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PASRR
Specialized Services
NF PTAC March 13, 2018
Session Topics
Hot Topics:
• Certification
• Form 1013 Issues
• Errors on PL1s
• NFSS Status
• Technical Support
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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
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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.
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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.
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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.
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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.
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The Alert
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Able or Unable
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Confirm Selection
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Section D
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Admitting on PL1
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Admit Screen
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Section D Date of Entry
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SimpleLTC process: Certify PL1
SimpleLTC process: Certify PL1
Form 1013
What is it for?
Where can you find it?
https://hhs.texas.gov/laws-regulations/forms/1000-1999/form-1013-request-change-a-negative-pasrr-level-1-pl1.
Read the instructions.
Fill out the form completely and legibly
Attach supporting documents
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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.
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NFSS-FAQ
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What is the status?
Therapies
• Pending state review
• Pending denial
• Pending state review
• Approved/Denied (ends here)
• SAS request pending
• Process Complete
DME/CMWC
• 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
What is the status?
• 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.
• 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.
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:
Getting Help
Emailing us is the best way to get the answers you need.
Emails can be viewed by more than one staff.
You get a response in writing.
You can include more information to help us identify solutions.
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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
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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.
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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.
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Referring Entities and PL1s
Contact MI PASRR at [email protected] if you encounter problems getting the PL1 upon an admission from a hospital.
Contact IDD PASRR at [email protected] if you encounter problems with non-hospital referring entities.
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SS
IDT
PE
PL1Seeking
Admission
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Ref
erri
ng
Enti
ty (
RE)
PA
SRR
Lev
el 1
(P
L1)
Nu
rsin
g Fa
cilit
y (N
F)P
ASR
R L
evel
1(P
L1)
LID
DA
/LM
HA
PA
SRR
Eva
luat
ion
(P
E)
Div
ersi
on
/Tr
ansi
tio
nPre-Admission Screening and Resident Review
Process Begins
Referring Entity completes the PL1
§17.301
Is the PL1 positive or negative?
Positive
Negative
Nursing Facility enters the Positive PL1 into the portal
for:Expedited
Admissions and Exempted Hospital
Discharges §19.2704
Authority enters the PL1 into the portal
for:Positive Pre-Admissions
§17.302
NF Certifies able/unable to serve in
portal
NF Convenes IDT within 14 days of
admission meeting with resident, LAR, RN,
and LIDDA/LMHA§19.2704(i)(2)
NF Initiates specialized services
by submitting request to DADS
within 20 business days after date of
IDT§19.2704(i)(7)(A)
NF documents IDT in the
portal within 3 business days
of meeting date
§19.2704(i)(5)
NF delivers specialized
services within 3 days after
approval
Completes PE within 7 days
after receiving a copy of the PL1 from the
RE or notification
from the portal
§17.302
Positive
If PE is Positive, confirms
participation in IDT and specialized
services agreed to within 5 business days of meeting
§17.302(c)(3)
Assign a Service Coordinator, § 17.501(a)
Convene a Service Planning Team Meeting
(SPT) § 17.501(b)(1)(B) and develop an individual
service plan (ISP) §17(b)(1)(c)
SPT develops, revises, implements,
and monitors a transition plan as
necessary§ 17.503
SC conducts monthly monitoring and quarterly service planning visits w/i
first 180 days after the individual moves into a Medicaid community
program § 17.501(b)(1)(A)
CLO DiversionsLA discusses
community living options with resident/LAR
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§17.501(2)(B)
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
§17.503(a)(1)
True DiversionsFamily, acting as the RE, contacts the LA
prior to the individual ever entering the NF
Nursing Facility enters the PL1 into the portal
for: Negative Pre-
Admissions and admits the individual into the
NF§19.2704
Positive Pre-
Admission
Pre-Admission
Exempted hospital
discharge and
expedited
CLO – Community Living OptionsIDT- Interdisciplinary Team
LIDDA-Local Intellectual and Developmental Disability Authority
LMHA-Local Mental Health AuthorityLAR – Legally Authorized Representative
MDS-Minimum Data SetNF-Nursing Facility
PE – PASRR Evaluation (PL2)PL1- PASRR Level 1
SPT- Service Planning TeamSC-Service Coordination
Annually documents in
LTC Online Portal all
specialized services being
provided§19.2704(i)(8)
Revised 11/28/17
If NF certifies “unable to serve”
contacts the LIDDA/ LMHA who will assist in finding
alternate placement
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MEDICARE/MEDICAID REQUESTS FOR PT/OT/SPEECHM
edic
are
On
lyM
edic
are
wit
h M
edic
aid
Pen
din
gM
edic
are/
Med
icai
d –
(Fu
ll D
ual
El
igib
le)
Phase
Medicare Only:ID/DD
IDT held(note on IDT resident is Medicare
only)
No Medicaid Service
Coordination No SPT
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
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
Specialized Services
identified and alternate funding
sources are discussed
5-17-2017
Resources
Code of Federal Regulations for PASRR-42 CFR 483.100-138:
http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=11a937aed017d1ada834f32ad51fc20e&mc=true&n=sp42.5.483.c&r=SUBPART&ty=HTML#se42.5.483_1112
PASRR rules pertaining to NFs:
http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=1&ch=19&sch=BB&rl=Y
PASRR rules pertaining to LIDDA/LMHAs:
http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=17
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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
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Training - Cont’d
PASRR training including WBTs can be found at:
https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/preadmission-screening-resident-review-pasrr/pasrr-training
Specialized Services Training:
https://attendee.gotowebinar.com/recording/8706031307509441538
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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
https://www.simpleltc.com/texas-pasrr-resources/
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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
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PASRR Contact Information
IDD PASRR
PASRR Hotline: 1 (855) 435-7180
or
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