NF PTAC March 13, 2018 PASRR. Specialized Services

Transcription

1 NF PTAC March 13, 2018 PASRR Specialized Services

2 Session Topics Hot Topics: Certification Form 1013 Issues Errors on PL1s NFSS Status Technical Support 2

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4 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 4

5 Didn t Certify? What happens if you don t certify on the PL1 Section D part N? PASRR Quality Monitoring staff runs reports showing cases where section D part N is blank on positive PASRR cases. Survey staff may cite facilities who have not completed the required certification. 5

6 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. 6

7 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. 7

8 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. 8

9 The Alert 9

10 Able or Unable 10

11 Confirm Selection 11

12 Section D 12

13 Admitting on PL1 13

14 Admit Screen 14

15 Section D Date of Entry 15

16 SimpleLTC process: Certify PL1

17 SimpleLTC process: Certify PL1

18 Form 1013 What is it for? Where can you find it? regulations/forms/ /form request-change-a-negative-pasrrlevel-1-pl1. Read the instructions. Fill out the form completely and legibly Attach supporting documents 18

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20 Errors on the PL1 Sometimes the information you get on the PL1 is not correct: Name Spelling DOB SSN Medicaid # Verify before you data entry information into the portal. Check it again after you enter it. 20

21 NFSS-FAQ 21

22 What is the status? DME/CMWC Therapies Pending state review Pending denial Pending state review Approved/Denied (ends here) SAS request pending Process Complete Pending state review Pending denial Pending state review Approved/Denied (ends here) Pending NF receipt Pending state confirmation Submitted to SAS SAS request pending Process Complete

23 What is the status? WHEN THE STATUS IS PENDING STATE REVIEW IT IS STILL IN THE PASRR REVIEWER S WORKFLOW AND THEY HAVE NOT GOTTEN TO IT YET. THE NF WILL RECEIVE AN ALERT WHEN THE STATUS CHANGES. When the status is Provider Action Required (PAR) : the NF Provider must take action on their side in order to move the request along. To know what action they need to take, they need to review the code in the PTID Notes.

24 What is the status? The NF provider must look up the code and suggested action in the LTC Nursing Facility/Hospice User Guide found on the TMHP website and look for the corresponding code in the Provider Workflow Rejection Messages section:

25 Getting Help ing us is the best way to get the answers you need. s can be viewed by more than one staff. You get a response in writing. You can include more information to help us identify solutions. 25

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27 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 27

28 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. 28

29 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. 29

30 Referring Entities and PL1s Contact MI PASRR at if you encounter problems getting the PL1 upon an admission from a hospital. Contact IDD PASRR at PASRR.Support@hhsc.state.tx.us if you encounter problems with nonhospital referring entities. 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 sessions: May 8 July 10 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