The Indiana PASRR Level II Process A Powerful Tool in Long-Term Care

1. The Indiana PASRR Level II ProcessA Powerful Tool in Long-Term Care National PASRR Conference Indianapolis, IN March 25, 2014 Willard Mays, M.A. National Association of PASRR Professionals

2. Administration on Aging “ It is estimated that only half of older adults who acknowledge mental health problems receive treatment from any health care provider, and only a fraction of those receive specialty mental health services.”

3. Nursing Homes are Key Players! • Of all older adults that are institutionalized with mental illnesses 89% are in NFs 1 • More than 500,000 (Excluding Dementia) 2 • Older Adults with SMI are 3 times more likely to be admitted to NFs than those without SMI 3 & stay longer (46.6% vs. 24.1% @ 90 days)2 • Although only about 5% of older adults are in nursing homes, two-thirds of these residents have some kind of mental disorder 4 1. US DHHS, 1999) 2. Fullerton et al., (2009) 3. Bartels et al., (2000), 4. Smyer et al.,(1994)

4. Nursing Homes are Key Players! • Most common MH disorders in NFs: Dementia complicated by behavioral symptoms, mood disorders, anxiety disorders, and serious mental illnesses such as schizophrenia and psychotic disorders • Federal and State regulations require NFs to provide or arrange for services to meet the needs of their residents. This applies to MH needs as well as physical health needs!

5. What Are The Types of Reviews? • Preadmission screening (PAS) • Level I – Everyone • Level 2 – MI and/or MR/DD • Significant change RR • Significant change in physical or mental condition • Based on MDS • NF judgment call • Yearly RR • Previously determined to be MI and in need of MH services and all residents with MR/DD, and • Residents with MI not currently being served by CMHC, and • Identified by CMHC as needing yearly RR • Residents who were missed

6. PAS Agency Responsibilities • Performstate required PAS • Assure that Level I is completed for all Medicaid Certified NF applicants • Determineif Level II review is necessary and, when review is needed, notify applicant and refer to: • CMHC for MI, or • Diagnostic & Evaluation (D&E) Team for MR/DD or MI/MR/DD • Reviewevaluation information and determine if the NF applicant is: • Appropriate for NF admission; and • In need of specialized services. • Issue Form 4B and send 4B, Level II evaluation & recommendations, certification, and related paperwork to NF and CMHC or BDDS

7. CMHC Responsibilities Perform Preadmission Screening (PAS) reviews as needed • Complete Level II reviews within 4 day average turnaround time from written notification (PAS Agency) • Determine if future Yearly RR’s are necessary Perform Resident Reviews (RR) as needed • Complete paperwork and transmit assessment data to Division of Aging • Provide NF with cover letter, certification, and copy of Level II evaluation and recommendations

8. CMHC Responsibilities • Yearly RR • Limited to residents previously identified as MI and in need of MH services and not currently being served by the CMHC • Determine if future RR’s are necessary • CMHC does tracking and scheduling • Reassessment (if needed) in same calendar quarter • Significant Change RR • 4 day average turnaround time from written notification (NF) • Determine if future RR’s are necessary • Residents that were missed • Same as significant change process except for time frames; Level II must be completed within 30 calendar days following referral

9. CMHC Responsibilities • Identifyassessors to Division of Aging • Assure that assessors are appropriately trained • Notifyappropriate CMHC of resident transfer (when notified by NF) • Comply with FSSA rules and regulations (DMHA contract, PASRR manual, Medicaid bulletins, etc.) • NotifyDepartment of Health when NF is out of compliance

10. CMHC Take-Aways • The NF applicants and residents that receive PASRR Level II reviews are not “clients” of the CMHC. The CMHC is performing an administrative function on behalf of the State so that appropriate placement and service decisions can be made. • If the CMHC is later contacted for services for the resident, the individual becomes a client. • The PASRR Level II may be the only mental health assessment the person has ever had!

11. Nursing Facility Responsibilities • Comply with Federal CMS MDS and PASRR requirements • Completed Level I in every resident file • New MDS when there is a significant change in condition (up to 14 days) • Develop and implement new plan of care (7 days) • Based on above, determine if new Level II review is needed (within 21 day total) • Notify CMHC or BDDS in writing if new review is needed • Promptly notify CMHC or BDDS if previously identified MI or MR/DD resident has been admitted, discharged or transferred • Provide list of identified MI andMR/DD residents to HP Enterprise Services

12. Nursing Facility Take-Aways • Follow up on PAS and RR service recommendations • The PASRR Level II recommendations should be a major resource in the development of the resident’s plan of care • Requesting a PASRR Level II is not the same thing as accessing or providing services for the resident. Priority #1 is to get the residents the services they need!

13. Division of Aging Responsibilities • Coordinatewith the Indiana State Department of Health and HP Enterprise Services to assure that a sample of residents identified as having MI and/or MR/DD, and in need of services, are included in surveys • Maintain list of identified assessors (by CMHC) • Provide or arrange appropriate training • QA program • Maintain data

14. Indiana State Department of Health Responsibilities • Identify PASRR residents as target group for surveys • Hold NF accountable for providing or arranging services to meet residents MH needs

15. HP Enterprise Services Responsibilities • Send out Medicaid Bulletins • Determine if NF followed through with responsibilities • Identify residents who were missed or otherwise need RR Roeing Inc. • Data Management