Transcript PASRR PreAdmission Screening & Resident Review Fall 2011 NJ Department of Health & Senior Services.

PASRR
PreAdmission Screening & Resident Review
Fall 2011
NJ Department of Health & Senior Services
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Objectives for Training
 Understand PASRR regulations
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Identify PASRR responsibilities for state
staff and providers
Explain PASRR requirements
Review and understand all elements of the
PASRR Level I Screening Form LTC-26
Review and understand the Notice
of Referral for Level II Evaluation Form
LTC-29
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What is PASRR?
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PreAdmission Screening and Resident Review
Part of the Federal Nursing Home Reform Act of 1987
(aka OBRA ’87)
Federal Requirement as set forth in 42 CFR 483 et seq
Requires states to ensure that all individuals entering
Medicaid-certified Nursing Facilities (NFs) are screened for
Serious Mental Illness (SMI) and/or Intellectual Disability
(ID)/Related Condition (RC)
RCs are severe and chronic Developmental Disabilities
(DDs) such as autism, seizure disorder, cerebral palsy,
spina bifida or head injury with date of onset prior to
age 22
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Purpose of PASRR
Ensures that all NF applicants and residents
with SMI and/or ID/DD are:
 Identified
 Placed appropriately (least restrictive
setting)
 Provided with the MI/ID/DD services they
need including Specialized Services
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PASRR Components
There are two components to PASRR
 Level I – Screening for indicators of SMI
and/or ID/DD
 Level II – Evaluation and Determination
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PASRR Responsibilities
Level I Screen
● NF professional staff complete for private pay
applicants from community
● NJ Department of Health’s Office of Community
Choice Options (OCCO) staff complete clinical
eligibility assessment (PAS/PreAdmission Screen)
and the PASRR Level I Screen for community
applicants who are currently Medicaid or potentially
Medicaid eligible within 6 months of NF admission
● Hospital – hospital discharge planners
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APS, Hospice and Respite – care managers
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PASRR Responsibilities
Level II Evaluation and Determination
● The Department of Human Services staff
administer the evaluation and
determination process
● The Division of Mental Health Services is
responsible for individuals screening
positive for mental health indicators while
the Division of Developmental Disabilities
is responsible for individuals screening
positive for ID/DD indicators
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Exceptions to PASRR
PASRR is not needed for entry into the
following facilities:
 Assisted Living
 Fully private pay NFs
 Transitional Care Units in hospitals
 New Jersey Veteran Homes
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Who can complete a Level I?
The minimum credentials for an screening
professional completing a Level Screening
Tool are:
 Certified Social Worker (CSW)
 Registered Nurse (RN)
 Physicians and Physician Assistants may
also complete the Level I Screening Form
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Hospital Discharges to NF
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Hospital discharge planners complete a Level I Screening Tool
(LTC-26) on all discharges to a Medicaid-certified NF
All Level I positive screens must be referred to DDD and/or
DMHS for a Level II Evaluation unless certified as Exempted
Hospital Discharge
CMS regulations allow for a suspension of the Level II for short
term (less than 30 days) rehab admissions with physician’s
certification – Exempted Hospital Discharge
All positive screens for individuals who are currently Medicaid
or potentially Medicaid eligible within 6 months of NF
admission must also have an EARC-PAS completed by a certified
EARC-PAS hospital assessor or have an onsite hospital PAS
(PreAdmission Screen) completed by OCCO prior to discharge to
the NF, per usual EARC-PAS/OCCO PAS procedure
Copies of Level I – and Level II documents if applicable –
must go with the individual to the NF for inclusion in
active NF record
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Community NF Admissions
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NF personnel must complete a Level I
Screening Tool on each private pay
admission from the community
All positive screens must be referred to
DDD and/or DMHS for a Level II
Evaluation
Copies of the Level I – and Level II
documents if applicable – must be placed
on the active NF chart
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Key Points about the
PASRR Level I Screen
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A new Level I Screen is required for each new NF
admission
 Valid for entire period of continuous NF placement
 Repeat Level I is not needed if NF resident is
hospitalized then is readmitted to NF from hospital
 Valid for NF-to-NF interfacility transfer
A new Level I Screen must be completed even when
an individual discharges to the community from a
previous NF stay then requires subsequent NF
placement
The Level I Screen is valid for one NF admission only
and can be completed up to 30 days prior to NF
admission
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Level I Screening Forms:
LTC-26 and LTC-29
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LTC-26 Level I Screening Form
 Complete consumer’s identifying information
 MI Screen: Answer questions 1-5 with available information
 ID/DD Screen: Answer questions 6-10 with available
information
 Scoring: positive or negative screen?
 Does individual qualify for a Categorical Determination?
 Does hospitalized patient qualify for an Exempted Hospital
Discharge?
LTC-29 Notice of Referral for Level II PASRR Evaluation
 If Level I is positive, screener informs consumer of Level II
referral and completes Form LTC-29 and gives original to
consumer, copy in consumer record
 Required for first-time identification of SMI/ID/DD
The LTC-26 and LTC-29 were revised March 2011
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Categorical Determinations
There are several populations that do
not require a full Level II Evaluation, whose
Level II may be abbreviated, if they fall into
one of the following categories:
 Dementia with ID/DD (a DDD function,
category not listed on the LTC-26)
 Terminal Illness
 Severe Physical Illness
 Respite Care
 Protective Services
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Categorical Determinations Dementia with ID/DD and
Terminal Illness
Dementia with ID/DD:
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Diagnosis of MR and/or DD
Documented diagnosis of dementia, including Alzheimer's
Disease or related disorder, based on the most current
Diagnostic Statistical Manual (DSM-IV) criteria
Terminal Illness:
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Diagnosis of serious mental illness, intellectual disability and/or
developmental disability
Not a danger to self or others
Certified by a physician and/or hospice care staff as having a
life expectancy of six months or less
Requires continuous nursing care or medical
supervision/treatment due to a physical condition
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Categorical Determinations Severe Physical Illness
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Applies to individuals with serious mental illness,
intellectual disability and/or developmental disability
who may not be expected to benefit from specialized
services due to impairment caused by a severe
medical illness
Examples of severe medical illnesses include:
 Amyotrophic lateral sclerosis, Huntington’s disease,
ventilator dependency, severe congestive heart
failure, end-stage chronic obstructive pulmonary
disease, end-stage Parkinson’s disease, cerebellar
degeneration, cerebrovascular accident, end-stage
renal disease, severe diabetic neuropathies and
refractory anemia
 An individual who is comatose or in a persistent
vegetative state
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Categorical Determinations Respite Care1
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An adult may be admitted to a NF from home or
an Adult Family Care home (a non-institutional
setting) for short-term respite care not to exceed
thirty (30) days per state or federal annual
funding cycle
The maximum annual limit of up to 30 days NF
respite may be taken intermittently or
consecutively following prior approval by Statedesignated staff
Respite care is a temporary, finite service provided
to an individual with a cognitive impairment
and/or self-care deficits in daily living tasks, for
the purpose of relieving the caregiver in a noninstitutional setting
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Categorical Determinations
Respite Care2
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At time of admission to a NF for respite care,
there must be expressed intent by the
individual and/or their legal representative to
leave the NF and return to the home by the
expiration of the respite approval period
If the individual remains in the NF beyond
the pre-approved respite limit, the
individual must undergo a complete PASRR
Level II evaluation coordinated through the
Division of Mental Health Services and/or the
Division of Developmental Disabilities
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Categorical Determinations Protective Services
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Adult may be admitted to NF from the community for a
period not to exceed 7 days while NF or alternative
arrangements for longer care are made
Emergency placement allowed only when a crisis arises
outside of normal state business hours
The individual must be in need of intensive emergency
intervention and in imminent danger as certified in
writing by the Adult Protective Services worker and/or
supervisor
NF placement must be the placement of last resort
If the individual remains in the NF beyond the 7-day
limit, then the individual must undergo a complete
PASRR Level II evaluation coordinated through the
Division of Mental Health Services and/or the Division of
Developmental Disabilities
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Exempted Hospital Discharge
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If a hospital patient screened positive on
the Level I and is being discharged to a
NF for subacute care, and a physician
certifies that the individual is likely to
require less than 30 days skilled nursing
care, a Level II Evaluation can be
suspended
If the NF resident remains in the NF on or
after the 30th day, the Level II must be
completed prior to day 40
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Level II
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May block NF admission of individuals who
might otherwise be admitted:
 May meet NF LOC but MI/ID/DD needs cannot be met
in NF
 Determination may be made that individual requires
Specialized Services.
o SMI – inpatient psychiatric treatment
o ID/DD – Developmental Center (ICF-MR) or
community-based setting meeting ICF-MR
standards for skill deficits or other specialized
training requiring 24/7 coverage by trained
personnel to teach the individual functional skills.
Level II determination may also indicate that the
individual’s needs could be better met in the community
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Specialized Services
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Not permitted in NJ NFs as set forth in New
Jersey Administrative Code 8:85
No FFP (Federal Financial Participation) for
Specialized Services if provided to a NF resident
as NF services
States can provide Specialized Services as
services over and above NF services though NJ
chose to provide Specialized Services outside of
NF setting
The NF must provide mental health or intellectual
disability/developmental disability services which
are of a lesser intensity than Specialized Services
to all residents who need such services
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Resident Review1
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CMS no longer requires annual resident reviews
However, PASRR requires the resident review
evaluation process whenever significant change
in resident’s physical or mental condition occurs:
 significant deterioration
 significant improvement
 when resident expresses a desire to return to
the community
NF must use the MDS 3.0 Significant Change in
Status Assessment to trigger care planning and
resident review
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Resident Review 2
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NF must refer resident to Division of Mental
Health Services and/or Division of
Developmental Disabilities upon SCSA
(Significant Change in Status Assessment)
Resident Review by respective division will
determine if resident needs additional or
different services in the NF, or if Specialized
Services are required, and/or identify
community supports and services for an
individual’s discharge to the community
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Department of Health & Senior Services
OCCO Contact Information
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OCCO Northern Regional Office, Newark
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OCCO Central Regional Office, Edison
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OCCO Southern Regional Office,
Hammonton
Bergen, Essex, Hudson, Morris, Passaic, Sussex &
Warren Counties
Phone: (973) 648-4691; Fax: (973) 693-5046
Hunterdon, Middlesex, Monmouth, Ocean, Somerset
& Union Counties
Phone: (732) 777-4650; Fax: (732) 777-4681
Atlantic, Burlington, Camden, Cape May, Cumberland,
Gloucester, Mercer & Salem Counties
Phone: (609) 704-6050; Fax: (609) 704-6055
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Questions?
 PASRR resources and correspondence can be
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found on the DHSS website at
http://nj.gov/health/senior/pasrr.shtml
The LTC-26 Level I Screening Form and LTC-29
Notice of Referral for Level II PASRR Evaluation
can be found on the DHSS website at
http://web.doh.state.nj.us/apps2/forms/
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