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. 39, No. 167, August 27, 2013 issue of the Florida Administrative Register.

 

59G-1.040 Pre-Admission Screening and Resident Review.

(1) No change.

(a) The Pre-Admission Screening and Resident Review (PASRR) is a federal requirement mandated by the Social Security Act, Title 42, Subpart C, Sections 483.100 through 483.138, Code of Federal Regulations Nursing Home Reform Act, as amended. It is intended to ensure that Medicaid-certified nursing facility applicants and residents with a diagnosis of or suspicion of serious mental illness or intellectual disabilities, or related conditions, are identified and admitted or allowed to remain in the nursing facility only if there is a verified need for such services.

(b) No change.

(c) Florida’s PASRR process promotes community-focused, patient-centered care by ensuring psychological, psychiatric, and functional needs are considered along with personal goals and preferences when planning long-term care services. Multiple state agencies and providers work together to ensure the individual’s long-term care needs are met in the most integrated setting appropriate.

(2) No change.

(a) No change.

(b) Agency for Persons with Disabilities – The Florida Agency for Persons with Disabilities (APD) works in partnership with local communities to support persons with developmental disabilities in living, learning and working in their communities. APD serves Floridians with autism, cerebral palsy, Down syndrome, intellectual disabilities, Prader-Willi syndrome, and spina bifida. APD is responsible for completing the Pre-Admission Screening and Resident Review (PASRR) Level II evaluations and determinations for intellectual disabilities (ID) or related conditions.

(c)(b) No change.

(d)(c) Child(ren) – Individuals who are under the age of 21 age three through 20.

(d)Early Steps – Florida's early intervention system, administered by the Florida Department of Health, Children’s Medical Services, that offers services to eligible infants and toddlers (birth through age three) with significant delays or a condition likely to result in a developmental delay. Early intervention is provided to support families and caregivers in developing the competence and confidence to help their child learn and develop.

(e) Florida Department of Children and Families – The Florida Department of Children and Families (DCF) is the agency in Florida that supports Florida families through a variety of human services programs such as the DCF Mental Health program and the Automated Community Connection to Economic Self Sufficiency (ACCESS) program. The DCF Mental Health program office or State-designated contracted provider is responsible for completing the Pre-Admission Screening and Resident Review (PASRR) Level II evaluations and determinations for serious mental illness (SMI). ACCESS helps to promote strong and economically self-sufficient communities by providing food, cash and medical assistance to individuals and families on the road to economic recovery. ACCESS is responsible for determining Medicaid eligibility, including eligibility for Medicaid long-term care services.

(f)(e) Intellectual Disability (ID) – As defined in the Social Security Act, Title 42, Subpart C, Section 483.102(b)(3), Code of Federal Regulations, iIndividuals are determined to have ID (mild, moderate, severe, or profound) according to the criteria in American Association on Mental Retardation's Manual on Classification in Mental Retardation (1983) the American Association on Intellectual Disabilities’ manual entitled, Intellectual Disability: Definition, Classification, and Systems of Supports (11th Ed. 2010), incorporated by reference. The American Association on Mental Retardation's Manual on Classification in Mental Retardation (1983) is available for inspection at the Agency for Health Care Administration, Building 3, 2727 Mahan Drive, Tallahassee, Florida, 32308. ID includes related conditions, i.e., individuals who have a severe, chronic disability that meets all of the following conditions:

1. through 3. No change.

4. No change.

a. through f. No change.

(g) Inter-Facility Transfer – The transfer of a resident from one nursing facility to another nursing facility.

(h)(f) No change.

(i)(g) No change.

(g)(h) New Admission – An individual admitted to any a nursing facility (NF) for the first time or not admitted as a readmission or not admitted as an inter-facility transfer.

(h)(i) No change.

(i)(j) Readmission. – An individual who is readmitted within 90 days to any an NF from a hospital to which the individual was originally transferred by an that NF for receiving care.

(j)(k) Serious Mental Illness (SMI) – As defined in the Social Security Act, Title 42, Subpart C, Section 483.102(b)(1), Code of Federal Regulations, aAn individual is considered to have an SMI, if the individual meets the following requirements on diagnosis, level of impairment, and duration of illness:

1. Diagnosis: A major mental disorder under the Diagnostic and Statistical Manual of Mental Disorders (3rd 4th Ed., Revised 1987 2000), incorporated by reference, such as a schizophrenic, mood, paranoid, panic, or other severe anxiety disorder; somatoform disorder; personality disorder; other psychotic disorder; or another mental disorder that may lead to a chronic disability, but not a primary diagnosis of dementia, including Alzheimer’s disease or a related disorder, or a nonprimary diagnosis of dementia unless the primary diagnosis is a major mental disorder. The Diagnostic and Statistical Manual of Mental Disorders (3rd Ed. R. 1987) is available for inspection at the Agency for Health Care Administration, Building 3, 2727 Mahan Drive, Tallahassee, Florida, 32308.

2. through 3. No change.

(k)(l) through (l)(m) No change.

(3) The Level I PASRR Screener or, for children under age three, the Early Steps program, must be notified whenever an individual is referred to an NF for admission.

(4) No change.

(a) through (b) No change.

(c) Individuals not requiring a Level I PASRR prior to admission to an NF, referred to as provisional admissions, are as follows:

1. In cases of delirium, a Level I PASRR must be completed within seven days after the delirium clears;

2. For emergency admissions requiring protective services, a Level I PASRR must be completed within seven days of admission;

3. An individual admitted to an NF for a caregiver’s respite, unless the stay exceeds 30 days; however, a Level I PASRR must be completed in advance of the expiration of the 30 days, if the stay is expected to exceed the time limit;

4. An individual who is admitted to an NF under the 30-day hospital discharge exception, pursuant to Title 42, Code of Federal Regulations, section 483.106(b)(2); however, if the individual’s stay exceeds the 30 days, a Level I PASRR must be completed no later than the 40th day; or

5. A child admitted to an NF under age three; however, a Level I PASRR must be completed within seven days of the child’s third birthday, if the child is still residing in the NF.

(c)(d) The Level I PASRR must be completed by the Level I PASRR Screener prior to an individual’s admission to an NF subject to the exceptions in subparagraphs (4)(c)1.-5.

(d)(e) No change.

1. through 5. No change.

6. An assessment conducted by CARES if the individual is an adult the Department of Elder Affairs (DOEA), if appropriate;

7. An assessment conducted by the Children’s Multidisciplinary Assessment Team (CMAT) if the individual is a child, if appropriate; and

8. An assessment conducted by the Early Steps program, if appropriate.

(e)(f) The Level I PASRR Screener is responsible for documenting on a Level I PASRR screening whether the individual is seeking a provisional admission into an NF and the type of provisional admission. They are also responsible for documenting and tracking the appropriate time limits for when a Level I PASRR must be completed for these provisional admissions and making certain that the individual is referred for a Level II PASRR prior to the expiration of the time period.

(5) No change.

(a) through (c) No change.

1. In cases of delirium, a Level II PASRR must be completed within seven days after the delirium clears;

2. For emergency admissions requiring protective services, a Level II PASRR must be completed within seven days of admission;

3.1. No change.

2. If a child under age three is admitted to the NF, then a Level II PASRR must be completed within seven days of the child’s third birthday;

4.3. If the individual does not enter the NF within 30 days of the Level II PASRR evaluation, the a new Level II PASRR must be reviewed and validated completed prior to admission to the NF;

5.4. No change.

6.5. If there is a significant change in the resident’s mental or physical condition, the nursing facility must notify the Level I PASRR Screener in accordance with 42 USC 1396r, and a new Level II PASRR must be completed; or

7.6. If an individual is admitted to an NF for a caregiver’s respite, a Level II PASRR must be completed in advance of the expiration of 14 30 days, if the stay is expected to exceed the 14 30-day time limit no more than twice a year; or.

8.6. Excluding the above-listed exceptions in 1-7, within seven days of receiving a Level I PASRR indicating a diagnosis or suspicion of SMI and/or ID or a related condition.

(d) through (f) No change.

1. through 7. No change.

8. Documents that a pre-admission counseling packet was reviewed and provided to the individual or legal guardian, if appropriate, including a signed receipt of the packet; however, in the event the individual or legal guardian refuses to sign off on the packet, the Level II PASRR evaluator will document their refusal;

(8)(9) through (11)(12) No change.

(g) through (h) No change.

(6) No change.

(a) DCF must ensure completion of the Level II PASRR evaluations for individuals age three years and older whose Level I PASRR indicated a suspicion of SMI.

(b) No change.

1. Confirm or rule out the presence of SMI. A qualified mental health professional must confirm or reject the suspicion of SMI indicated in the Level I PASRR by reviewing accurate and recent data of performing a comprehensive history and a physical examination of the person, or performing or ensuring the performance of the same, including:

a. through g. No change.

2. through 3. No change.

(7) Level II PASRR Evaluations for Individuals for Whom a Level I PASRR Indicated a Suspicion of ID.

(a) APD must ensure completion of the Level II PASRR evaluations for individuals age three and older whose Level I PASRR indicated a suspicion of ID.

(b) No change.

1. through 3. No change.

a. through c. No change.

i. through v. No change.

d. through h. No change.

i. Speech and language (communication) development, such as expressive language (verbal and nonverbal), receptive language (verbal and nonverbal), extent to which non-oral nonoral communication systems can improve the individual's function capacity, auditory functioning, and extent to which amplification devices (for example, hearing aid) or a program of amplification can improve the individual's functional capacity;

j. through o. No change.

(c) No change.

(8) through (10) No change.

(11) No change.

(a) Nursing facilities are required to maintain copies of all PASRR screenings, evaluations, and re-evaluations in the resident’s file for the duration of the individual’s stay in the facility and for a period of five years, even after the resident has been discharged or has been transferred to another facility.

(b) No change.

(12) No change.

(a) No change.

(b) The Level I PASRR Screener must perform a quality assurance review of Level II PASRR screenings to determine compliance with the requirements outlined in this rule, the Social Security Act, Title 42, Subpart C, sections 483.100 through 483.138, Code of Federal Regulations, the Florida Medicaid State Plan federal regulations, state law, and the executed memorandum of understanding. If deficiencies are found, the Level I PASRR Screener will notify the agency performing the Level II PASRR of the deficiencies. Within five business days of receipt of the notice, the agency will correct all deficiencies and submit an amended Level II PASRR.

(13)(a) Annual Reporting to the Secretary of the United States Department of Health and Human Services.

(b) Florida Medicaid must report annually to the Secretary of Health and Human Services the number and disposition of residents not requiring NF services, but requiring specialized services; and residents not requiring NF services and not requiring specialized services.

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905(8), 409.912, 409.913 FS. History–New____________.

 

The following changes have been made to the SUMMARY section of the notice:

 

NOTE: The Agency has determined that the electronic uploading materials incorporated by reference in paragraph 59G-1.040(2)(e) and subparagraph 59G-1.040(2)(k)1. would constitute a violation of federal copyright law. This material is available for public inspection and examination at the Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, FL 32308 and at the time of adoption, may be viewed at the Department of State, Administrative Register and Code, Room 701, The Capital, 402 South Monroe St., Tallahassee, FL 32399.