Pre-Admission Screening and Resident Review

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-1.040Pre-Admission Screening and Resident Review

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 42 No. 211, October 28, 2016 issue of the Florida Administrative Register.

59G-1.040Preadmission Screening and Resident Review.

(1) No change.

(2) Definitions.

(a) through (i) No change.

(j) Serious Mental Illness (SMI) – As defined in 42 CFR 483.102(b)(1).

(k) through (l) No change.

(3) No change.

(4) Level II PASRR Evaluation Request.

(a) Upon completion of the Level I PASRR screen, if the individual has a diagnosis of or suspicion of having an SMI, ID, or both:

(a)1. The Level I PASRR screener must send the individual or their legal representative, as applicable, written notice stating the individual has a diagnosis of, or is suspected of having, an SMI, ID, or both, and is being referred for a Level II PASRR evaluation.

(b)2. The AHCA-designated Level I PASRR screener must send all of the following documentation for a Level II PASRR evaluation to the Agency for Persons with Disabilities (APD), or the state’s contracted vendor, for individuals diagnosed with, or suspected of having, an ID; or, to the state’s contracted Level II PASRR evaluator for individuals diagnosed with, or suspected of having, an SMI:

1.a. Completed Preadmission Screening and Resident Review (PASRR) Level I Screen For Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID) (Level I PASRR Screen), AHCA MedServ Form 004 Part A, ________, incorporated by reference and available on AHCA’s Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml, and at [DOS place holder Ref-______].

2.b. Informed consent, as documented on the Level I PASRR Screen, AHCA MedServ Form 004 Part A_______, or the Preadmission Screening and Resident Review (PASRR) Resident Review (RR) - Evaluation Request For a Significant Change for Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID) (Resident Review-Evaluation Request), AHCA MedServ Form 004 Part A1_______, incorporated by reference and available on AHCA’s Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml, and at [DOS place holder Ref-______].             

3.c. AHCA 5000-3008 Form, June 2016, incorporated by reference in Rule 59G-1.045, F.A.C.

4.d. Other medical documentation including history, most recent physical, relevant case notes or records of treatment and medication administration records, as applicable.

5.e. Psychiatric or psychological evaluation, if available.

6.f. An assessment conducted by CARES or the minimum data set (MDS), if applicable, if the individual is age 21 years and older.

7.g. An assessment conducted by DOH or the MDS, if applicable, if the individual is under the age of 21 years.

(5) No change.

(6) Level II Evaluation Time Frames.

(a) No change.

(b) Exceptions to the timeframe specified in paragraph (6)(a) are as follows:

1. through 3. No change.

4. By calendar day 40, when an individual is admitted to an NF under the hospital discharge exemption, and is expected to stay in the NF longer than 30 calendar days. In this instance, the NF must notify the AHCA-designated Level I screener on the 25th day of the individual’s stay if the stay is expected to extend past 30 calendar days.

5. No change.

(7) No change.

(8) Level II Evaluation Entities and Components.

(a) No change.

1. No change.

2. Agency for Persons with Disabilities, or the state’s contracted vendor, for individuals diagnosed with, or suspected of having, an ID.

(b) through (c) No change.

(9) through 16) No change.

 

Changes to the forms incorporated by reference in the rule are as follows:

The Preadmission Screening and Resident Review (PASRR) LEVEL I SCREEN For Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID), AHCA MedServ Form 004 Part A, ___________:

Page 3, boxed paragraph following sentence 3. B. now reads:

A Level II PASRR evaluation must be completed prior to admission if any box in Section I.A. or I.B. is checked and or there is a ‘yes’ checked in Section II.1, II.2, or II.3, unless the individual meets the definition of a provisional admission or a hospital discharge exemption.

The Preadmission Screening and Resident Review (PASRR) RESIDENT REVIEW (RR) – EVALUATION REQUEST For a Significant Change for Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID), AHCA MedServ Form 004 Part A1, ___________: No Change.