The second component of PASRR, the Level II evaluation, is executed by Department of Mental Health. Find the answers to FAQ concerning PASRR at http://www.bock-associates.com/Missouri/. PASRR Level II MI. Most recent Mental Health . Level I Screening. Three state agencies have a major role to play in PASRR: the Medicaid agency, the state mental health authority (SMHA), and the state intellectual disability authority (SIDA). The NC Medicaid will forward the North Carolina Level I The PASRR process can be found in the OBRA regulations (42 CFR §§ 483.100 - 483.138). guardian will also receive written notification, accompanied by notification of appeal rights through the fair require an update, as described in Section II.D should be reported to NC Medicaid PASRR department using the Reporting a Complaint with Health Service Regulation (HSR), Missouri Department of Health and Senior Services Individuals with disabilities now have greater control over their community-based care and services. Forward the form to the Chief Counsel of Administrative Hearings at the Division of Legal Services (Administrative Hearings Section) and verify receipt. The Level II evaluation examines the diagnosis of record to confirm or disconfirm whether the individual with a positive Level I has MI or ID/RC, determines whether placement or continued stay in the requested or current NF is appropriate; and calculates the individual's MI/ID service needs, including services the … This principle is central to the Supreme Court's Olmstead decision. OBH-PASRR Contact Information. Section II: PASRR Level I Definition and Process The first screening, PASRR Level I, assesses for potential mental illness and/or intellectual disability. required and requests that medical records be available for the on-site assessor. In order to receive written results of these processes, the referral source must identify Box 570 It is important to understand that MI and ID have specific definitions for the purposes of PASRR. The Level II PASRR confirms or rules out an SMI, ID or both. However, the Division of Healthcare Financing strongly recommends doing an LT101 on all admissions and is required for payment with Medicaid clients. The referral source can avoid unnecessary Level II screens and the delays associated with them if they can Notification of Change in Condition Form. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, the decline is not considered “self- limiting”; Impacts more than one area of the resident’s health status; and. Contact Michelle Newberry, Bock Associates Project Director, michelle.newberry@bock-associates.com for any other questions or concerns. Section A1550 9/6/2017 11 Section A1550: Conditions related to ID/DD status such as: Down Syndrome, Autism, Epilepsy, other organic conditions. facility prior approval process. For information on abuse statistics in Missouri, see Elder Abuse - It is a Crime.FY16. One important concept of the Tools of Choice training includes teaching people to be aware of common negative interactions. All Sections, except for Section 1, must be completed by the Psychiatrist or Psychiatric Advanced Practice Nurse conducting the Evaluation. 24. When the submitted Level I screen indicates that the individual does have indicators of a serious mental illness In order to use Kepro’s provider portal, each nursing home and hospital should appoint one person to be the administrator, or owner, of the provider portal account. KEPRO provides PASRR services that deliver reliable, timely and clinically-valid PASRR recommendations and determinations that protect the interests of the individual, while ensuring state compliance with federal statutes. Level II Evaluation. A resident who experiences an improved medical condition—such that the resident’s plan of care or placement recommendations may require modification. (This preference may be communicated verbally or through other forms of communication, including behavior.). Verify that the caller has the legal authority to act on the person’s behalf to  initiate the appeal (e.g. A Level II is necessary to confirm the indicated diagnosis noted in the Level I Screening and to determine whether placement or continued stay in a Nursing Facility is appropriate. well as detailed instructions about completing a PASRR Level II assessment. Determine an individual's current developmental strengths and weaknesses as the basis for Information concerning Level One screening is located on the DHSS webpage at https://health.mo.gov/seniors/nursinghomes/pasrr.php. NF Admission. Collect information from caller and the DMH file to complete the DSS Division of Legal Services form titled PASRR Program Preadmission Appeal. I. llness (MI) or I. ntellectual and Developmental Disabilities (I. D/DD ) ” Admitting History & Physical. The Court held that states are required to provide community-based services for people with disabilities who would otherwise be entitled to institutional services when: (a) such placement is appropriate; (b) the affected person does not oppose such treatment; and (c) the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of other individuals with disabilities. Screening Resident Review (PASRR) Level I and Level II forms. Level II outcome determinations resulting in a "C", "B", or "J" alpha code remain valid unless A resident who exhibits behavioral, psychiatric, or mood-related symptoms suggesting the presence of a diagnosis of mental illness as defined under 42 CFR §483.102 (where dementia is not the primary diagnosis). The referral source will be asked to DMH and Bock Associates (assessor) will give testimony during the hearing. Upon receipt of this information, the information is assessed for referral to a Level II face to face OBH PASRR Level II Request for Resident Review– 7/16/18 Signature required on Bottom of Page 2 Page 1 of 2. sent to the referral source. source will be notified by written notification of the determination. Resident Reviews are required for nursing facility residents experiencing a “significant change in condition.”  A change requires a referral for a PASRR Resident Review assessment if a mental illness, intellectual disability, or related condition is present or is suspected. completed (referred for a face-to-face assessment) until a FL-2 or MDS, and current History and Physical are Learning about the coercives can help individuals to know how to respond to people in a positive way that makes everyone's life better. Requires interdisciplinary review and/or revision of the care plan. Check off each item that has been included in the submission and attach the documentation to the PASRR Level II Evaluation. individual also has a primary diagnosis of a dementing illness (e.g., Dementia or Alzheimer's Disease), the Created with Sketch. A resident whose intellectual disability as defined under 42 CFR §483.102, or whose related condition as defined under 42 CFR §435.1010, was not previously identified and evaluated through PASRR. Level II screen during the initial notification via Provider Link or fax, and the process discussed in Section To request copies of previous PASRR evaluations contact Bock and Associates at records.mo@bock-associates.com. If the individual is a Medicaid recipient, the referral source contacts Medicaid's fiscal The Health Care Authority (HCA) contracts with PASRR evaluators to complete the Level II process. and are completed within 7 business days. CLARIFICATIONS 1. The Department of Health and Senior Services (DHSS) utilizes the Initial Assessment-Social and Medical forms (DA124 A/B) to initiate the process for admission to a Nursing Facility. The SMHA has responsibility for Level II determinations (the final legal document), but not for Level II evaluations, which must be performed by an entity independent of the SMHA. A resident whose condition or treatment is or will be significantly different than described in the resident’s most recent PASRR Level II evaluation and determination. Jefferson City, MO 65102-0570 To appeal a PASRR decision contact DMHNotifications@DMH.mo.gov. The applicant/resident and/or legal the Send the notification to: DMHNotifications@dmh.mo.gov. When the referral source is initiating a Level I identification screen for an individual with MI or IDD/RC and the learning, mobility, self-direction, and capacity for independent living). A verbal call is placed to the referring facility within seven (7) business days from the date Q: Will users be able to see the submitted PASRRs from other users within their facility? A resident transferred, admitted, or readmitted to a nursing facility following an inpatient psychiatric stay or equally intensive treatment. Questions regarding the New York PASRR Level II process may be answered by e-mailing Ascend at: Ascend-NYPASRR@maximus.com , by calling the Ascend New York PASRR Help Desk: 877-431-1388, ext. These negative interactions are labeled as coercive behaviors. The receiving nursing facility submits the North Carolina Nursing Facilities Tracking Form to Either agency may delegate its responsibilities to another party, such as a vendor of PASRR services. Level II Evaluation. and c) result in substantial functional limitations of three or more life activities (self-care, understanding and use of language, The Medicaid agency is ultimately responsible for overseeing the PASRR program. Section) completed prior to the individual's admission to a Medicaid certified nursing facility (regardless of whether the If you suspect someone is being abused, neglected or exploited, call the hotline at 800-392-0210. them of the final decision and their appeal rights. Level II PASRR Evaluation o The Level II PASRR evaluation determines if the mental retardation or other related condition needs of the individual can be met in a Nursing Facility or if the individual requires Specialized Services. evaluation. services needs. The Department of Health Care Services (DHCS) is responsible for SMI Level II Evaluations, which by law must be performed by a third party contractor, Kepro. By funding services and supports provided by networks of community-based organizations, and with investments in research, education, and innovation, ACL helps make this principle a reality for millions of Americans. The Examiner may record an N/A to indicate Not Applicable or an N/K to indicate Not Known. DMH will forward the case exhibits and PASRR file to the individual who filed the appeal, the hearings officer and other parties as indicated. Level II face-to-face Pre-admission screens (PAS) must occur prior to admission (excluding those situations assess for both NF placement appropriateness and specialized service needs. The Medicaid level of care criteria can be found in DHSS regulation 19 CSR 30-81.030. Intellectual or Developmental Disabilities(IDD) or retardation. The Level II screening is triggered by evidence of a serious mental illness (MI), 4. ∗Definition of a . The hotline operates 365 days per year from 7 a.m. to 12 a.m. Hearing-impaired persons may call the Telecommunications Device for the Deaf (TDD), at 800-735-2466 or 800-735-2966 to utilize Relay Missouri. described in Change In Condition the resident experiences a change in status. Advancing independence, integration, and inclusion throughout life. This podcast series describes 10 Common Coercives and demonstrates how they may affect others. II.C.i called Pre-admission Screen PAS is initiated. individual may not require Level II screening or may be allowed an abbreviated categorical Level II screen. evaluation and therapy notes . Level I screening process. Tools of Choice is a widely used successful behavior and relationship improvement training program. New Admission Defined ∗A PASRR Level I Screen is required for any . The Office of Behavioral Health (OBH) - PASRR Program is the Level II PASRR authority that makes placement and services recommendations and authorization for payment for those individuals suspected of having a mental illness wishing to reside in a nursing home. It is an in-depth evaluation of the individual and a determination of the need for NF services. Note that a completed LTC-26 Level I Screen must be submitted with this form. Fax: 1.877.652.4995 . This information is considered to be part of the Level II screening by Federal regulations: The following information will be required: Results of the face-to-face assessment and medical record information are reviewed by NC Medicaid PASRR Everyone who applies for admission to a nursing facility (NF) must be “screened” for evidence of serious mental illness (MI) and/or intellectual disabilities (ID), developmental disabilities (DD), or related conditions (RC). PASRR Level I (DHS 1178) Instructions Medical Evaluation for Persons with Mental Illness Psychiatric Evaluation Part I Psychiatric Evaluation Part II Serious Mental Illness (SMI) Criteria PASRR Applicable DSM-III-R Diagnoses PASRR for Persons with Intellectual Disability/Developmental Disabilities and Related Conditions. IDD/RC, Level II screens must be performed both prior to admission (PAS) to individual is a Medicaid recipient or is a private payee). Either way, they are unable to protect their own interests or adequately perform or obtain services necessary to meet their essential human needs (192.2400, RSMo). condition related to Intellectual or Developmental Disabilities (RC) as defined by state and federal Must the Level I screener inform the individual seeking admission to a nursing facility that he or she … e. A decrease or clearing of dementia or delirium which may allow the person to benefit from mental health services. To appeal a PASRR decision contact DMHNotifications@dmh.mo.gov. This shall be done at least 95% of the total referrals within that month. To Report a change in condition related to disability or mental illness, complete the notification to DMH form and e-mail it to:  DMHNotifications@dmh.mo.gov. A current history and physical (performed within the past 12 months) that includes: guardianship, active durable power of attorney for health care decision making, other). All those who have a suspected or confirmed mental illness or intellectual disability must receive a more in-depth assessment, the Individualized PASRR Level II Evaluation. Please complete the notification of change in condition form. the NC Medicaid. If the Screening is positive for possible SMI and/or ID/DD/RC, then a Level II Evaluation will be performed. Abuse happens to people of all ethnicities and income levels and can be physical, sexual or emotional in nature. Maximus performs Pre-Admission Screening and Resident Review (PASRR) Level I screens and Level II evaluations on individuals who are applying to or residing in Medicaid-certified nursing homes. 3. To check the status of a nursing facility application, please contact DHSS COMRU at 573-522-3092 or by email at comru@health.mo.gov. retardation or related conditions), A copy of the FL2, MDS, or physician notes which document diagnosis. New NF Admission . See definitions for PASRR for mental illness, intellectual disability and related condition at end of this section. Bureau of Health Services Regulation MO P&A is a federally mandated system in the state of Missouri which provides protection of the rights of persons with disabilities through legally-based advocacy. Adequate supporting documentation with a MD signature must be submitted for review by the NC Medicaid PASRR nurse consultant. 7. The Level I screen (DA 124C) given to all NF applicants is reviewed by DHSS Central Office Medical Review Unit (COMRU). The Centers for Medicare & Medicaid Services (CMS) contracted with Acumen, LLC and subcontracted with Mission Analytics Group, Inc. to develop the PASRR Technical Assistance Center. An individual with a mental illness diagnosis may be exempted from a Level 2 evaluation if dementia is documented as primary (dementia more progressed than symptoms of the mental illness). Individuals who had been institutionalized for decades are now receiving services in their community; Individuals who lost their housing and/or community-based supportive services when they were forced to enter institutions due to an acute health care problem have had the needed services provided or restored; Individuals with disabilities are able to access home and community-based services through Medicaid "Waiver" programs; Increased hours of personal care and assistance are being provided to individuals who require additional services to remain in the community; and. “Change in Condition” Not to be confused with “Change in Status”. PASRR has two core components. Positive Behavior Intervention and Crisis Plans, Structured Environment, Socialization and Personal Support Network, Skilled Nursing Facility Eligibility and Pre-Admission Screening & Resident Review (PASRR). Validate the absence or presence of a qualifying exemption; 3. The Level II must be Note. The NC Medicaid notifies the referral source that a Level II PASRR screen is nursing facility and can only be met in a psychiatric hospital or a specialized facility dedicated to the care of The PASRR process begins with a Level I Preadmission Screen, which is designed to identify all individuals seeking admission to a nursing facility that have, or may have, SMI and/or ID/DD. 2. (Olmstead) found the unjustified segregation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act (ADA) and that individuals with disabilities must receive services in the most integrated setting appropriate to their needs. MO P&A provides nine federally-funded programs to protect the legal rights of persons with disabilities. Missouri’s Adult Abuse and Neglect Hotline responds to reports of abuse, neglect, and financial exploitation. Kepro utilizes a multidisciplinary approach. The PASRR process consists of a Level I Screening, Level II Evaluation, and a final Determination. If the Level II outcome determination indicates that nursing facility placement is not appropriate, the referral What is considered a "significant change in condition?". 14. Therapist Aid resources are created with individuals in mind, which means avoiding jargon, and creating tools that are useful in theory and practice. If you have questions about Money Follows the Person, call 573-751-8021 or send an email inquiry to MHD.MoneyFollowsPerson@dss.mo.gov. The PASRR Level II is a comprehensive evaluation required as a result of a positive Level I Screening. professionals, a summary of findings is completed documenting recommended placement and specialized These definitions do not necessarily correspond to the definitions used in other contexts. Those individuals who test positive at Level I are then evaluated in depth, called "Level II" PASRR. This series consists of an introduction and ten separate tracks that can be listened to individually or collectively. When the final determination is made, a PASRR number is assigned, if appropriate and Therapist Aid is dedicated to helping mental health professionals improve their craft by providing free evidence-based education and therapy tools. If the PASRR Level I does not trigger MI and/or ID, print the PASRR Level I and place it in the client’s chart. The purpose of this site is to provide technical assistance to states that may need assistance with their Preadmission Screening and Resident Review (PASRR) programs. Understanding PASRR: Part 2, How to . 4. (Appendix B). hearing process. Level II screening is to determine if the individual has any special needs due to his/her identified condition that Financial Exploitation - A person commits the crime of financial exploitation of an elderly or disabled person if such person knowingly and by deception, intimidation, or force obtains control over the elderly or disabled person's property with the intent to permanently deprive the elderly or disabled person of the use, benefit or possession of his or her property thereby benefiting such person or detrimentally affecting the elderly or disabled person (. developmentally disabled. 1 of 9. Significant changes and other conditions which A resident who indicates a preference to leave the facility. As a result of this court decision and enforcement activities, many individuals have transitioned from an institution to the community, and many individuals have avoided unnecessary institutionalization. They may give you other resources or services within your community to provide you with ongoing care following your crisis. 8. Screening Form to the nursing facility for the resident's file. Only the DMH state contracted entity (Bock Associates) can complete the Level II evaluations. Most recent Physician’s . DMH will perform the following steps to execute the appeal of the PASRR decision: The BHCH is staffed by mental health professionals who can respond to your crisis 24 hours per day and 7 days per week. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis. This can be accomplished by faxing/mailing the Tracking Form OBH-PASRR Level II Assessment INSTRUCTIONS- FINAL as of 1/2020 Page . The second component of PASRR, the Level II evaluation, is executed by Department of Mental Health. Neglect – the failure to provide services to an eligible adult by any person, firm or corporation with a legal or contractual duty to do so, when such failure presents either an imminent danger to the health, safety, or welfare of the client or a substantial probability that death or serious physical harm would result (192.2400, RSMo). ∗ Note: A Psychiatric hospital stay requires a new PASRR Level ll referral and evaluation with a determination of no specialized services before returning to the NF. A resident with behavioral, psychiatric, or mood-related symptoms that have not responded to ongoing treatment. The Olmstead decision fundamentally changed the way our country approaches disability rights and opened doors for millions of Americans to live the lives we want to live, in the community, alongside people of all ages, with and without disabilities. Complete medical history; review of all body systems, A comprehensive drug history including, but not limited to, current or immediate past use of send some or all of the following patient information to the NC Medicaid PASRR department which is required to make an appropriate assessment of the individual's present condition. The referral source will be notified of the need for a A letter is mailed by the NC Medicaid to the resident/responsible party informing All calls are strictly confidential. via a Tracking Form. Related Items. The State Intellectual Disability Authority (SIDA) has responsibility both for Level II evaluations and for Level II determinations. Please note, "Related Conditions" are not a form of intellectual disability but produce similar functional impairments guidelines. The U.S. Supreme Court’s 1999 landmark decision in Olmstead v. L.C. and require similar treatment or services and must: a) emerge before the age of 22; b) be expected to continue indefinitely; P.O. new. 3475 , or by emailing pasrr@health.ny.gov . The purpose of the A resident who demonstrates increased behavioral, psychiatric, or mood-related symptoms. For those suspected of meeting state and federal PASRR criteria for MI or provide clear evidence of a dementia diagnosis, e.g., a neurological assessment and diagnosis, a mental status