Provider PASRR Training

Preadmission Screening and Annual Resident Review Verification (PASRR)

May  2014  

OBJECTIVES:

§  To  gain  a  greater  understanding  of  PASRR  and  how  it  effects  PCS.  

 §  To  become  knowledgeable  of  the  internal  

processes  Liberty  follows  in  order  to  obtain  a  PASRR  for  processing  of  a  PCS  request.  

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WHAT IS PASRR?

§  The  Preadmission  Screening  and  Annual  Resident  Review  (PASRR)  is  a  review  of  any  individual  who  is  being  considered  for  admission  into  a  Medicaid  CerKfied  Adult  Care  Home.  

§  As  required  by  the  US  Department  of  JusKce  SeQlement  Agreement  effecKve  January  1,  2013,  individuals  requesKng  admission  to  Adult  Care  Homes  (ACH)  must  be  pre-­‐screened  for  serious  mental  illness  (SMI).  

§  The  North  Carolina  Department  of  Health  and  Human  Services  (DHHS)  is  the  agency  that  provides  a  Level  I  screening,  conducted  by  an  independent  screener  for  all  applicants  to  Adult  Care  Homes  licensed  under  G.S.  131D,  ArKcle  1  to  idenKfy  beneficiaries  with  SMI.  

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PASRR: APPLICATION PROCESS; LEVEL 1 SCREENING

The PASRR process is only required for Medicaid eligible individuals.

§  The  primary  physician  or  referring  agency’s  appropriate  clinical  staff  completes  the  Medicaid  Uniform  Screening  Tool  (MUST),  and  the  family  is  provided  with  the  opportunity  to  provide  input.    

§  The  individual  compleKng  the  MUST  form  must  be  familiar  enough  with  the  beneficiary’s  mental  health  status  and  history  to  provide  accurate  informaKon  required  by  the  screening  form.    

§  If  there  is  clearly  no  evidence  of  SMI,  a  PASRR  number  will  be  generated  automaKcally  by  the  MUST.    

§  If  the  individual  meets  the  criteria  and  the  individual  chooses  to  reside  in  an  adult  care  home,  the  admission  process  can  begin.  

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PASRR: APPLICATION PROCESS; LEVEL 2 SCREENING

§  If  there  is  any  indicaKon  of  SMI,  addiKonal  informaKon  will  be  required  through  a  manual  review  process,  in  which  the  applicant  will  be  referred  for  a  level  II  face-­‐to-­‐face  evaluaKon.  

§  If  a  Level  II  evaluaKon  is  needed,  the  PASRR  contractor  noKfies  the  referral  source  that  a  Level  II  PASRR  evaluaKon  is  required  and  requests,  if  applicable,  that  medical  records  be  available  for  the  on-­‐site  evaluaKon  by  a  qualified  mental  health  professional  (QMHP).    

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PASRR APPLICATION PROCESS: LEVEL 2 SCREENING (CONT.)

The Level 2 screening process is as follows: §  A  face-­‐to-­‐face,  in-­‐depth  assessment  is  performed  by  the  

QMHP.  §  The  completed  Level  II  evaluaKon  with  recommendaKons  is  

then  forwarded  to  DHHS.  §  AZer  the  compleKon  of  the  Level  II  evaluaKon,  DHHS  

makes  the  final  determinaKon  for  placement  and  services.  A  PASRR  number  is  assigned,  and  if  an  adult  care  home  is  determined  to  be  the  appropriate  Level  of  Care,  copies  are  sent  to  appropriate  sources.  

§  A  cerKfied  noKficaKon  of  the  determinaKon  and  other  available  opKons  are  mailed  by  the  PASRR  contractor  to  the  beneficiary/responsible  party.    

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PASRR: APPLICATION PROCESS: CONTACTS

Questions? §  PASRR  contractor:  The  Division  of  Mental  Health,  

Developmental  DisabiliKes,  and  Substance  Abuse  Services  (DMH/DD/SAS)  

§  N.C.  Division  of  Mental  Health/Developmental  DisabiliKes/Substance  Abuse  Services  (DMH/DD/SAS)  has  idenKfied  staff  to  serve  as  liaisons  to  provide  technical  assistance,  answer  quesKons,  and  assist  with  locaKng  PASRR  Level  I  Screeners:  

             Barbara  Flood  –  EAST  -­‐  919-­‐218-­‐3872,  [email protected]                    Patricia  McNear  –  CENTRAL  –  919-­‐981-­‐2580,  [email protected]                  Bill  Joyce  –  WEST  –  336-­‐312-­‐0212,  [email protected]  

           Sandee  Resnick-­‐  Accountability  Team  Leader  -­‐  (919)  981-­‐2580  

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WHO DOES NOT NEED A PASRR?

The following beneficiaries do NOT require a PASRR:

§  Beneficiaries  who  have  been  admiQed  into  an  ACH  prior  to  January  1,  2013,  regardless  of  payer  source  (Private,  Medicaid,  or  pending  Medicaid).  

§  Beneficiaries  who  reside  in  a  5600a  or  5600c  facility  type.  

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PASRR AND PCS

§  Clinical  Coverage  Policy  3L  (3.2.3b)  remains  in  effect  and  requires  that  a  Medicaid  beneficiary  residing  in  or  applying  for  admission  to  an  ACH  be  screened  for  serious  mental  illness  using  the  PASRR  prior  to  an  assessment  for  PCS.  

§  Adult  Care  Home  providers  licensed  under  G.S.  131D-­‐2.4  will  not  receive  prior  approval  to  render  or  bill  for  PCS  without  verificaKon  of  a  PASRR  number.  

Important  Note:  This  is  not  required  for  beneficiaries  residing  in  an  ACH  who  are  currently  receiving  PCS.  

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PCS REQUESTS AND PASRR

§  If  the  facility  is  a  5600a,  5600c,  or  the  beneficiary  was  admiQed  into  the  facility  prior  to  January  1,  2013,  a  note  on  the  top  of  the  request  form  would  help  (include  admission  date)  to  prevent  any  delay  in  the  processing  of  the  PCS  request.  

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Facilities:

RECOMMENDATIONS FOR ENTERING PASRR NUMBER ON DMA 3051

§  Enter  in  SecKon  A:  Recipient  Demographics  in  blank  space  to  the  right  of  Medicaid  ID  #  

§  Print  Legibly:  PASRR  #  10-­‐digit  Alpha  and  effecKve  date  

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PASRR AND PA EFFECTIVE DATES

For beneficiaries requiring a PASRR, PAs become effective when:

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§  If  a  PASRR  is  effecKve  on  the  date  the  PCS  request  is  received  or  prior,  PAs  will  be  effecKve  the  date  of  the  request.  

§  If  the  PASRR  is  received  within  30  days  from  the  request  received  date,  then  the  PAs  will  become  effecKve  the  date  the  PASRR  became  effecKve.  

§  If  no  PASRR  is  received  within  30  days  of  the  PCS  request,  then  Liberty  will  send  a  technical  denial  for  PCS.  

PASRR VERIFICATION

§  Liberty  Healthcare  will  verify  a  PASRR  has  been  approved  on  every  new  ACH  PCS  request.  

§  VerificaKon  is  confirmed  through  the  NCMust  system.  §  If  unable  to  verify  a  PASRR  through  the  NCMust  system,  Liberty  will  call  the  facility  in  an  aQempt  to  obtain  a  PASRR.  

§  If  a  PASRR  is  not  required,  Liberty  Healthcare  will  request  the  admission  date  (if  prior  to  1.1.13)  through  a  copy  of  an  FL2  or  any  other  documentaKon  that  reflects  the  admission  date  or  have  the  facility  confirm  they  are  a  5600a  or  5600c.  

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THANK YOU FOR YOUR INTEREST IN PASRR