NF PTAC Dec 12, 2017 PASRR. Specialized Services

Transcription

1 NF PTAC Dec 12, 2017 PASRR Specialized Services

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3 Session Topics Hot Topics: Certification Revised Chapter 19 BB Rules Taking charge of your PASRR knowledge Reminders: IDT membership Preadmission Referring Entity Issues 3

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5 Certification NFs must indicate they can meet the individuals needs identified on the PE This indication is completed on the PL1 after a positive PE has been submitted An enhancement was developed to send two alerts to the NF to remind them to compete the certification requirement 5

6 Didn t Certify? What happens if you don t certify on the PL1 Section D part N? PASRR Quality Monitoring staff will run reports showing cases where section D part N is blank and the individual appears to be in the NF. Survey staff may cite facilities who have not completed the required certification. 6

7 Didn t Certify or Admit? What happens if you don t certify you can meet the needs or admit the individual on the PL1 section D parts N and O? When the PL1 was submitted as a Preadmission type of admission, the NF accepting the individual must complete both sections D parts N and O. 7

8 Didn t Certify or Admit Continued Facilities may be cited for failure to certify. After 90 days, if section D parts N and O have not been completed, the status of the PL1 will change to NF Placement Exhausted. When this happens, the NF will not be able to submit requests for services using the NFSS process. The PL1, PE and IDT will have to be completed again. 8

9 How do I certify/admit? TMHP shows buttons on the yellow toolbar for the PL1. When a positive PE has been submitted the Able to Serve and Unable to Serve buttons will be available. The NF should click on the appropriate button. If Able to Serve is selected the Admitted selection will be available to allow you to enter a date in Section D part O. 9

10 Revised NF Rules Revisions were made to Chapter 19, Subchapter BB: dtac$ext.viewtac?tac_view=5&ti=40& pt=1&ch=19&sch=bb&rl=y 10

11 Be Educated Purpose Limitation on Charges for Nursing Facility Services Definitions Nursing Facility Responsibilities Related to PASRR Nursing Facility Responsibilities Related to the Fair Hearing Process Nursing Facility Responsibilities Related to a Designated Resident Transition Activities Related to Designated Residents Educational and Informational Activities for Residents Incident and Complaint Reporting 11

12 Be Educated Continued Nursing Facility Specialized Services for Designated Residents Requesting Authorization to Provide Therapy Services Qualifications of a Provider of Therapy Services Payment for Therapy Services Requesting Authorization to Provide Durable Medical Equipment and Customized Manual Wheelchairs Payment for Durable Medical Equipment and Customized Manual Wheelchairs Administrative Requirements for Durable Medical Equipment and Customized Manual Wheelchairs 12

13 Important Changes Besides the new rules for PASRR specialized services some changes were made to RULE Nursing Facility Responsibilities Related to PASRR. 1. (7) submit a complete and accurate request for nursing facility specialized services in the LTC Online Portal within 20 business days after the date of the IDT meeting; 2. (8) start providing a therapy service within 3 business days after receiving approval from HHSC in the LTC Online Portal; 13

14 Important Changes Continued Rule concerning Requesting Authorization to Provide Durable Medical Equipment and Customized Manual Wheelchairs (d) After a nursing facility submits a request for authorization to provide DME or a CMWC to a designated resident: (1) the nursing facility receives a written approval or denial of its request through the LTC Online Portal; and (2) HHSC notifies the designated resident or the designated resident's LAR that the request has been approved or denied. (e) If HHSC approves a request to provide DME or a CMWC to a designated resident, the nursing facility must order the DME or CMWC from a DME supplier within 5 business days after receiving notification of the approval through the LTC Online Portal. (f) If HHSC denies a request to provide DME or a CMWC to a designated resident, the designated resident may request a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules), to appeal the denial. 14

15 Taking Charge! PASRR is ever evolving and changing to meet the needs of the people we serve. You must educate yourself and those you manage: Read the rules Take the trainings Use the TMHP/Simple LTC guides Develop binders/training for new hires Ask Share 15

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17 The IDT The IDT and your LTCMI are linked. Knowing when an IDT is needed, keeping the meeting dates current, inviting the required members and submitting the IDT form accurately and timely will help you to avoid citation and submit your LTCMI on time. 17

18 Who Needs An IDT Meeting? IDT meetings are required for individuals: with a confirmed positive PE and who are not enrolled in Hospice care regardless of their age or payor source An IDT meeting must also be conducted for these individuals annually. 18

19 IDT Members? At a minimum the required members of the PASRR IDT are: The individual The Legally Authorized Representative (if applicable) The RN from the NF The LA staff as indicated by the individual s PASRR eligibility (IDD/MI) 19

20 Invalid IDTs If the required members are not in attendance (by phone or in person) and in the case of the individual or LAR, there is not documentation of efforts made to invite them, the IDT is considered invalid. Federal Requirements instruct States as to who has to attend PASRR IDT meetings. 20

21 LTCMI/IDT What do you do when you try to submit your LTCMI but the system does not find an IDT current within the past 12 months? Is the individual discharged? If so, enter discharge in section B of the PL1 and submit the update. Is the date of the last IDT older than 12 months from the date of the LTCMI submission? Conduct an annual IDT 21

22 LTCMI/IDT Continued Is there an IDT submitted for an individual who is still in your facility? If not, schedule the initial IDT. Do not conduct a meeting without the appropriate LA staff in attendance. Do not conduct a meeting without the RN from the NF in attendance. Do not record that the LA staff and/or the RN were in attendance if they were not there. 22

23 SS Who Qualifies? Individuals who qualify for PASRR Specialized Services: have a diagnosis of mental illness or an intellectual disability with onset before age 18 or developmental disability (related condition) with onset before age 22 reside in a Medicaid-certified NF have a confirmed positive PARR Evaluation (PE) receive Medicaid are 21 years of age and older. 23

24 Services on the IDT The PASRR IDT form is to record PASRR specialized services only. The slide before this one provides instruction on who qualifies for SS. If someone does not have Medicaid or is younger than 21, the IDT meeting is still held. Use the comment box to record non-pasrr services. 24

25 Preadmission Any admission from the community that is not expedited or exempted (i.e.: psychiatric hospital, home, group home, assisted living, jail) If the PL1 screening is negative: RE sends PL1 to NF with individual NF admits individual and submits PL1 into the LTC Portal 25

26 Preadmission Continued If the PL1 screening is positive: RE faxes PL1 to LA this starts the 72 hour timer for the LA to meet face to face with the individual LA submits the PL1 into the LTC Portal LA completes and submits the PE into the LTC portal within 7 days NF reviews PE and certifies on the PL1 if they are Able or Unable to serve individual before the individual is admitted 26

27 Referring Entities and PL1s Contact MI PASRR at if you encounter problems getting the PL1 on or before an admission from a hospital. Contact IDD PASRR at PASRR.Support@hhsc.state.tx.us if you encounter problems with nonhospital referring entities. 27

28 NF Responsibilities The NF Responsibilities Checklist we have given out before has been revised. Please see the handout provided by SimpleLTC. This checklist can be used to check off requirements to make sure you are in compliance. 28

29 Working Together Collaborative and respectful relationships must be developed between all parties involved in PASRR in order to ensure the individual receives services in the most appropriate settings. Page 29 35

30 Other Information PASRR Flow Chart Medicaid/Medicare Requests for PT/OT/Speech Resources Training Contact Information 30

31 Seeking Admission PL1 PE IDT SS 31

32 Referring Entity (RE) PASRR Level 1 (PL1) Positive Process Begins Referring Entity completes the PL Pre-Admission Screening and Resident Review Is the PL1 positive or negative? Negative Pre- Admission Positive Exempted hospital discharge and expedited CLO Community Living Options IDT- Interdisciplinary Team LIDDA-Local Intellectual and Developmental Disability Authority LMHA-Local Mental Health Authority LAR Legally Authorized Representative MDS-Minimum Data Set NF-Nursing Facility PE PASRR Evaluation (PL2) PL1- PASRR Level 1 SPT- Service Planning Team SC-Service Coordination True Diversions Family, acting as the RE, contacts the LA prior to the individual ever entering the NF Nursing Facility (NF) PASRR Level 1(PL1) LIDDA/ LMHA PASRR Evaluation (PE) Positive Pre- Admission Nursing Facility enters the PL1 into the portal for: Negative Pre- Admissions and admits the individual into the NF Authority enters the PL1 into the portal for: Positive Pre- Admissions Nursing Facility enters the Positive PL1 into the portal for: Expedited Admissions and Exempted Hospital Discharges Completes PE within 7 days after receiving a copy of the PL1 from the RE or notification from the portal NF Certifies able/ unable to serve in portal CLO Diversions LA discusses community living options with resident/lar NF Convenes IDT within 14 days of admission meeting with resident, LAR, RN, and LIDDA/LMHA (i)(2) If NF certifies unable to serve contacts the LIDDA/ LMHA who will assist in finding alternate placement NF documents IDT in the portal within 3 business days of meeting date (i)(5) If PE is Positive, confirms participation in IDT and specialized services agreed to within 5 business days of meeting (c)(3) NF Initiates specialized services by submitting request to DADS within 20 business days after date of IDT (i)(7)(A) Assign a Service Coordinator, (a) Convene a Service Planning Team Meeting (SPT) (b)(1)(B) and develop an individual service plan (ISP) 17(b)(1)(c) NF delivers specialized services within 3 days after approval Annually documents in LTC Online Portal all specialized services being provided (i)(8) While the resident is in the NF, the SC will facilitate the initiation of LIDDA specialized services and coordination of the resident s specialized services with the SPT (2)(B) Diversion/ Transition Resident wants to move to the community. Referrals for alternate placement come from relocation specialist, ombudsman, Section Q of MDS, the PE, or the resident (a)(1) SPT develops, revises, implements, and monitors a transition plan as necessary SC conducts monthly monitoring and quarterly service planning visits w/i first 180 days after the individual moves into a Medicaid community program (b)(1)(A) 32 Revised 11/28/17

33 MEDICARE/MEDICAID REQUESTS FOR PT/OT/SPEECH Phase Medicare Only Medicare Only: ID/DD IDT held (note on IDT resident is Medicare only) Specialized Services identified and alternate funding sources are discussed No Medicaid Service Coordination No SPT Medicare with Medicaid Pending Medicare with Medicaid Pending: ID/DD IDT held (note on IDT resident is awaiting Medicaid) TMHP issues alert when resident s Medicaid # is assigned Service Coordinator convenes SPT to discuss initiation of Medicaid PASRR habilitation services once full eligibility is verified by contacting PASRR.Support@hhsc.st ate.tx.us Medicare/Medicaid (Full Dual Eligible) Medicare/ Medicaid Dual-Eligible (Full) IDT for new admissions/ SPT for current residents Rehabilitative Services through Medicare NF requests PASRR Habilitation OT/PT/ST (Medicaid) Service Coordinator monitors initiation/ delivery of all services 33

34 Resources Code of Federal Regulations for PASRR-42 CFR : 32ad51fc20e&mc=true&n=sp c&r=SUBPART& ty=html#se _1112 PASRR rules pertaining to NFs: _view=5&ti=40&pt=1&ch=19&sch=bb&rl=y PASRR rules pertaining to LIDDA/LMHAs: _view=4&ti=40&pt=1&ch=17 34

35 Training New PASRR NF-focused web-based trainings (WBTs) are on the HHS website. Anyone working directly with PASRR should take the trainings The trainings can be accessed at any time The WBTs test user knowledge and offer certificates upon completion 35

36 Training - Cont d PASRR training including WBTs can be found at: Specialized Services Training: rding/

37 More Training SimpleLTC maintains several recorded webinars about PASRR The information posted includes handouts, Q&A, slides, and minutes of any NF meetings or trainings 37

38 Webinars for NFs HHS/PASRR will conduct webinars to discuss various topics important to NFs. Completed sessions: slides, minutes and Q&A are now posted on SimpleLTC s website noted on previous slide Next session: February 13 All sessions are from 10:30-11:30 38

39 PASRR Contact Information IDD PASRR PASRR Hotline: 1 (855) or PASRR.Support@hhsc.state.tx.us 39

40 PASRR Contact Information MI PASRR 40