Embed Size (px)
Citation preview
1
Rick Scott, Governor Charles T. Corley, Secretary
PrePre--Admission Screening and Admission Screening and Resident Review (PASRR) Training Resident Review (PASRR) Training
PART ONEPART ONE•• What Is PASRR? History and ProcessWhat Is PASRR? History and Process•• PASRR and Level of CarePASRR and Level of Care•• Implementation of New PASRR FormsImplementation of New PASRR Forms•• PASRR Training and Contact Information PASRR Training and Contact Information
Presented by the Comprehensive Assessment and Review Presented by the Comprehensive Assessment and Review for Longfor Long--Term Care Services Program (CARES)Term Care Services Program (CARES)
November 2011November 2011
Acronym LegendAHCA: Agency for Health Care AdministrationAPD: Agency for Persons with DisabilitiesCARES: Comprehensive Assessment and Review for Long-Term Care ServicesCFR: Code of Federal RegulationsCIRTS: Client Information and Registration Tracking System-DOEAg g yCMAT: Children’s Multidisciplinary Assessment TeamDOEA: Department of Elder AffairsHIPAA: Health Information Portability and Accountability ActLOC: Level of CareMDS: Minimum Data SetMH: Mental HealthMI: Mental IllnessMR: Mental Retardation
22
NF: Nursing FacilityPASRR: Pre-Admission Screening and Resident ReviewSAMH: Substance Abuse and Mental HealthSMHA: State Mental Health AuthoritySMA: State Medicaid AgencySMRA: State Mental Retardation AuthoritySMI: Serious Mental IllnessSS: Specialized Services
2
What is PASRR?PASRR or Pre-Admission Screening and Resident Review is a screening and evaluation process to ensure all nursing facility applicants and residentsensure all nursing facility applicants and residents with Serious Mental Illness (SMI) and/or Mental Retardation (MR) are:
IdentifiedPlaced appropriately in the least restrictive environmentAdmitted or allowed to remain in a nursing facility only if they are appropriately servedProvided with the MI/MR services they need includingProvided 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.
33
What is PASRR?Two part PASRR process:
Level I Pre-Admission Screen and DeterminationApplies 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 ReviewRequired 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 pif 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.
44
3
General PASRR Process
5SS = Specialized Services RR= Resident Review NF = Nursing Facility
Overview of State PASRR Programs
6
4
Overview of State PASRR Programs Continued
7
fff
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 thatlook 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 familyindividual 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.”
88
5
PASRR Regulations - History
OBRA 87-Covered anyone who was mentally illOBRA 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 gevaluation is done prior to nursing facility admission ensures client needs can be met.
1010
6
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/BULLETINS/2455%20Summer%202011%20Provider%20Bulletin%2009.pdf
1111
Implementation of New PASRR Forms
Effective date for new PASRR forms is November 14 2011November 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
1212
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.
7
Training
PASRR training materials, forms, and form instructions can be found on the DOEA CARESinstructions 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
1313
CARES Program Office.
CARES Local Contacts for PASRR Training or Technical Assistance
1414
8
15
DOEA CARES State OfficeKathi Chisolm, PASRR Point of Contact, (850) 414-2343
Additional Contact Information
CARES Regional Program Supervisors (RPS)Carol Klauer, Region 1 RPS, [email protected] Young, Region 2 RPS, [email protected]
Sheila Mitchell, Region 3 RPS, [email protected]
PASRR Compliance QuestionsLocal AHCA Health Quality Assurance Field Office
http://ahca.myflorida.com/mchq/index.shtml#6Kim Smoak, AHCA Health Quality Assurance
1616
9
Thank you for watching PartThank you for watching PartThank you for watching Part Thank you for watching Part One of One of PrePre--Admission Admission
Screening and Screening and Resident Review (PASRR) Resident Review (PASRR)
TrainingTraining
17
Training. Training.
Rick Scott, Governor Charles T. Corley, Secretary
PrePre--Admission Screening and Admission Screening and Resident Review (PASRR) Training Resident Review (PASRR) Training
PART TWOPART TWO•• Level I Screening and Determination ProcessLevel I Screening and Determination Process•• Categorical and Advance DeterminationsCategorical and Advance Determinations•• Categorical and Advance DeterminationsCategorical and Advance Determinations•• Hospital ExemptionsHospital Exemptions•• Completing the Level I Screen and DeterminationCompleting the Level I Screen and Determination
Presented by the Comprehensive Assessment and Review Presented by the Comprehensive Assessment and Review for Longfor Long--Term Care Services Program (CARES)Term Care Services Program (CARES)
November 2011November 2011
10
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 sourcepayer 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 individualThe individual’s representative (if applicable)The individual’s family (if available and agreed to by the individual or legal representative)representative)
20
11
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, orLevel I screeners with professional qualifications and/or centralized guidance.
Categorical Determinations are realCategorical Determinations are real determinations, with reports (not “exemptions”).
21
Level I PASRR, to fulfill its purpose:
22
12
Look Behind
The Level I evaluator should not just relyThe Level I evaluator should not just rely on “known diagnosis” but should “use discretion in reviewing client data and look behind diagnostic labels…for any presenting evidence of MI.”
-Federal Register
23
Types of Determinations
24
13
Advance Group Determinations
25
Advance Group Determinations (continued)
26
14
Hospital Exemption
27
28
15
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)
2929
PASRR Level I Screen Covers the Following Areas:
Section I: Guide For Determining An Indication Of Or ASection 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 DisorderSection IV: Exempted Hospital DischargeSection V: Advance Group DeterminationsSection VI: Individualized Evaluation Determination
3030
16
Fill in Fill in Name, Date
of Birth, Address.
Answer Yes or No
to first d i i
31
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 allSection I questions (1A 1B 2
32
(1A , 1B, 2 can be seen here. 3 and 4 are on the next slide).
17
Complete Section I and then you must
continue to Section II.
33
For Part A and Part B, check Yes if the
guide indicates MI/MR.
Check No if there
is no indication of MI/MR.
If No, you can
34
sign and date. If Yes,
you must continue to Section III.
18
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
35
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.36
19
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.
37
Answer each
question by checking
either Yes or No.
Complete the date,
signature
38
signature, and Level II
referral information at bottom of
page.
20
39
Thank you for watching PartThank you for watching PartThank you for watching Part Thank you for watching Part Two of Two of PrePre--Admission Admission
Screening and Screening and Resident Review (PASRR) Resident Review (PASRR)
TrainingTraining
40
Training. Training.
21
Rick Scott, Governor Charles T. Corley, Secretary
PrePre Admission Screening andAdmission Screening andPrePre--Admission Screening and Admission Screening and Resident Review (PASRR) Training Resident Review (PASRR) Training
PART THREEPART THREE•• Level Level II ProcessII Process•• Serious Mental Illness and Mental RetardationSerious Mental Illness and Mental Retardation
C l ti th N R t f L l II E l ti dC l ti th N R t f L l II E l ti d•• Completing the New Request for Level II Evaluation andCompleting the New Request for Level II Evaluation andDetermination or Resident ReviewDetermination 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 Longfor Long--Term Care Services Program (CARES)Term Care Services Program (CARES)
November 2011November 2011
42
22
43
44
23
45
46
24
47
48
25
49
Completing the Request for Level II Evaluation and Determination
or 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)
5050
26
Enter date of request and check the type
of requestof request.Enter your
name, agency and phone
number.Complete
PASRR Level II reviewer’s II reviewer s
name, agency and phone
number.
51
Enter Name, Date of Birth
d C t
Check
and Current Location of
individual to be evaluated by the Level II reviewer.
52
Check appropriate
MI/MR Indicator(s).
27
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
53
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
54
The date of distribution of the
Level II Evaluation and Determination and to whom it is distributed
is also found here.
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
Thank you for watching PartThank you for watching PartThank you for watching Part Thank you for watching Part Three of Three of PrePre--Admission Admission
Screening and Screening and Resident Review (PASRR) Resident Review (PASRR)
TrainingTraining
68
Training. Training.
