Transcript Indiana’s PASARR Program - National Association of PASRR

The Indiana PASRR Level II Process
A Powerful Tool in Long-Term Care
National PASRR Conference
Indianapolis, IN
March 25, 2014
Willard Mays, M.A.
National Association of PASRR Professionals
Administration on Aging
“ It is estimated that only half of older adults who
acknowledge mental health problems receive
treatment from any health care provider, and
only a fraction of those receive specialty mental
health services.”
2
Nursing Homes are Key Players!
•
Of all older adults that are institutionalized with
mental illnesses 89% are in NFs 1
• More than 500,000 (Excluding Dementia) 2
• Older Adults with SMI are 3 times more likely to be
admitted to NFs than those without SMI 3
& stay longer (46.6% vs. 24.1% @ 90 days)2
• Although only about 5% of older adults are in
nursing homes, two-thirds of these residents have
some kind of mental disorder 4
1. US DHHS, 1999) 2. Fullerton et al., (2009) 3. Bartels et al., (2000),
4. Smyer et al.,(1994)
3
Nursing Homes are Key Players!
• Most common MH disorders in NFs:
Dementia complicated by behavioral symptoms, mood
disorders, anxiety disorders, and serious mental
illnesses such as schizophrenia and psychotic
disorders
• Federal and State regulations require NFs to
provide or arrange for services to meet the
needs of their residents. This applies to MH
needs as well as physical health needs!
4
What Are The Types of Reviews?
• Preadmission screening (PAS)
– Level I – Everyone
– Level 2 – MI and/or MR/DD
• Significant change RR
– Significant change in physical or mental condition
– Based on MDS
– NF judgment call
• Yearly RR
– Previously determined to be MI and in need of MH services and
all residents with MR/DD, and
– Residents with MI not currently being served by CMHC, and
– Identified by CMHC as needing yearly RR
• Residents who were missed
5
PAS Agency Responsibilities
• Perform state required PAS
• Assure that Level I is completed for all Medicaid Certified NF
applicants
• Determine if Level II review is necessary and, when review is
needed, notify applicant and refer to:
– CMHC for MI, or
– Diagnostic & Evaluation (D&E) Team for MR/DD or MI/MR/DD
• Review evaluation information and determine if the NF
applicant is:
– Appropriate for NF admission; and
– In need of specialized services.
• Issue Form 4B and send 4B, Level II evaluation &
recommendations, certification, and related paperwork to NF
and CMHC or BDDS
6
CMHC Responsibilities
Perform Preadmission Screening (PAS) reviews as
needed
– Complete Level II reviews within 4 day average
turnaround time from written notification (PAS
Agency)
– Determine if future Yearly RR’s are necessary
Perform Resident Reviews (RR) as needed
– Complete paperwork and transmit assessment data to
Division of Aging
– Provide NF with cover letter, certification, and copy of
Level II evaluation and recommendations
7
CMHC Responsibilities
– Yearly RR
• Limited to residents previously identified as MI and in
need of MH services and not currently being served by
the CMHC
• Determine if future RR’s are necessary
• CMHC does tracking and scheduling
• Reassessment (if needed) in same calendar quarter
– Significant Change RR
• 4 day average turnaround time from written notification
(NF)
• Determine if future RR’s are necessary
– Residents that were missed
• Same as significant change process except for time
frames; Level II must be completed within 30 calendar
days following referral
8
CMHC Responsibilities
• Identify assessors to Division of Aging
• Assure that assessors are appropriately
trained
• Notify appropriate CMHC of resident
transfer (when notified by NF)
• Comply with FSSA rules and regulations
(DMHA contract, PASRR manual,
Medicaid bulletins, etc.)
• Notify Department of Health when NF is
out of compliance
9
CMHC Take-Aways
• The NF applicants and residents that receive PASRR
Level II reviews are not “clients” of the CMHC. The
CMHC is performing an administrative function on
behalf of the State so that appropriate placement and
service decisions can be made.
• If the CMHC is later contacted for services for the
resident, the individual becomes a client.
• The PASRR Level II may be the only mental
health assessment the person has ever had!
10
Nursing Facility Responsibilities
• Comply with Federal CMS MDS and PASRR
requirements
– Completed Level I in every resident file
– New MDS when there is a significant change in condition (up to
14 days)
– Develop and implement new plan of care (7 days)
– Based on above, determine if new Level II review is needed
(within 21 day total)
– Notify CMHC or BDDS in writing if new review is needed
• Promptly notify CMHC or BDDS if previously identified MI or
MR/DD resident has been admitted, discharged or transferred
• Provide list of identified MI and MR/DD residents to HP
Enterprise Services
11
Nursing Facility Take-Aways
• Follow up on PAS and RR service recommendations
• The PASRR Level II recommendations should be a
major resource in the development of the resident’s
plan of care
• Requesting a PASRR Level II is not the same thing as
accessing or providing services for the resident.
Priority #1 is to get the residents the
services they need!
12
Division of Aging Responsibilities
• Coordinate with the Indiana State Department of
Health and HP Enterprise Services to assure that a
sample of residents identified as having MI and/or
MR/DD, and in need of services, are included in
surveys
• Maintain list of identified assessors (by CMHC)
• Provide or arrange appropriate
training
• QA program
• Maintain data
13
Indiana State Department of Health
Responsibilities
• Identify PASRR residents
as target group for surveys
• Hold NF accountable for
providing or arranging
services to meet residents
MH needs
14
HP Enterprise Services Responsibilities
• Send out Medicaid Bulletins
• Determine if NF followed through with
responsibilities
• Identify residents who were missed or
otherwise need RR
Roeing Inc.
• Data Management
15