Understanding PASRR for PCS Request Processing in Adult Care Homes

1. Preadmission Screening and Annual Resident Review Verification (PASRR) May 2014

2. Objectives: To gain a greater understanding of PASRR and how it effects PCS. To become knowledgeable of the internal processes Liberty follows in order to obtain a PASRR for processing of a PCS request.

3. What is PASRR? The Preadmission Screening and Annual Resident Review (PASRR) is a review of anyindividual who is being considered for admission into a Medicaid Certified Adult Care Home. As required by the US Department of Justice Settlement Agreement effective January 1, 2013, individuals requesting admission to Adult Care Homes (ACH) must be pre-screened for serious mental illness (SMI). The North Carolina Department of Health and Human Services (DHHS) is the agency that provides a Level I screening, conducted by an independent screener forall applicants to Adult Care Homes licensed under G.S. 131D, Article 1 to identify beneficiaries withSMI.

4. PASRR: Application Process; Level 1 Screening The PASRR process is only required for Medicaid eligible individuals. The primary physician or referring agency’s appropriate clinical staff completes the Medicaid Uniform Screening Tool (MUST), and the family is provided with the opportunity to provide input. The individual completing the MUST form must be familiar enough with the beneficiary’s mental health status and history to provide accurate information required by the screening form. If there is clearly no evidence of SMI, a PASRR number will be generated automatically by the MUST. If the individual meets the criteria and the individual chooses to reside in an adult care home, the admission process can begin.

5. PASRR: Application Process; Level 2 Screening If there is any indication of SMI, additional information will be required through a manual review process, in which the applicant will be referred for a level II face-to-face evaluation. If a Level II evaluation is needed, the PASRR contractor notifies the referral source that a Level II PASRR evaluation is required and requests, if applicable, that medical records be available for the on-site evaluation by a qualified mental health professional (QMHP).

6. PASRR Application Process: Level 2 Screening (Cont.) The Level 2 screening process is as follows: A face-to-face, in-depth assessment is performed by the QMHP. The completed Level II evaluation with recommendations is then forwarded to DHHS. After the completion of the Level II evaluation, DHHS makes the final determination for placement and services. A PASRR number is assigned, and if an adult care home is determined to be the appropriate Level of Care, copies are sent to appropriate sources. A certified notification of the determination and other available options are mailed by the PASRR contractor to the beneficiary/responsible party.

7. PASRR: Application Process: Contacts Questions? PASRR contractor: The Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS) N.C. Division of Mental Health/Developmental Disabilities/Substance Abuse Services (DMH/DD/SAS) has identified staff to serve as liaisons to provide technical assistance, answer questions, and assist with locating PASRR Level I Screeners: Barbara Flood – EAST - 919-218-3872, barbara.flood@dhhs.nc.gov Patricia McNear – CENTRAL – 919-981-2580, patricia.mcnear@dhhs.nc.govBill Joyce – WEST – 336-312-0212, bill.joyce@dhhs.nc.gov SandeeResnick- Accountability Team Leader - (919) 981-2580

8. Who Does Not Need A PASRR? The following beneficiaries do NOT require a PASRR: Beneficiaries who have been admitted into an ACH prior to January 1, 2013, regardless of payer source (Private, Medicaid, or pending Medicaid). Beneficiaries who reside in a 5600a or 5600c facility type.

9. PASRR and PCS Clinical Coverage Policy 3L (3.2.3b) remains in effect and requires that a Medicaid beneficiary residing in or applying for admission to an ACH be screened for serious mental illness using the PASRR prior to an assessment for PCS. Adult Care Home providers licensed under G.S. 131D-2.4 will not receive prior approval to render or bill for PCS without verification of a PASRR number. Important Note: This is not required for beneficiaries residing in an ACH who are currently receiving PCS.

10. PCS Requests and PASRR If the facility is a 5600a, 5600c, or the beneficiary was admitted into the facility prior to January 1, 2013, a note on the top of the request form would help (include admission date) to prevent any delay in the processing of the PCS request. Facilities:

11. Recommendations for entering PASRR number on DMA 3051 Enter in Section A: Recipient Demographics in blank space to the right of Medicaid ID # Print Legibly: PASRR # 10-digit Alpha and effective date

12. PASRR and PA Effective Dates For beneficiaries requiring a PASRR, PAs become effective when: If a PASRR is effective on the date the PCS request is received or prior, PAs will be effective the date of the request. If the PASRR is received within 30 days from the request received date, then the PAs will become effective the date the PASRR became effective. If no PASRR is received within 30 days of the PCS request, then Liberty will send a technical denial for PCS.

13. PASRR Verification Liberty Healthcare will verify a PASRR has been approved on every new ACH PCS request. Verification is confirmed through the NCMust system. If unable to verify a PASRR through the NCMust system, Liberty will call the facility in an attempt to obtain a PASRR. If a PASRR is not required, Liberty Healthcare will request the admission date (if prior to 1.1.13) through a copy of an FL2 or any other documentation that reflects the admission date or have the facility confirm they are a 5600a or 5600c.

14. THANK YOU FOR YOUR INTEREST INPASRR