the DHSS Level I screener/State Medical Consultants. The purpose of the PASRR Level II Evaluation is to comprehensively assess individuals who are known to have SMI, ID, or a RC, or who met the federal criteria for suspicion and could be affected by those conditions.

PASRR H I STORY AND O VERVI EW The Level II evaluation examines the diagnosis of record to confirm or disconfirm a positive Level I to determine whether placement or continued stay in the requested or current NF is appropriate; and to calculate the MI/ID services the individual needs. The Level II Evaluation is the basis for determining the individual's needs for care and/or specialized services (SS).

PASRR H I STORY AND O VERVI EW DMH contracts with Bock Associates for completion of the Level II evaluations for both ID/MI. The Bock Assessors determine the least restrictive and most appropriate setting in which an individual’s needs may be supported. PASRR can assist states to meet obligations under the Americans with Disabilities Act (ADA) and the Supreme Court's Olmstead decision.

PASRR, ADA AND O LM STEAD The Department of Health and Human Services (HHS) is increasingly holding states accountable to comply with the Olmstead Supreme Court decision. Under the ADA, individuals with disabilities cannot be required to be institutionalized to receive public benefits that could be furnished in community-based settings.

PASRR H I STORY AND O VERVI EW PASRR determinations must consider community services first, and recommend institutional placement only when appropriate.

PASRR D ETERM I NATI ONS The State Mental Health or Intellectual Disability Authority (SMH/IDA) must make two determinations: • Whether nursing facility services are appropriate and needed • Whether specialized services are needed

PASRR T I M E F RAM ES PASRR determinations must be made in writing within an annual average of 7 to 9 working days from the date a positive Level I screen is identified of referral. PASRR ends with notification of the determination.

A PPEALS Any and all negative determinations can be appealed. No person is denied a determination that NF services are needed when a preferred placement is unavailable.

S UM M ARY • PASRR is to identify appropriate placement and services (New admissions and existing residents.) • NF application includes PASRR for individuals with ID MI or a related condition. • NF eligibility includes a Level of Care (LOC). • PASRR consists of two components and an appeal process. • PASRR is a tool that states can use to meet Olmstead obligations.

R ESOURCES • CMS PASRR Technical Assistance Center • www.pasrrassist.org This Photo by Unknown Author is licensed under CC BY-SA

N ATI ONAL A SSOCI ATI ON OF PASRR P ROFESSI ONALS ( NAPP) NAPP is a non-profit educational organization dedicated to advancing the profession of individuals and organizations working in the federally mandated: Pre-Admission Screening and Resident Review (PASRR) Program www.pasrr.org

I NS AND OUTS OF THE DA12 4 D E B B I E P O O L , B S N , R N , L N H A C L I N I C A L E D U C ATO R M U M D S A N D Q U A L I T Y R E S E A R C H T E A M S I N C L A I R S C H O O L O F N U R S I N G U N I V E R S I T Y O F M I S S O U R I C O L U M B I A

W HO R EQUI RES A DA-12 4 C A PPLI CATI ON ANY RESIDENT ADMITTED THIS INCLUDES DUALLY TO A MEDICAID CERTIFIED BEDS, BOTH CERTIFIED BED MUST MEDICARE AND COMPLETE A DA124 C MEDICAID (LEVEL 1) APPLICATION

DA-12 4 C L EVEL 1 A PPLI CATI ON • For a person’s first admission to a nursing facility; • If the person has been out of a nursing facility 60 days or greater ; • If Family Support Division (FSD) requests re-applying for Medicaid (indicate re-applying for Medicaid on the DA-124 A/B); • If the resident (with MI or MR) has had a Significant Change in Status per the MDS 3.0, indicate the Change of Status on the DA-124 A/B.