Welcome PASRR/CARE training for Nursing Facility and Nursing Facility for Mental Health - PowerPoint Presentation

1. Welcome PASRR/CARE training for Nursing Facility and Nursing Facility for Mental Health For level II and resident review2020Presented by Anne Yeakley CARE Program ManagerKDADS CARE Program

2. To ask questions during the training make sure you go to the chat box and ask your questions and we will try to answer them we go2020

3. PRE-ADMISSION SCREENING and RESIDENT REVIEWTo comply with Section 1919(e)(7) of the Social Security Act, every individual admitting to a Medicaid-certified nursing facility must have proof of a valid PASRR unless an exception applies. The purpose of the PASRR is to determine whether an individual with mental illness or intellectual disability requires the level of services provided by a nursing facility or specialized mental health or intellectual disability services.What is a PASRR?

4. The Client Assessment, Referral, and Evaluation (CARE) Program was developed by the state of Kansas for data collection, individual assessment, referral to community-based services, and appropriate placement in long-term care facilities. What is the CARE Program?2020

5. www.KDADS.KS.Gov/How to get to our website2020

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10. The purpose of the level II PASRR is to determine if a person that ALSO has IDD or MI needs the level of care provided by a nursing facility, and IF they do, what services should the nursing facility provide.There are NOT level I and level II facilities. The clients are a level I or level II PASRR person(s).Level II clients may go to any nursing facility that can meet their needs. Things to remember:2020

11. The level II is determined by section B. PASRR of the Level I CARE Assessment.The Client must meet all of the criteria lined out in the Code of Federal Regulations (CFR)The criteria are as follows:NOTE: These are the exact same requirements if you are trying to do a Change in Condition.How does a person Trigger for a Level II2020

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13. There has to be one of the following mental illness diagnosis:If there is a primary diagnosis of dementia, Alzheimer's, or Major Neurocognitive disorder then the level II assessment will be canceled.For the Level II Mental Illness2020

14. 295.70 (F25.0) Schizoaffective Disorder, Bipolar Type (F35.1) Schizoaffective Disorder, Depressive type295.90 (F20.9) Schizophrenia296.34 (F33.3) Major Depressive Disorder, Recurrent, Severe, with Psychotic Features296.44 (F31.2) Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior296.54 (F31.5) Bipolar I disorder, most recent episode (or current) depressed, specified as with psychotic behavior298.9 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder296.23 (F32.2) Major Depressive Disorder, Singe Episode, Severe296.24 (F32.3) Major Depressive Disorder, Single Episode, With Psychotic Features296.32 (F33.1) Major Depressive Disorder, Recurrent Moderate296.43 (F33.2) Major Depressive Disorder, Recurrent, Severe, Without Psychotic Features296.35 (F33.41) Major Depressive Disorder, Recurrent, In Partial Remission296.89 (F31.81) Bipolar II Disorder297.10 (F22) Delusional Disorder300.01 (F41.0) Panic Disorder300.22 (F40.00) Agoraphobia300.3 (F42) Obsessive-Compulsive Disorder300.3 (F42) Hoarding Disorder301.83 (F60.3) Borderline Personality Disorder309.81 (F43.10) Posttraumatic Stress DisorderHas to be one of these diagnosis's on medical or psychological documentation2020

15. Treatment History: Which includes one or more of the following.2 Partial Hospitalizations: The customer participated more than one (1) day in a program offered by mental health entity, which included therapies and services during the daytime.OR2 inpatient hospitalizations: The customer had two (2) or more hospitalizations in a psychiatric hospital or in a psychiatric unit of a hospital, and the hospital stays were for 24 hours or more. A stay in a state hospital for two (2) or more consecutive years count as two (2) inpatient hospitalizations.If there is a diagnosis there MUST also be:2020

16. OR1 inpatient and 1 Partial: The customer had at least one (1) Inpatient and one (1) Partial hospitalization.ORSupportive Services: Has the customer received support services that significantly increased for a period of 30 consecutive days or longer in the last two years that were provided by a Community Mental Health Center (CMHC), the Veterans Affairs (VA) Hospital, or a correctional facility?Treatment History

17. ORIntervention: Housing- When the individual has been evicted (including from a shelter) for situations which include:Inappropriate social behavior (i.e., screaming, verbal harassment of others, physical violence toward others, inappropriate sexual behavior and etc.); andAbuse or neglect of physical property (i.e., failure to maintain property as outlined in the lease, intentional destruction of property such as through kicking or hitting walls or doors, etc.).Note: Nonpayment of rent, substance abuse, and other such situations can only be included in this category if a direct relationship between the activity and an increase in the severity of the mental illness can be shownTreatment History2020

18. Law enforcement officials- When the individual has been arrested and/or taken into custody due to:Harm to self, or property; inappropriate social behavior (i.e., screaming, verbal harassment of others, physical violence toward others, inappropriate sexual behavior, etc.); orEvidence of impairment so severe as to require monitoring for safety.Note: Substance abuse can only be included in this category if a direct relationship between the activity and an increase in the severity of the mental illness can be shown.Adult protective services (APS)- When the individual has been determined by an APS worker to be a danger to self or others due to the severity of the mental illness. For example, the individual threatens harm to self or others, is not eating, exhibits extreme weight loss or is non-compliant with medications.Treatment History2020

19. (There are 3 different level of impairments listed. If none is selected then it does not meet the criteria for the MI Level II)Interpersonal FunctioningThe customer has serious difficulty interacting appropriately and communicating effectively with other persons. There may be a history of altercations, evictions, firing, fear of strangers, avoidance of interpersonal relationships, and social isolation.Concentration/ Persistence/ PaceThe customer has serious difficulty in sustaining focused attention for a long enough period to permit the completion of tasks commonly found in work settings or in structured activities occurring in the school or home. The customer has difficulties in concentration, an inability to complete simple tasks within an established time period, makes frequent errors, or requires assistance in the completion of these tasks.Adaptation to ChangeThe individual has serious difficulty adapting to typical changes in circumstances associated with work, school, family, or social interaction, manifests agitation, exacerbated signs and symptoms associated with the illness, or withdrawal from the situation, or requires intervention by the mental health or judicial systemLevel of Impairment: 2020Must also have a level of impairment

20. If there is no diagnosis then it’s canceled, if a diagnosis exists and there are no treatments or interventions then it’s canceled. If there is a diagnosis and treatment but no level of impairments then it does not meet the criteria for mental Illness screen. If yes to all 3, then it does get sent for a screen.*If there is a primary of dementia, Alzheimer's, or Neurocognitive disorder then it’s canceled.2020

21. Criteria for the Developmental Disability and Related Conditions Screen:The customer has significantly sub average, intellectual functioning as evidenced by an IQ score of 70 or below on a standardized measure of intelligence prior to the age of 18.Also there must be a diagnosisThe Developmental Disability and Related Condition Screen 2020

22. Related ConditionThe customer has a condition such as autism, cerebral palsy, epilepsy, Spina Bifida, Down’s syndrome, or other similar physical and/or mental impairment that is:Evidenced by a severe, chronic disability;Manifested before the age of 22;Will likely continue indefinitely;The Developmental Disability and Related Condition Screen 2020

23. Reflects a need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services which are lifelong, or extended in duration and are individually planned and coordinated; andResults in substantial functional limitations in three or more major life activities.Self-CareLanguageEconomic Self-SufficiencyMobilityLearningIndependent Living SkillsSelf DirectionThe Developmental Disability and Related Condition Screen 2020

24. If KDADS cannot obtain an IQ test with a score below 70 before the client was 18 and a diagnosis listed in the history and physical then it does not meet criteria for the IDD/RC screenIf KDADS cannot obtain medical records listing the diagnoses listed for related conditions before the age of 22, then it does not meet criteria for the IDD/RC screenThe Developmental Disability and Related Condition Screen 2020

25. Once the level I is complete the AAA level I assessor or the trained hospital assessors are to gather all the paperwork needed to prove that the client does trigger for a level II.Once KDADS has all the required documentation, KDADS makes a determination if the level II meets criteria. If it does, it will be sent to Healthsource Integrated Solutions (HIS). If it does not, it will be canceled and a determination letter will be sent to the client.If the level II meets criteria and is sent to HIS, they have 6 business days to return the completed assessment to KDADS.Then KDADS has 1 to 2 business days to complete the determination letter. Level II Process2020

26. A letter of determination is created by the CARE Program from KDADS from the Level II assessment.The determination letter is proof of PASRRDetermines if admittance to a nursing facility is granted and for how long.Medicaid pays from the date of service, only if the determination letter is completed BEFORE the date of service. If the letter is from a resident review, the time can’t lapse. Medicaid STOPS paying from the date the letter ends, and begins again the date the new letter is completed.Determination Letter2020

27. A client may NOT enter the NFMH without the determination letter completed and valid.A client may NOT enter the NF without the determination letter completed and validDetermination Letter2020

28. EXCEPTIONS to this law of PASRR are for nursing facilities only:If the client enters a NF on a less than 30 day, Respite, or Emergency or Terminal Illness the level II does not need to be completed prior to admission.If the client stays longer than the 30 days or graduates off of Hospice, or decides to stay longer than the Respite, a level I will need to be completed.If the level I triggers a level II a level II will need to be completed.Medicaid will cover from the date of service, ONLY in these instances only.Determination Letter2020

29. The determination letterParagraph one tells when the assessment was completedParagraph two tells if the person can or cannot enter a nursing facility or nursing facility for mental health.Paragraph three tells the person how long their stay will be in the nursing facility or nursing facility for mental health.Paragraph four leads into the recommendations. These recommendations are to be reflected in the person’s Care Plan at the nursing facility. The recommendations are to be followed and they are checked on.First by resident review, when a review is completed the assessor is to compare the letter with the Care PlanSecond, survey and certification. When they are served the surveyor may also check to see if the recommendations are being followed.

30. The Determination letter is only valid for 3, 6, 9, or 12 months. Once it is due the NF/NFMH is responsible to request the Resident Review.If you have a permanent PASRR MI3 or MR3 you will not need to continue the level II PASRR process as long as they are in your facility. Determination Letter2020

31. First paragraph will tell you when the assessment was completed and by whom.Second section is what was determined, nursing facility placement or not and why.NEW Determination Letter

32. The Third Section will be the list of recommendations that the nursing facilities must include in the care plan for each level II client they admitThe third section will also include the length this PASRR determination is valid for.Section Four is the directions for the individual how to appeal and get copies if they need them.NEW Determination Letter

33. Who is responsible to request the Resident Review?The nursing facility or nursing facility for mental health that the client is residing in at the time that it is due. If the client is not at the nursing facility, but is having a short term stay at OSH, LSH, JAIL, or the hospital, or any behavioral health unit. The NF/NFMH is still responsible to send in the resident review to KDADS and the assessor will go to the place that they are at and complete the assessment. Resident Review2020

34. If the client has discharged from the NF/NFMH to OSH, LSH, or Jail etc. These facilities can complete the Resident Review. As long as the level II expired while they were admitted to the facility and IF they came to the facility from the NF/NFMH.The level II expires on the date given in the determination letter, if the person was not in a nursing facility on that date they must start over with a level IIf the person had a continued PASRR, they expire upon discharge of the nursing facility, and they must start over with a level IThe NF/NFMH may receive a request for documentation if the client has recently discharged from the facility.Resident Review2020

35. If it is a Resident Review Change in Condition:This is when the client has not been a level II or triggered for a level II, but now meets the criteriaRequest the Change in Condition from KDADS CARERequest can be made while they are at a short term stay for behavioral management or med review.They can come back to your facility while waiting for a Resident Review Change in Condition, these need to be completed as soon as possible, but does not limit them coming back to your facility. Resident Review

36. How to request a resident review PASRR:The requesting facility will complete the Resident Review ChecklistThe requesting facility will complete the KDADS release of information.The completed forms and all the required documentation will be faxed 785-291-3427 or emailed KDADS.CARE@ks.gov to the KDADS CARE Program for processing.Resident Review2020

37. 2020ChecklistPlease be sure to include information for the responsible person at your facility that the level II Assessor needs to contact to set up the assessment

38. KDADS Release of information form

39. A Resident Review is a brief version of the Level II CARE assessment that evaluates the resident’s current condition to determine the resident’s status and on-going treatment needs.They look to see if the nursing facility is following the recommendations lined out in the Determination letterIf the client continues to need nursing facility level of careIf discussion of discharging is taking place. PASRR is to encourage the client to go back to the community to live in the least restrictive environment possible.Resident Review2020

40. When should the Resident Review be Requested?The resident has had a significant change in condition in their mental status that now meets the criteria for a level II PASRRORIf a resident had a level 1 CARE assessment that did not trigger for a level II, and they are now meeting the criteria for a level II. You will do a resident review change in condition. The checklist needs to be completed with the KDADS release of information. All documentation will be required in addition to the admitting MDS and the most recent MDS, and the MDS must show a change in the condition and diagnosis or it will not be considered for the level II Resident Review Change in Condition PASRR. ORResident Review2020

41. When should the Resident Review be Requested?If the resident admitted to your nursing facility and the level I did not correctly identify that there is an ID/DD/RC. You will complete the Resident Review Checklist and the KDADS release of information and send in all of the forms needed. If there is not documentation showing the IQ score was obtained before the age of 18 it will be canceled. If there is not documentation showing the Related Condition was before the age of 22, it will be canceled. ORIf the Determination letter stated that there is a temporary stay, the Resident Review should be requested before the end of the allowed stay. Please request at least 2 weeks before the end date to allow time for the assessor to complete the Resident Review.Resident Review2020

42. Consequences of not completing on time.If the client is a Medicaid client, Medicaid will stop paying the nursing facility for the stay on the date the PASRR ended. They will not being payment until the date of the following Determination letter is completed. There is no back pay for time lapsed.If the client is in your nursing facility or nursing facility for mental health and you are having a survey. If that clients file is pulled for chart review, and the surveyor notices that the PASRR has expired, you will be issued a C tag by the State of Kansas.You may also receive a C tag from the state of Kansas if the recommendations in the Determination letter are not reflected or being met in the residents Care Plan.Resident Review2020

43. The following slides are how to complete the Authorization for Release of Protected Health Information. (ARPHI)Not completing this form correctly will cause delays in the Resident Review.Directions on how to complete the form are attached to it, when you print it from the KDADS Website.Directions on how to complete the form are also listed in the CARE Manual 2019.KDADS Release of Information2020

44. Enter the legal name of the ClientEnter the Social Security Number (optional)Enter the Date of birthHow to complete The ARPHI2020

45. This box will include the organizations, doctors, and/or family members, Guardian, DPOA for Healthcare, names and information that the Healthsource Integrated Solutions Assessor will need to contact to obtain the paperwork or information required to initiate a CARE Level II assessment, Resident Review, or Change of Condition.How to complete The ARPHI2020

46. This box will include the organizations and individuals receiving the PASRR information NOTE: KDADS may only send a copy of the determination letter to individuals/entities listed in this section.How to complete The ARPHI2020

47. Always check this option since CARE Level II information will be received on behalf of KDADS, Always select this option as HealthSource Integrated Solutions is gathering the information.How to complete The ARPHI2020

48. Per HIPAA LAW: Each line item must be initialed on this form by: The ClientThe ACTIVE DPOA for HealthcareThe GuardianIF the client has a Guardian, ONLY the guardian may sign this form.How to complete The ARPHI2020

49. Explanation: ARPHI form and assessment will not be validated if signature fields are left blank by the individual, individual’s guardian, DPOA, or individual representative.How to complete The ARPHI2020How to explain what these mean to the clients and others.

50. Explanation: ARPHI is valid for one year from the date it is signed.How to explain what these mean to the clients and others.How to complete The ARPHI

51. Explanation: The signer has the right to send notice to the AAA or KDADS and revoke this authorization. All actions will stop when this happens and could make the assessment invalid.How to explain what these mean to the clients and others.How to complete The ARPHI2020

52. Explanation: The signer is giving KDADS permission to disclose information to a third party for further review. Once the documentation leaves KDADS custody and control, KDADS is no longer responsible for HIPAA compliance. All subcontractors of KDADS are required to comply with HIPAA requirements.How to explain what these mean to the clients and others.How to complete The ARPHI2020

53. Explanation: This is not a guarantee of treatment or of Medicaid eligibility. This is solely for the purpose of obtaining health information and possible disclosure for a third party. This is NOT a guarantee of Medicaid payment or eligibility or admission to a nursing facility.How to explain what these mean to the clients and others.How to complete The ARPHI2020

54. Reasons a customer is not permitted to sign on own behalfTwo (2) different physician orders state customer lacks capacityJudge order stating customer lacks capacityCustomer has a legal guardianHow to complete the ARPHI2020

55. Personal Representative:HIPAA defines the person who is authorized to act on behalf of the patient in making healthcare-related decisions as the patient’s personal representative.Kansas State Law determines that ONLY the following are authorized to act as the patient’s personal representative:Healthcare power of attorneyCourt-appointed legal guardianParent or guardian of an unemancipated minorExecuter of estate of a deceased person.How to complete the ARPHI2020

56. Verification of SignaturesReview the legal documentation given to your facility to verify that the person represented as the guardian or active Durable Power of Attorney for healthcare is the person that is signing.Also that the DPOA for healthcare is ACTIVE.How to complete the ARPHI2020

57. All forms and documentation including the legal documentation should be sent to the KDADS CARE Program at:Email KDADS.CARE@ks.govFax: 785-291-3437Resident Review2020

58. CARE Program Manager , 785-296-6446, kdads.care@ks.gov CARE Level II Specialist 785-296-5831 kdads.care@ks.gov CARE Specialist kdads.care@ks.gov CARE II Nurse kdads.care@ks.gov KDADS CARE Program FAX: 785-291-3427How to contact the KDADS CARE Program.2020

59. The following slides are to explain the differences in the PASRR and the Continued Stay Screen.They are often confusedConfusing these two separate programs can cost a nursing facility medicaid payment when they believe they have a PASRR and it is a continued stay screen instead.Confusion can cause a nursing facility to get a C tag from the state of Kansas upon survey because the PASRR screen HAS to be on file, and many people confuse Continued Stay with PASRR, so the PASRR is not on file, and can cost the facility a C tag.Continued Stay Screen2020

60. The Continued Stay Screen is a State of Kansas regulation for nursing facilities for mental health only.This program is the KDADS Behavioral Health Commission and not the KDADS CARE Program.The Continued Stay Screen is StateThe PASRR is FederalContinued Stay Screen2020

61. The Nursing Facility for Mental Health is required to submit a census every month to the KDADS Behavioral Health Commission.This census is then sent to the CMHC and the CMHC is to go to the nursing facility for mental health and complete a Continued Stay Screen.The CMHC also completes the PASRR screen, but they are directed and assigned through Healthsource Integrated Solutions. The PASRR assessors have a different set of requirements than a Continued Stay assessor.Continued Stay Screen2020

62. IF you are a Nursing Facility for Mental Health, you are required by state regulation to have a Continued Stay Screen completed on ALL of your residents EVERY single year from 6 months after admission until they are no longer in your building.Continued Stay Screen2020

63. Continued Stay Screens are completed on a resident residing in a nursing facility for mental health every 365 days, until the person discharges from the nursing facility for mental healthThe PASRR is a temporary stay of 3, 6, 9, or 12 months according to the PASRR Determination letter. These are meant to be short term stays, the nursing facilities should be helping the person become stable and independent to leave and live in the community. If the PASRR client residing in the nursing facility past a certain time frame then they will receive a long term PASRR (was called permanent PASRR). A long term PASRR does NOT mean they never have to dischargeIt ONLY means, they no longer have to do the PASRR process as long as they are residing in a nursing facility.Once discharged the PASRR is no longer validIF there is a change in condition a resident review should be requested.The final PASRR has no effect on the Continued Stay ProcessContinued Stay Screen2020

64. CMHC Continued Stay Screen, screener will come to the facility to screen the resident.The Screener will submit the screen to KDADS, Behavioral Health Commission.KDADS Behavioral Health will review the screen and approve, request additional information, or deny the results of the screen.Letter of results are mailed to client, guardian, NFMH, and the CMHC.Continued Stay Screen2020

65. If the result of a Continued Stay Screen is continued stay, the client will remain at the NFMH.If the result is discharge, KDADS Behavioral Health will reach out to the NFMH to ensure they are in agreement with the discharge. If not then addition information will need to be provided to KDADS Behavioral Health. The NFMH will have 120 days to discharge the client, if the letter says to discharge..NFMH’s social worker and the local Community Mental Health Center CMHC should work with the family, guardian or others to ensure a safe discharge to a home. A discharge should never result in homelessness.Continued Stay Screen2020

66. Clients, families, guardians or others have the right to appeal the results of a Continued Stay Screen. This must be done within 30 days of notification (date of the letter).Continued Stay Screen notifications letters should be received within 7-10 days of final decision.Notifications are sent via US Mail to the client and the NFMH. CMHCs are notified via e-mail.Prior Authorizations are submitted at the same time as the notification.Continued Stay Screen2020

67. Continued Stay letter says continued stay at the topThe PASRR letter says PASRR determination at the topThe Continued Stay letter says Continued stay in the body of the letter.The PASRR letter says PASRR or Level II or Resident Review in the body of the letter.The continued stay is 1 pageThe PASRR determination is 1 - 2 pages.

68. Please note that if you get a discharge letter from PASRR and from Continued Stay and the dates of discharge are not the same:Contact the KDADS CARE Program we will work with Continued Stay to get them on the same pagePlease note that because PASRR is Federal and Continued Stay is State, the PASRR trumps the Continued Stay for discharge purposes.PASRR Vs. Continued Stay

69. In your residents files, there should be a recent (within the last year) Continued Stay AND a PASRR Determination letter.Survey and Certification are looking for the PASRR Determination letter.We have discovered MANY NFMHs do not have both of these screens up to date, because of the confusion. It would be best to go through your files and verify you have BOTH the Continued Stay and the PASRR on file.PASRR Vs. Continued Stay2020

70. Sarah HussainMental Health Program Manager785-296-2518Sarah.Hussain@ks.govKDADS Continued Stay ProgramKDADS.ContStay@ks.govHow to contact KDADS Behavioral Health Commission2020

71. QUESTIONS?2020