Pre-Admission Screen and Residential Review (PASRR) and Specialized - - PowerPoint PPT Presentation

Pre-Admission Screen and Residential Review (PASRR) and Specialized Services

Ma ura K le in PASRR Co ntra c t Administra to r June 6, 2016

What are Specialized Services (SS) and Specialized Psychiatric Rehabilitation Services (SPRS)?

Any se rvic e o r suppo rt re c o mme nde d b y a n individua lize d L e ve l I I de te rmina tio n tha t a pa rtic ula r nursing fa c ility re side nt re q uire s due to me nta l illne ss o r inte lle c tua l disa b ility tha t supple me nts the sc o pe o f se rvic e s tha t the fa c ility must pro vide unde r re imb urse me nt a s nursing fa c ility se rvic e s.

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• Oxfo rd Dic tio na ry

Three separate definitions and Three different determinations

• SS fo r pe rso ns with a de ve lo pme nta l disa b ility
• SS fo r pe rso ns with se rio us me nta l illne ss
• SPRS fo r pe rso ns who ha ve a se rio us me nta l illne ss

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• Ac tivitie s a re to b e inte g ra te d into a “no rma l da ily

rhythm.”

• E

a c h pla n must b e imple me nte d b y a ll sta ff who wo rk with the re side nt e xc e pt fo r tho se ite ms tha t must b e imple me nte d o nly b y lic e nse d pe rso nne l.

• Allo wa nc e sho uld b e ma de fo r individua lize d fre e

time .

• Ac tivity sc he dule s sho uld a llo w fo r fle xib le

pa rtic ipa tio n in a b ro a d ra ng e o f o ptio ns ra the r tha n a fixe d re g ime n.

Care Planning

SS-SPRS Responsibility

• F

a c ilitie s do no t ne e d a spe c ia l lic e nse o r a ppro va l fro m the Wisc o nsin De pa rtme nt o f He a lth Se rvic e s.

• A fa c ility is pe rmitte d to re fuse to a dmit a n

individua l who se ne e ds c a nno t b e me t b y the nursing fa c ility, b ut this must b e do ne b a se d o n a full a sse ssme nt o f the individua l’ s ne e ds a nd fa c ility’ s c a pa c ity to me e t the individua l’ s ne e ds.

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Staffing Requirements

• Se rvic e s a b o ve a nd b e yo nd the e xpe c ta tio n fo r

‘ se rvic e s o f a le sse r inte nsity’

• Se rvic e s a re de live re d b y pro vide rs with spe c ific

q ua lific a tio ns

• Qua lifie d Me nta l He a lth Pro fe ssio na l (QMHP)
• Qua lifie d I

nte lle c tua l Disa b ility Pro fe ssio na l (QI DP)

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Staffing Requirements

F a c ilitie s o fte n c o ntra c t with e xisting pro vide rs fo r the se se rvic e s

• I

de a lly inc lude s pro vide rs o f ho me a nd c o mmunity- b a se d se rvic e s

• Ma ximize s inte g ra tio n into the c o mmunity a nd he lps

to fa c ilita te tra nsitio n o ut o f the institutio n

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• De te rmina tio n do e s no t c ha ng e re imb urse me nt;

‘ se rvic e s o f a le sse r inte nsity’ a re pro vide d fro m the fa c ility’ s b a se ra te o r dire c t-b ille d.

• F

a c ilitie s tha t a re a b le to pro vide SS a re re imb urse d b y the sta te fo r pro viding the se se rvic e s.

• SPRS is pro vide d a t a da ily ra te pe r re side nt.

Reimbursement

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A nursing fa c ility sho uld re q ue st a ne w sc re e n fo r a n individua l who ma y no lo ng e r re q uire SS-SPRS fo r two po ssib le re a so ns:

• T

he individua l’ s inde pe nde nt func tio ning is no t sig nific a ntly impa ire d b y the ir me nta l illne ss o r inte lle c tua l disa b ility; the y a re g e ne ra lly inde pe nde nt.

• T

he individua l’ s me dic a l c o nditio n (o r de me ntia ) ha s de c line d to a po int to whic h the individua l no lo ng e r c a n pa rtic ipa te in o r b e ne fit fro m SS-SPRS.

Change of Status

Contact Information

• F
• r PASRR que stions, c o nta c t Ma ura K

le in: ma ura .kle in@ wisc o nsin.g o v o r 608-266-7072.

• F
• r SPRS r

e imbur se me nt que stions, c o nta c t Ma rg ie

Ho lzhue te r: ma rjo rie .ho lzhe ute r@ wisc o nsin.g o v o r 608-267-0996.

• F
• r L

e ve l II que stions, c o nta c t Be ha vio ra l Co nsulting

Se rvic e s: b c se rv@ a tt.ne t o r 262-376-1224.

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