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PASARR TRAINING 2018

PASARR TRAINING 2018. Amy Hubbard, MSW Director of Clinical Services Behavioral Consulting Services.

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PASARR TRAINING 2018

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  1. PASARR TRAINING 2018 Amy Hubbard, MSW Director of Clinical Services Behavioral Consulting Services

  2. Preadmission Screening and Resident Review (PASARR) is a federally mandated process to help ensure that individuals are not inappropriately placed in nursing homes for long term care.  PASARR requires that all applicants to Medicaid-certified nursing facilities must be  1) evaluated for a mental illness and/or development disability; 2) offered the most appropriate setting for their needs; and 3) receive the services they need in that setting.  All applicants to Medicaid-certified nursing facilities must be given a preliminary assessment to determine whether they might have a mental illness or development disability.  This screening is called a "Level 1" screen.  Individuals who test positive at level one then require a more in-depth screening called a "Level 2" PASARR.  The results of the Level 2 evaluation determine need, appropriate setting, and need for specialized treatment for the individual's mental illness or intellectual disability.

  3. CONTACT INFORMATION Behavioral Consulting Services 1533 Wisconsin Avenue Grafton, WI 53024 BCS website: www.behavioralconsultingservices.com Phone: 262-376-1224 Fax: 262-376-0928 262-376-0948 262-474-0027 262-474-0028 Donna Wrenn, PASARR Contract Administrator 608-266-7072 Website to download Level I screens: dhs.wisconsin.gov/forms Search for form number: F-22191 For PASRR definitions and resources go to dhs.wisconsin.gov and search PASRR.

  4. Per State of Wisconsin DHS website: • PASRR REQUIREMENTS • Purpose: To ensure that individuals who have a mental illness or who have an intellectual/developmental disability (mental retardation): • Are placed in a nursing facility only when their needs: • a) Cannot be met in an appropriate community placement (note: there are many persons who may qualify for a Title 19 care level whose needs can be met in an appropriate community placement --- PASRR prohibits the admission or retention of such individuals in a nursing facility under circumstances described later); and • b) Do not require the specialized care and treatment of an inpatient psychiatric hospital or ICF/IID placement. • 2) Receive appropriate treatment (specialized services) for their mental illness or developmental disability if their independent functioning is limited due to their disability. • Applicability: The federal PASRR statutes and regulations apply to all individuals who are seeking admission to a nursing facility and all residents of a nursing facility, irrespective of source of payment. The PASRR process only applies to Medicaid certified (Title 19) nursing facilities. PASRR does not apply to hospitals, Medicare certified only nursing facilities, DHS 132 licensed only nursing homes, ICFs/IID, or group homes (CBRFs and adult family homes). PASRR will apply to individuals who are seeking admission to a nursing facility, but currently reside in a group home, ICF/IID, etc.

  5. OUTLINE FOR TODAY • Why are Level I screens necessary? • Who is responsible for the completion of Level I screens? • When should a Level I referral be made for a Level II? (diagnoses and time-frames) • Discuss encrypted emails (how is this going?) • Should situational depression (also known as adjustment disorder or reactive depression)be referred for a Level II? • When should anxiety with a PRN medication be referred? • Should dementia with depression (anxiety/psychosis) be referred for a Level II? • What are Specialized Services/Specialized Psychiatric Rehabilitative Services. Where to finds resources for these determinations on the state website. • What documentation is needed for a Level II? (Level I, dx list, med list, psych eval/notes, nursing notes, social history, face-sheet, H&P, parts of MDS)

  6. PASARR reminders • The PASARR process is to screen for a mental illness (MI) or intellectual disability (ID), not a review process for medications. • The PASARR process makes 2 determinations: 1) Nursing Home placement (yes or no) 2) Specialized Services (yes or no - whether or not an individual is in need of intensive psychiatric services for for their MI or ID while in the NH.) • Nursing Homes need a corresponding diagnosis for every medication that is prescribed. This should be clearly documented prior to NH admission.

  7. Case examples • Myocardial infarct • ESRD • Diabetes • History of breast and bladder cancer • Degenerative joint disease • Osteoporosis • Depression – receives prozac • Arthritis

  8. Case examples • Anxiety – receives ativan PRN (about 10x in past 30 days) • Depression – receives celexa • Hypertension • Congestive heart failure • Parkinson’s • Cardiomyopathy • Chronic obstructive pulmonary disease

  9. Case examples • Osteopenia • Anemia • Congestive heart failure • Chronic obstructive pulmonary disease • Myocardial infarct • Hypertension • Aortic aneurysm • Cardiomegaly • Depression – no meds, no signs or symptoms

  10. Case examples • Dementia with hallucinations – receives haldol • Chronic obstructive pulmonary disease • Degenerative joint disease • Congestive heart failure

  11. Case examples • Congestive heart failure • Chronic obstructive pulmonary disease • Atrial fib. • Dementia • Chronic kidney disease • Diabetes • Anxiety – receives ativan PRN (15/22 days)

  12. Case examples • Alcohol abuse / withdrawal – receives ativan • Dementia with behaviors – receives haldol and celexa • Cirrhosis • Chronic kidney disease • Degenerative joint disease • Hypertension • Anemia

  13. Case examples • Diabetes • Hypertension • Congestive heart failure • End stage dementia • Receives trazadone for sleep

  14. Case examples • Cancer • ESRD • Hyperlipidemia • Spinal stenosis • Osteoarthritis • Receives remeron for appetite

  15. Case examples • Schizophrenia – receives zyprexa • Parkinson’s • Diabetes • Hypertension • Degenerative joint disease • Cardiomyopathy • Receiving hospice services

  16. Case examples • Osteopenia • Osteoarthritis • Dementia with depression – receives celexa • Chronic obstructive pulmonary disease • Congestive heart failure • Spinal stenosis • Kyphosis

  17. Case examples • Prostate cancer with mets • Hospice is involved • Osteopenia • Arthritis • Hypertension • Anxiety – recevies PRN ativan 2x in 30 days

  18. Case examples • Diabetes • Cerebrovascular accident • Osteoporosis • Degenerative joint disease • Hypertension • Situational depression – receives citalopram (diagnosed 1 ½ years ago) • Dementia with anxiety – receives xanax

  19. Case examples • Diabetes • Cerebrovascular accident • Hypertension • Osteopenia • Depression – no meds (symptoms are present) • Congestive heart failure • Chronic obstructive pulmonary disease • Atrial fib.

  20. Case examples • Right hip fracture • Recent fall • Cerebrovascular accident • Myocardial infarct • Situational depression – receives zoloft (diagnosed 1 month ago) • Osteoarthritis

  21. Case examples • Alcohol dementia • Atrial fib. • Anxiety - receives xanax on a routine basis • Osteoarthritis • Congestive heart failure • Cardiomegaly

  22. Case examples • Schizophrenia – no medications, no symptoms • Degenerative joint disease • Cancer • ESRD • Fractured right hip

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