Rick Sc Scott, ott, Governor or 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 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 2 SS: Specialized Services 1
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. 3 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. 4 2
General PASRR Process SS = Specialized Services RR= Resident Review NF = Nursing Facility 5 Overview of State PASRR Programs 6 3
Overview of State PASRR Programs Continued fff 7 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.” 8 4
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”). 9 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. 10 10 5
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 11 11 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. 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. 12 12 6
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 on the new PASRR forms and the PASRR process is available by contacting your local CARES Program Office. 13 13 CARES Local Contacts for PASRR Training or Technical Assistance 14 14 7
15 Additional Contact Information DOEA CARES State Office Kathi Chisolm, PASRR Point of Contact, (850) 414-2343 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 16 16 8
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 Training. Training. 17 Rick Sc Scott, ott, Governor or 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 9
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. 19 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) 20 10
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”). 21 Level I PASRR, to fulfill its purpose: 22 11
Recommend
More recommend
