Texas Register - Texas New Mexico Hospice Organization



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| |FAQ: TEXAS PREADMISSION SCREENING AND RESIDENT REVIEW |July 9, 2013 |

Disclaimer: The answers provided in this document are the result of the Texas and New Mexico Hospice Organization’s research and analysis. If you have specific questions on rules and interpretation, contact the Texas Department of Aging and Disability Services’ Regional or State Offices.

The following acronyms are used in the FAQ:

• CFR – Code of Federal Regulations

• DADS – Department of Aging and Disability Services

• DD – Developmental Disability

• ID - Intellectual Disability

• LA – Local Authority

• MI – Mental Illness

• MR – Mental Retardation

• NF – Nursing Facility

• PASRR – Preadmission Screening and Resident Review

• PDF – Portable Document Format

• PL1 – Preadmission Level 1

• RC – Related Condition

• RE – Referring Entity

• TAC – Texas Administrative Code

• TMHP – Texas Medicaid Healthcare Partnership

• TNMHO – Texas and New Mexico Hospice Organization

Question: What does PASRR mean?

Answer: PASRR stands for Preadmission Screening and Resident Review.

Question: What is the purpose of PASRR?

Answer: The PASRR process is administered to identify individuals who have a diagnosis of mental illness (MI), intellectual disability (ID – the federal government still calls it MR) or a developmental disability (DD) seeking admission into a nursing facility (NF) or those residing in a NF. The process ensures that the placement in the NF is appropriate and to assess for specialized services.

Question: Who does the PASRR apply to?

Answer: PASRR is a federally mandated program that applies to all individuals seeking admission into a Medicaid-certified NF, regardless of what entity is paying for the NF care.

Questions: What are specialized services?

Answer: Specialized services are defined as support services provided to individuals residing in the NF. Services can be physical, occupational and/or speech therapy, and customized adaptive aids. Additional services are available to people with intellectual disabilities. They are: assistance in accessing appropriate services and supports to achieve a quality of life and community participation, which can include alternate placement out of the NF and vocational training in some parts of the state. The specialized services are in addition to what the NF is required to provide to the individual.

Question: Who provides the specialized services?

Answer: The local authority (LA) will assess the individual and determine if they need the specialized services. This is done after the Level 1 screening (PL1) is completed and submitted to the NF and LA (if appropriate). The LA provides the services.

Question: What is a Level 1 screening (PL1)?

Answer: The PL1 is conducted on everyone seeking admission into the Medicaid-certified NF regardless of the funding source or diagnosis.

Question: Does this include hospice recipients?

Answer: Yes, this includes hospice recipients.

Question: Who does the PL1?

Answer: A referring entity (RE) completes the PL1. The RE is an entity that refers an individual to the NF, it could be a hospital, clinic, physician, the individual seeking admission, family member, a hospice provider, law enforcement etc. The PL1 is completed under the following circumstances and by specific referring entities (RE):

• Permanent admission into the NF: A hospice provider never seeks permanent admission. The RE seeking permanent admission would be the individual, family, hospital, physician etc and they would complete the PL1.

• Inpatient Respite Care: In this situation the hospice provider is considered the RE will complete the PL1.

• General Inpatient Care: In this situation, the hospice provider is considered the RE will complete the PL1.

Question: Why does the hospice provider have to complete the PL1 for respite and general inpatient care when the stay is short term?

Answer: The federal government mandated that everyone seeking admission (whatever that type of admission is) must have this screening. The federal government quoted “respite” specifically in the law.

Question: Respite and general inpatient care is short and many people go into the NF over and over. The assessment is extremely long! Do we have to complete the PL1 every time a recipient needs to go to the NF?

Answer: Yes, every time the hospice recipient goes into the NF for either one of these services, the hospice provider must complete the PL1. TNMHO has asked DADS to consider making the PL1 a secured PDF document whereby the hospice can data enter the recipient information and save it in their computer. This would allow the provider to update the information, print off the PL1 and obtain appropriate signatures.

Question: Where can the hospice provider access the PL1 Form?

Answer: You can access the form at: . Everyone uses the same form. DADS’ staff advised TNMHO that many RE’s who complete the form are not doing it correctly. Many RE’s are filling in the form without reading the instructions. This is where “we” are making the mistake. DADS encourages all RE’s to follow or double check the instructions to ensure the PL1 is filled out correctly. Incorrect forms delay admissions.

Question: If a hospice recipient or the family wants to seek admission into the NF, and asks us to help complete the PL1, can we complete the form for them?

Answer: There is no rule that says the hospice provider cannot assist the family in completing the PL1.

Question: Hospice admissions for respite and inpatient care can be last minute. How can we ensure a fast admission into the NF?

Answer: By state and federal rule, a person with a terminal illness is considered an expedited admission.

Question: What is an expedited admission process?

Answer: The short answer to this is that when the hospice provider completes the PL1 assessment, you make a copy of it and provide it to the NF. If the hospice recipient has MI, ID or DD, the hospice provider will give a copy to the LA as well. The NF will work with you to admit the recipient as expeditiously as possible.

Question: If the hospice recipient has MI, ID or DD, what do I do with the PL1?

Answer: If you have a positive screening for MI, ID or DD, you will make a copy of the PL1 and submit it to the LA.

Question: Where do I find the LA?

Answer: The listing for LA’s is found at: .

Question: Does the hospice provider get paid to complete the assessment?

Answer: No. Any additional funding or billing activities is specific to the LA.

Question: There are two rules that seem to conflict; §17.202 addresses the expedited process and §17.301 addresses the RE responsibilities. The expedited process says the RE completes the PL1 and enters the assessment into the TMHP portal. The rule about RE responsibilities says the RE makes copies of the assessment and provides a copy to the NF and if necessary the LA. Which process do we follow?

Answer: DADS has advised that hospice providers do NOT data enter the PL1 into the TMHP portal. The NF and LA will handle the data entry.

Question: Once the hospice provider has completed the assessment and given it to the NF, and if necessary the LA, what happens next?

Answer: Once the NF has the PL1, they will work with you to admit the hospice recipient into the NF. The additional responsibilities that the NF and LA are required to do won’t involve the hospice provider. The LA may come out to evaluate the hospice recipient by conducting a second level screening. To the best of my knowledge, I have not heard of anyone on hospice who is permanently residing in the NF with any of the diagnoses, getting specialized services, but it could happen. If this does occur, you would want to contact the IDT at the NF and LA since you are responsible for everything related to the terminal illness.

Question: Will there be any training?

Answer: There have been a few trainings on PASRR. You can access handouts and information on training at: . DADS is considering additional trainings or links to trainings that have occurred, but the links are not currently available on the PASRR website.

Question: Where is the PASRR website?

Answer: The PASRR website is: .

Question: What rules apply?

Answer: The PASRR rules are as follows:

• 40 TAC 17 Preadmission Screening and Resident Review (PASRR) at: $ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=17.\

• 42 CFR 483 Requirements for States and Long Term Care Facilities, Subpart C Preadmission Screening and Annual Review of Mentally Ill and Mentally Retarded Individuals or you can read the Federal Register information at: .

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