MDS 3.0 and PASRR. 10/12/2010 Webinar for NAPP members. Dan Timmel CMS PASRR Technical Assistance Center. Slides prepared by Breck Douglas (9/10)

Transcription

1 MDS 3.0 and PASRR 10/12/2010 Webinar for NAPP members Dan Timmel CMS PASRR Technical Assistance Center Slides prepared by Breck Douglas (9/10)

2 Agenda What is MDS? How and why does it affect me? Review MDS 3.0 changes related to PASRR How will MDS 3.0 affect Change in Status Evaluations Review criteria for Change in Status Evaluations Questions and answers Resources 2

3 What is MDS? MDS: Minimum Data Set. Actually quite a robust set of data on every resident in Medicaid certified nursing facilities. The MDS is a powerful tool for implementing standardized assessment and for facilitating care management in nursing homes (NHs)... Its content has implications for residents, families, providers, researchers, and policymakers (CMS, 2010). The MDS assessment is completed at admission and then once every quarter, and upon a significant change, for all NF residents. The assessment is used in care planning. 3

4 A view of page one of the MDS 3.0, and the new PASRR question on page three: 4

5 How will MDS 3.0 affect me? MDS 3.0 is designed to improve the reliability, accuracy, and usefulness of the MDS. These improvements support the intent that MDS be a tool to improve clinical assessments. MDS 3.0 issued by nursing facilities starting October 1, New to MDS 3.0 is question A1500 which documents if a PASRR Level II determination has been issued. This is the first time PASRR has been specifically addressed in the MDS process and will bring individuals identified by PASRR to heightened awareness. 5

6 MDS 3.0 PASRR Item A CONFIDENTIAL

7 How will MDS 3.0 affect PASRR? Better defined scenarios for nursing facilities illustrating when a change in status (CoS) may require PASRR evaluation should lead in most states to an increase in referrals from NFs: For Level II resident reviews for persons already identified through PASRR, (A1500 = Yes) whenever the resident experiences a significant Change of Status (CoS) For Level II evaluations for NF residents with newly identified or suspected SMI, ID or DD who have never before been identified through PASRR, when the resident experiences a significant Change of Status (CoS) 7

8 MDS 3.0 instructs NF staff that If an MDS significant change in status assessment (SCSA) is completed for a resident for whom A1500 is YES, or for whom mental illness, mental retardation, or a related condition is suspected, then a referral to the state mental health or mental retardation authority is required, for possible Resident Review, a Level II evaluation. 8

9 MDS triggered Level II referrals The purpose of this instruction is to make the relationship explicit between the facility s obligation to perform SCSAs under MDS 3.0, and the facility s obligation under PASRR to refer for possible Level II Resident Reviews. The instruction is not an MDS requirement but a practical instruction to facilities about how they can meet their PASRR obligation while performing MDS activities. 9

10 MDS triggered Level II referrals The challenge is that NF staff have not been able to determine whether the individual requires a first time or an updated Resident Review. So the law at 1919(e)(7)(B)(iii) of the Social Security Act is broad and says that all CoS should be referred for Level II evaluation. State agencies may wish to collaborate on developing some criteria permitting facilities to omit referrals under certain conditions not related to PASRR 10 CONFIDENTIAL

11 How might this affect your PASRR program? Plan for a likely increase in CoS Level II evaluation referrals Possible need for a process to review requests for CoS Level II evaluations sent by nursing facilities as a result of MDS 3.0 It is possible that not all requests will need a full PASRR evaluation: For some requests, you will thank the NF for their diligence, and explain why a Level II PASRR is not needed For some you may gather information and update the extant PASRR Summary of Findings For some requests you may initiate a full comprehensive Level II evaluation and issue a new Summary of Findings 11

12 Criteria for CoS referral for RR Referral for RR evaluations are required for residents previously identified by PASRR in any of the following circumstances: (Please note this is not an exhaustive list.) transferred, admitted, or readmitted to a NF following an inpatient psychiatric stay or equally intensive treatment. increased behavioral, psychiatric, or mood-related symptoms. behavioral, psychiatric, or mood related symptoms have not responded to ongoing treatment. an improved medical condition, that may require modifying the plan of care or placement recommendations. See example CoS is physical, but behavioral, psychiatric, or mood-related symptoms, or cognitive abilities, may influence adjustment to an altered pattern of daily living. indicates a preference (may be communicated verbally or through other forms of communication, including behavior) to leave the facility. condition or treatment is or will be significantly different than described in the resident s most recent PASRR Level II evaluation and determination. See example 12

13 CoS example: Improved medical condition Example: an improved medical condition, such that the resident s plan of care or placement recommendations may require modifications. Mr. L has a diagnosis of serious mental illness, but his primary reason for admission was rehabilitation following a hip fracture. Once the hip fracture resolves and the he becomes ambulatory, even if other conditions exist for which Mr. L receives medical care, he should be referred for a PASRR evaluation to determine whether a change in his placement or services is needed. 13

14 CoS example: Prior LII outcome is no longer appropriate Example: condition or treatment significantly different than described in the resident s most recent PASRR Level II evaluation and determination : Ms. K has mental retardation. She is normally cooperative, but after she sustains a fall requiring a cast, she has become agitated and combative with the physical therapist and with staff who try to clean the area. She does not understand why her normal routine has changed and why staff needs to touch a painful area of her body. 14

15 Criteria for COS evaluations: Residents not previously identified by PASRR Referral for Level II Resident Review evaluations are required for residents who may not have previously been identified by PASRR to have mental illness, mental retardation, or a condition related to mental retardation in the following circumstances: (Please note this is not an exhaustive list.) exhibits behavioral, psychiatric, or mood related symptoms suggesting the presence of a diagnosis of mental illness (and dementia is not the primary diagnosis). mental retardation or condition related to mental retardation was not previously identified and evaluated through PASRR. transferred, admitted, or readmitted to a NF following an inpatient psychiatric stay or equally intensive treatment. 15

16 Questions and answers 16 CONFIDENTIAL

17 What s next? Educate NFs in your state about change of status guidelines. Ensure NFs know who to contact when they believe a PASRR CoS resident review might be necessary. Create a notification form that allows your state to identify trends and analyze in status change reporting Be ready to use the data available under MDS 3.0! 17

18 Resources CMS MDS PASRR training slides and The Assessment Schedule for the RAI: ingmaterials.asp You tube video of MDS section A training: Video for interviewing vulnerable elders Slides prepared by Breck Douglas (9/10)