Colorado Pre-Admission Screening and

Resident Review (PASRR)

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September 2019

Our Mission

Improving health care access and outcomes for the people we serve

while demonstrating sound stewardship of financial resources

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Objectives

• Section 1 – PASRR Structure, Purpose, Roles and Data (Obi Agomoh)

• Section 2 – PASRR Portal & Process (eQHealth)

• Section 3 – PASRR for Individuals with Mental Illness (Becky Huckaby)

• Section 4 – PASRR for Individuals with Intellectual and Developmental Disability(Karli Altman)

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PASRR Structure, Purpose,

Roles and DataSection 1

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Colorado PASRR Operating Value

Person CenterednessA person-centered approach is one that respects and values individual preferences, strengths, and contributions.

Working with clients and families, not doing things to them or for them.

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Person Centered PASRR

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PASRR Individual

Level I Assessors

Level I Reviewers

Level II Evaluators

Quality Reviewers

State Authorities

CMS

State PASRR Vendor

Community Support

Before the PASRR Rule

• Inappropriate Placements (Restrictive environments)

• Inadequate Assessments and Care Plan

• Inadequate Provision of Services

• Discrimination based on disability

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Institutionalization of individuals with disability

PASRR Requirements• Ensure All applicants are screened before admission

• Educate providers about service/support needs

• Ensure diversion and transition when appropriate

• Make clear how individual can be best supported

• Ensure admitting facility can meet needs

• Build relationships

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What is PASRR?

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Structure & Purpose of PASRR? Preadmission Screening & Resident Review (PASRR)

• Administered by Centers for Medicare and Medicaid Services (CMS) –Created in 1987

• All applicants to Medicaid-certified nursing facilities must be screened for: Serious Mental Illness (SMI), Intellectual/Developmental Disability (ID/DD)

or Related Condition (RC)

• Known or suspected condition must trigger evaluation To ensure appropriateness of NF placement To ensure receipt of needed services

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Legal Responsibilities for PASRR

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Federal Authority: Centers for Medicare and Medicaid Services (CMS)• Publishes rules and guidance• Audits state compliance

State Medicaid Authority (HCPF)• Responsible for state PASRR compliance• Oversight of state PASRR policy• Level I by default• Funding PASRR activities

State Mental Health Authority (OBH)• Oversight of Level II PASRR activities• Cannot do evaluations• Writes the Letter of Determination (LOD)

State IDD Authority (HCPF)• Oversight of Level II PASRR activities• Can do the evaluations • Writes the Letter of Determination (LOD)

eQHealth: Delegated PASRR entity• Level I assessments Data collecting & Reporting• PASRR applications Level II evaluations and summary findings

PASRR History

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Change Act YearTitle XIX regulation published (Medicaid SSA 1965Creation of 1915 (c) Waivers SSA 1981PASRR regulation published OBRA 1987

Required start of PASRR by states 1989Americans with Disabilities Act ADA 1990PASRR Final Rules published 1992Incorporation at 42 CFR 483.100-138 1994Elimination of required PASRR Annual Resident Review BBA 1997Olmstead v. L.C. Supreme Court Decision 1999Establishment of 1915(i) Waivers, Money Follows the Person (MFP) DRA 2005Creation of 1915(k) Waiver, expansion of MFP ACA 2010Roll out of MDS 3.0 with Q.A1500 and Section Q 2010New Guidance regarding PASRR specialized services issued 2013

Ultimate Goal of PASRR

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Optimize an individual’s• placement success,• treatment success, and ultimately,

• an individual’s quality of life

3 Most Important PASRR Activities

1. Screen (to identify the person) Screen all applicants to a Medicaid-certified nursing facility for evidence of mental illness (MI) and/or intellectual and developmental disability (I/DD)

2. Place (where needs will be met)Ensure that individuals are placed appropriately (community, nursing facility, or other appropriate settings)

3. Serve (to meet unique needs)Ensure they receive the services they need in those settings

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Required PASRR Screenings

Level I Screen (Broad Screening)

• Screening to determine presence of MI or IDD/RC• Required for all applicants to Medicaid-certified NFs

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SEP

Level I Screen for Medicaid Clients

Nursing Facility

Non–Medicaid Clients from

Community or Pay Source Change

Hospital

Non–Medicaid Clients Admitted

to NF from Hospital

PASRR Assessments/EvaluationsPre–Admission Process

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• SNF, Hospital, Single Entry Point Agencies• Trigger, Non trigger, Refer for further review

Level I Identification Screen (PASRR Level I)

• Utilization Review Contractor• Exemptions and categorical decisions

Pre-Admission Screen Advanced Group Authorization

• Independent Evaluators• Face to face comprehensive individualized evaluations

Partial Level II Evaluation & Level II Evaluation (PASRR Level II)

PASRR Assessments/EvaluationsPost Admission Process

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• SNF must report to PASRR authority

Post Admission Level I Update (PAL I)/Change in Condition

• Follow-up assessment by Reviewer

Status Change/Resident Review

• Independent Evaluators• NF must address all PASRR identified services in care plan

Partial Level II Evaluation & Level II Evaluation (PASRR Level II)

Letter of Determination (LOD)Issued by the State Mental Health Authority (SMHA) or State Intellectual Disability Authority (SIDA)

• Final review of Level II by SMHA/SIDA

• Determines if the client meets a PASRR related condition

• Determines if the client meets NF level of care

• Determines what services are to be provided while the client is at NF and may be time limited

• The PASRR legal document that authorizes facility to admit client

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PASRR MandateFour Important Questions

1. Does the individual have a PASRR condition?

2. What is the most appropriate placement for this individual?

3. Might this individual be a candidate for transition to the community? (necessary supports/services)

4. What unique disability supports and services does this individual need while a resident of a NF to ensure safety, health, and well-being?

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PASRR Mandate

Question 1: Does the individual have a PASRR condition?

• Diagnosis (or suspicion of) a major mental illness, intellectual disability, related condition

• Dementia (if present, is it primary?)

• Duration

• Disability

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PASRR Mandate cont.Serious Mental Illness:

• A primary diagnosis of schizophrenic, paranoid, major affective, schizoaffective disorders or other psychosis

• Major diagnosis that is not primary dementia

• Level of impairment in major life activities within the past 3 – 6 months (due to diagnosis)

• Recent treatment more intensive than outpatient more than once within the past two years or experience of an episode of significant life disruption

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PASRR and Individuals with IDDStates must conduct the PASRR process based on current standards

• May differ from the state’s definition for MI or ID

• The federal definition of ID for PASRR was published in 1983

By the American Association on Intellectual and Developmental Disabilities (AAIDD)

• Definition requires an IQ score of less than 70

As measured by a standardized, reliable test of intellectual functioning

ID encompasses a wide range of conditions and levels of impairmentSowers, 2016

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PASRR and Individuals with IDD

• To qualify as having ID for the purpose of PASRR, an individual must also have concurrent impairments in adaptive functioning

• Whatever form it takes, ID must have emerged before the age of 18, and must be likely to persist throughout a person’s life

Sowers, 2016

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Possible PASRR Related Conditions

Anoxia at birth Encephalitis Multiple Sclerosis Quadraplegia

Arthrogryposis Fetal Alcohol Syndrome

Muscular Dystrophy Seizure Disorder

Autism Fredreich’s Ataxia Paraparesis Spina Bifida

Congenital Blindness Hemiparesis Paraplegia Spinal Cord Injury

Cerebral Palsy Hemiplegia Polio Traumatic Brain Injury

Congenital Deafness Klippel-Feil Syndrome

PDD XXY Syndrome

Down Syndrome Meningitis Prader-Willi Syndrome

Hydrocephaly

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Functional Limitations

Self-care Understanding and use of language

Learning

Mobility Self-direction Capacity for independent living

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Areas of major life activities:

PASRR Mandate cont.

Question 2: What is the most appropriate placement for this individual?

• Least restrictive level of care Too acute/not acute enough

• NF(meets LOC and this NF can meet needs) NF must incorporate all PASRR identified services into care plan

• Specialized Services Services specific to the person to meet required needs

• Alternative Placement or Community Services

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PASRR Mandate cont.

Question 3: Might this individual be a candidate for transition to the community? (necessary supports/services)

• Community placement With or without supports Independent living Group home Assisted living

• Person directed care

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PASRR Mandate cont.

Question 4: What unique disability supports and services does this individual need while a resident of a NF to ensure safety, health, and well-being?

• Specialized Services

• Highest practicable physical, mental, and psychosocial well-being

• Any needed service/support

Not limited to facility’s existing resources

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• State Intellectual Developmental Disability Authority (SI/DDA)• State Mental Health Authority (SMHA) • State Medicaid Agency (SMA)

• Intellectual or Developmental Disability (I/DD)• Mental Illness (MI)

Obi AgomohPASRR Administrator

(SMA)

Karli Altman(SIDA)

EvaluationDetermination

Oversight

Operating Agency

Functions (May be delegated)

I/DD MI

Becky Huckaby(SMHA)

Determination (Only)Evaluation

PASRR Colorado Structure

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eQHealth

Data

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Nursing Facilities (NFs) in ColoradoAbout 88% of NFs in Colorado are Medicaid Certified and required to participate in PASRR

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195

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Medicaid Certified NFs Others

PASRR Assessments/Evaluations

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Evaluation Types 2017-18 2018-19Categorical - 2a (Level I Reviews) 5502 5615

Level II Eval - 1a 1027 901

Partial Level II - 1b 188 142

Status Change Level II - 2c 1424 1203

Status Change Partial Level II - 2d 78 102

Status Change Phone Reviews - 2b 4701 4081

Total (MI Evaluations) 12,920 12,044

IDD Evaluations 181 129

Grand Total (IDD & MI) 13,101 12,173

MDS Survey

*Subtotals may not equal total due to varying responses on different MDS surveys for the same client. Source: MDS Data

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Unique Survey Counts SFY2015-16 SFY2016-17 SFY2017/18 SFY2018-19

Total MDS Surveys 21,026 21,140 21,868 20,424

Total with PASRR

Condition = "Yes" 2,462 2,881 3,221 3,174

Total with MI and DD 52 89 76 78

Total with MI 1,791 2,290 2,649 2,634

Total with DD 144 173 202 207

Other Conditions 215 335 279 232

Missing 369 110 116 89

Contact Information

Obi AgomohState PASRR Administrator

303-866-6873Obi.Agomoh@state.co.us

Department of Health Care Policy & FinancingOffice of Community Living

Case Management and Quality Performance Divisionwww.colorado.gov/hcpf/pre-admission-screening-and-resident-review-program

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PASRR Portal and ProcessSection 2

Transition to eQHealth Solutions

Effective September 1, 2019 all PASRR authorization requests will transition to eQHealth Solutions

• Providers can submit authorization requests online through our portal “eQSuite ®” located at : eQSuite Portal Log in

• You can find additional training resources and our upcoming PASRR training webinars via our provider website. www.coloradopar.com

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Questions

BREAK

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PASRRfor Individuals with

Mental IllnessSection 3

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Section 3 Objectives

● Definition of Major Mental Illness (MMI)

● Level I Pre–Admission Screen (PAS)

● Post Admission Level I (PAL)

● Categorical Determinations

● Pre–Admission Level II Evaluation

● Resident Review/Status Change

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Major Mental Illness (MMI)• Serious Mental Illness:

A primary diagnosis of schizophrenic, paranoid, major affective, schizoaffective disorders or other psychosis

• An individual is considered to not have mental illness if he/she has:

A primary diagnosis of dementia (including Alzheimer's disease or a related disorder); or

A non-primary diagnosis of dementia (including Alzheimer's disease or a related disorder) without a primary diagnosis of serious mental illness, or intellectual or developmental disability or a related condition

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Level I Pre-Admission Screen (PAS)Completing the Level I Form

• Positive trigger for a review includes anything marked in sections: IA, III, and V OR both Section IB & IC.

• For any Level I that triggers in Section IA, Section V, or both Section IB and IC, a review must be faxed to the Utilization Review Contractor for the county in which the patient is physically located at the time of the Level I.

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Level I Pre-Admission Screen (PAS)What symptoms or conditions are a trigger?

• Major Mental Illness diagnosis

• Mild Depression diagnosis AND a GDS score of 6 and above

• PHQ Score of 10 and above

• Psychiatric Medications for Mental Health conditions

• Psych meds for Dementia that are over the Beer’s limit (or not on Beer’s list)

• Significant psych symptoms (serious interpersonal conflict, SI, hallucinations etc.)

• Diagnosis of Intellectual Disability

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Level I Pre-Admission Screen (PAS)Reportable conditions not requiring Utilization Review Contractor Level II review

• Complete the Level I PAS form with all reportable information and send directly to the accepting SNF.

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Level I Pre-Admission Screen (PAS)Reportable Conditions: What symptoms or conditions are NOT considered a trigger, but do require reporting on the Level I?

• Non-Major Mental Illness diagnosis (Anxiety, PTSD, Adjustment Disorder, Personality Disorder, etc.)

• Mild Depression diagnosis AND a GDS score of 5 or below

• Psychiatric medications for psychiatric diagnoses, must be reported, but do NOT trigger a review

• Psychiatric medications for Dementia, only need to be reported if the dosage is ABOVE the Beer’s limit

• The Beer’s limit ONLY applies to psych meds for Dementia, and is irrelevant for psych diagnoses

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Level I Pre-Admission Screen (PAS)Advanced Group Authorization

• PASRR Level I Authorization Outcomes:

Approved no MI-I/DD = Individual has a trigger that was reviewed and individual is determined to have no suspicion of MI or I/DD

Approved ‘time limited’ = Individual has triggers, nursing facility can admit meeting certain time limited criteria and must be reassessed for suspicion of PASRR if individual remains in NF beyond time limited approval

Refer for Level II = Individual has triggers with suspicion of MI or I/DD therefore full Level II evaluation and determination is required prior to admitting to facility or upon status change

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Pre–Admission Level II EvaluationMental Illness (MI)

• Completed by Level II independent evaluators

• SMHA receives report and makes determination

Intellectual or Developmental Disability (I/DD)

• SIDA is responsible for Level II evaluation and determination

• Upon completion, determination letters are distributed by the SMA or designee

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Pre–Admission Level II ProcessThe Utilization Review Contractor will do the following:

• Identify MI

• Notify referring entity

• Schedule a client interview within 2 days of receiving the assignment

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Categorical Determinations

• Categorical determinations permit states to omit the full Level II evaluation in certain circumstances that are time-limited or where the need for NF is clear.

• Contact with Utilization Review Contractor is required when in doubt

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Types of Categorical Determinations

• Dementia as primary diagnosis

• Terminal Illness/Severe Illness

• Convalescent Care/Respite Care

• Delirium

• Emergency Stay/Procedure

Note: The goal of Hospital Discharge Exemption could be met using the categorical determinations

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Categorical Determination cont.• A primary diagnosis of dementia, including Alzheimer's Disease or a

related disorder (must be substantiated based on a neurological examination)

• Terminal Illness; defined as a health condition that, due to its nature, can be expected to cause the person to die

Signed document from a physician that the person’s life expectancy is six months or less must be in the person’s active file

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Categorical Determination cont.

• Convalescent Care is defined as: A discharge from an acute care hospital

An admission for a prescribed, limited NF stay for rehabilitation or convalescent care

An admission for a medical or surgical condition that required hospitalization

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Categorical Determinations cont.• If an individual is determined to need convalescent care

A referral shall be made for a Level II evaluation if the individual remains in the nursing facility for longer than 60 days

A referral shall be made to the designated agencies

The individual shall receive a Level II evaluation within 2 business days of the referral

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Categorical Determinations cont.

Severe Illness:• An individual is considered severely ill if he or she is:

Comatose

Ventilator dependent

In a vegetative state

• Illness must result in a level of impairment so severe that the person could not be expected to benefit from specialized services

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Categorical Determinations cont.

Severe Illness includes but not limited to:

• Functioning at a brain stem level

• Advanced chronic obstructive pulmonary disease

• Parkinson’s disease

• Huntington’s

• Amyotrophic lateral sclerosis

• End stage congestive heart failure

• Acute CVA

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Categorical Determinations cont.• If the individual no longer meets the criteria as determined by the

Utilization Review Contractor complete:

A Mental Health referral

Level II evaluation

• An IDD Level II referral and evaluation shall be completed within 60 days of admission(even if the individual meets the criteria for severe illness)

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Categorical Determinations cont.Respite Care:

• Brief and time-limited stay (if the person requires the level of care provided by the NF)

• Each stay limited to a maximum of 30 days in a certification period (10 CCR 2505-10 8.400)

• Placement in community-based alternatives for respite is preferred

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Categorical Determinations cont.Respite Care:

• “A client receiving HCBS-EBD services who enters a nursing facility for respite care as a service under the HCBS-EBD program shall not be required to obtain a NF ULTC-100.2, and shall be continued as an HCBS-EBD client in order to receive the HCBS-EBD service of respite care in a nursing facility.”

• Because an admission to a nursing facility through the HCBS respite benefit waives the standard nursing home admission process, the PASRR process does not apply and Level I and II documents do not need to be completed prior to admission. (10 CCR 2505-10 8.485.60.D.3.(b)

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Categorical Determinations cont.Emergency Stay:

• If the SMHA determines that an individual requires inpatient psychiatric care and qualifies under the emergency procedures for a hold and treat order, this procedure shall supersede the PASRR determination process (C.R.S. section 27-65-106, et. seq)

• Emergency situation exists when the person is in a potentially harmful environment or the caregiver is suddenly incapacitated and cannot provide for the person’s care (The limit for the stay is 7 days)

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Categorical Determinations cont.

• Categorical determinations which may delay a Level II referral shall not prevent the NF from meeting the psychosocial, physical and medical needs of the resident

• Categorical Determinations may be applied only if an individual is in no danger to him/herself or others

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F32.9Depressive Disorder NOS (311)

● Commonly associated with a “mild or situational” depression● Does not exist in DSM-5● Where there was one diagnosis, now there are two:

(F32.89) Other Specified Depressive DisorderE.g. Recurrent Brief Depression, Short Duration Depressive Episode (4-13 days),

Depressive Episode with insufficient symptoms

(F32.9) Unspecified Depressive DisorderNo more specific diagnosis was able to be determined

The clinician has concluded that a depressive disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced

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Utilization Review ContractorWill Determine:

• Does the person appear to meet the criteria of major mental illness?

• No Mental Illness: Utilization Review Contractor completes “Advanced Group PAS Authorization,”

indicating “Approved, No MMI and faxes it to the receiving facility

• Presence of Mental Illness: Utilization Review Contractor may grant a categorical exemption from Level II or a

limited time frame

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Post Admission Level I’s (PAL)

• The Level I must be current and accurate (Use PASRR progress notes)

Communicate any activity timeframes

If anything changes, making the Level I info no longer accurate, then a PAL needs to be submitted

Identify whether the change in condition meets the criteria for referring to the Utilization Review Contractor for a Status Change Review

Provide PAL and all supporting documents to your Utilization Review Contractor if it meets criteria, within 10 days of identifying the change

Utilization Review Contractor reviews the PAL to determine if there is a need for a Level II then submits a Status Change in response to the PAL

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Resident Review (RR)Annual requirement was struck following the Balanced Budget Act of 1996

• Required upon a significant change in status

“Significant change” is defined by responses to the Minimum Data Set (MDS)

The MDS must first be administered within 14 days of NF admission and subsequently administered quarterly (in short form) and annually (in long form)

• Completed by Utilization Review Contractor

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Intent of RR• Stronger identification of PASRR triggers

• Clearly identifies date of compliance

• Incorporates all federally required diagnoses

• Triggers more closely align with those identified on the Level I update (“PAL”)

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Resident Review (RR)Status changes

• Expiration of exemption

• New MI or suspected MMI diagnosis

• New or worsened serious symptom

• New category of psych medications (not anti-anxiety)

• Return to the facility from psychiatric hospitalization

• Previous PASRR Level II no longer accurate

• Psych medications for dementia over the Beers list

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Resident Review (RR)

These Are Not Status Changes but PAL is still required

• Psych medication for medical conditions

• Admitted without required Pre-Admission Screen (PAS) or incorrect PAS

• Reduction in psych medication not currently reviewed does not require PAL unless the person goes back onto that medication within 30 days

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Resident Review (RR)Gradual Dose Reductions

• Progress note in the PASRR progress notes documenting gradual dose reductions (GDR)

• If the medication is totally discontinued and restarted within a month, no status change review requested, but can update progress notes, complete updated PAL

• If after three months the medication is restarted, refer for status change review

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Resident Review (RR)Status Change: Diagnosis of Mental Illness

Key Points:

• The Utilization Review staff will perform a clinical review of the individual based on information received by the NF

• Utilization Review Contractor review uses clinical judgment, and any combination of signs/symptoms to assess a case

• Doubling of antidepressant is no longer a trigger

• Psychiatric hospitalizations have been added

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Resident Review (RR)Providing Information to the Utilization Review Contractor:

• PAL must be completed for all status changes

• Utilization Review Contractor determines what additional information is necessary to conduct a Resident Review/Status Change

• Once Utilization Review Contractor has all the information they required from the NF; Utilization Review Contractor will complete the status change.

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Resident Review (RR)Status Change: Diagnosis and Triggers

• New Diagnosis: anxiety, personality disorder, panic disorder and somatoform need to be considered through the same clinical lens

• Utilization Reviewer's job is to substantiate or not substantiate any changes

• NF job is required to reconcile any differences in the medical record using information from reviewers

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Resident Review (RR)Diagnosis of Organic Condition

• Form provides opportunity to clarify organic conditions that impact a persons presentation

Psychotropic Medications

• Monitoring medication is important to assessing extenuating circumstances that could be impacting the persons presentation and behaviors

• Pay attention to the dosages of medications

• Be sure to use diagnoses and not just list symptoms of diagnosis

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Resident Review (RR)Diagnosis and Triggers: Determinations of outcome depends on Utilization Review Contractor findings:

• Approved, NO MI

NO MORE ACTION REQUIRED

• Approved with follow up next quarter

Burden to follow up is on Nursing Facility

• Finding of possible MMI

Triggers a RR Level II

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Resident Review (RR)Utilization Review Contractor Indication of Noncompliance

• Status Change

Failure of NF to refer for status change within 10 days

Failure of NF to provide necessary information (timely)

• Pre-Admission Screen (PAS)

Original PAS does not indicate triggers, where clearly noted

Person admitted without PAS

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Transfers

Transfer from Nursing Facility to Nursing Facility (does not apply to convalescent care approvals)

● Transfer can occur under the following situations:

Level II was completed within the last year and the information is still accurate transfer can be completed without an updated Level II.

A new Determination Letter will need to be issued by the SMHA prior to admission.

Level II evaluation was completed in over one year and the information is still accurate, the SMHA must be informed for further direction. It will be addressed on a case-by-case basis.

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Transfers

● Transfer will be conditional under the following situations:

Level II evaluation was completed in over one year and the information is not still accurate, a new, full Level II must completed and a determination letter issued before admission.

If the Level II Evaluation was completed within the last year and the information is not still accurate, a Level II Update must be done.

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Questions

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Contact Information

Becky Huckaby Raphaelson303-866-7414

Rebecca.HuckabyRaphaelson@state.co.us

Department of Human ServicesOffice of Behavioral Health

Community Programs

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BREAK

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PASRR for Individuals with Intellectual

and Developmental Disabilities

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Section 4

Developmental DisabilityA disability that:

• Manifests before the person reaches twenty-two years of age

• Constitutes a substantial disability to the affected individual, as demonstrated by the following criteria:

Is attributable to intellectual disability or related conditions which include cerebral palsy, epilepsy, autism or other neurological conditions when such conditions result in either impairment of general intellectual functioning or adaptive behavior similar to that of a person with an intellectual disability

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10 CCR 2505-10 8.600.4

Developmental Disability (cont’d)

Impairment of general intellectual functioning:

• The person has been determined to have a full scale intellectual quotient (FSIQ) equivalent which is two or more standard deviations below the mean (70 or less assuming a scale with a mean of 100 and a standard deviation of 15)

NOTE: A secondary score comparable to the General Abilities Index (GAI) for a Wechsler Intelligence Scale that is two or more standard deviations below the mean may be used only if a full scale score cannot be appropriately derived

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10 CCR 2505-10 8.600.4

Developmental Disability (cont’d)Impairment of general intellectual functioning (cont’d):

• Score shall be determined using a norm-referenced, standardized test of general intellectual functioning comparable to a comprehensively administered Wechsler Intelligence Scale or Stanford-Binet Intelligence Scales, as revised or current to the date of administration

• The test shall be administered by a licensed psychologist or a school psychologist

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10 CCR 2505-10 8.600.4

Developmental Disability (cont’d)Impairment of general intellectual functioning (cont’d):

• When determining the intellectual quotient equivalent score, a maximum confidence level of ninety percent (90%) shall be applied to the full scale score to determine if the interval includes a score of 70 or less and shall be interpreted to the benefit of the applicant being determined to have a developmental disability

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10 CCR 2505-10 8.600.4

Developmental Disability (cont’d)Adaptive behavior similar to that of a person with an intellectual disability:

• The person has an overall adaptive behavior composite or equivalent score that is two or more standard deviations below the mean

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10 CCR 2505-10 8.600.4

Developmental Disability (cont’d)Adaptive behavior similar to that of a person with an intellectual disability (cont’d):

• Measurements shall be determined using a norm-referenced, standardized assessment of adaptive behaviors that is appropriate to the person's living environment and comparable to a comprehensively administered Vineland Scale of Adaptive Behavior, as revised or current to the date of administration

• Assessment shall be administered and determined by a professional qualified to administer assessment used

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10 CCR 2505-10 8.600.4

Developmental Disability (cont’d)Adaptive behavior similar to that of a person with an intellectual disability (cont’d):

When determining the overall adaptive behavior score, a maximum confidence level of ninety percent (90%) shall be applied to the overall adaptive behavior score to determine if the interval includes a score of 70 or less and shall be interpreted to the benefit of the applicant being determined to have a developmental disability

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10 CCR 2505-10 8.600.4

Developmental Disability (cont’d)

NOTE: A person shall not be determined to have a developmental disability if it can be demonstrated such conditions are attributable to only a physical or sensory impairment or a mental illness

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10 CCR 2505-10 8.600.4

PASRR Intellectual & Developmental Disabilities (I/DD)

When to trigger a Level I Screen:

1. Diagnosis of I/DD

2. History of I/DD

3. Evidence of Suspected I/DD

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I/DD Level I Screen Triggers

1. Diagnosis of I/DD

• Check Yes if the person has a diagnosis of intellectual impairment or developmental disability

Examples: Developmental Disability, Intellectual Impairment or Disability, MR, Autism, Cognitive Impairment, or Developmental Delay

NOTE: Even when a person has a diagnosis of intellectual or developmental disability, formal DD Determination may need to be completed.

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I/DD Level I Screen Triggers

2. History of I/DD• Check Yes if the person has a history of intellectual or developmental

disability

• Examples: Diagnosis in prior records? Eligible for SSI or SSDI? If so, why? History of receiving special education? Why? Anecdotal history of intellectual or developmental disability?

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I/DD Level I Screen Triggers

3. Evidence of suspected I/DD

• Check Yes if there is evidence indicating a person possibly has an intellectual or developmental disability

• Impressions from personal interview/interactions Community Centered Board or Service Agency for individuals with I/DD Division of Vocational Rehabilitation (DVR) Independent living skills Social/adaptive skills Educational achievement/Vocational history

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I/DD Level I Screen Triggers

• If Yes is checked for any of these reasons the Level I Screen must be submitted to eQHealth

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Level I Screen Outcomes

• eQHealth determines which of the following outcomes is the result of the Level I Screen:

Approved, no I/DD (no Level II required)

Approved with follow-up next quarter (no Level II required)

Refer for Level II

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Level II for Persons with I/DDThe purpose of the Level II evaluation is to determine whether:

1. An individual has an intellectual or developmental disability

2. The individual requires the level of services provided by a nursing facility

3. The individual requires Specialized Services

(10 CCR 2505-10, 8.401.20)

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Level II for Persons with I/DD

1. Does the individual have an intellectual or developmental disability?

• Upon receipt of the Level I screen, eQHealth identifies whether DD Determination is required

• Community Centered Board (CCB) staff may need to complete DD Determination in conjunction with the PASRR Level II evaluation

Review of records / history

Possible coordination of new psychological assessments

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Level II for Persons with I/DD

2. Does the individual require the level of services provided by a nursing facility?

• Level II is required for all individuals with, or suspected of having, an I/DD seeking long-term care in a nursing facility

Evaluation is administered eQHealth

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Level II for Persons with I/DD

3. Does the individual require Specialized Services?

• Level II evaluation requires documentation specifying if Specialized Services are requested and/or needed

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Specialized Services (SS)• Specialized Services are managed by the CCB and are authorized in the

Determination Letter:

Voluntary services are available to persons with an I/DD while in the nursing facility

Community based - outside of the nursing facility

Includes support/supervision in the community and related transportation

Services shall not duplicate services available in and provided by the skilled nursing facility

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Specialized Services cont. • Assistive Technology• Behavioral Consultation• Behavioral Counseling• Behavioral Counseling Group• Behavioral Plan Assessment• Day Habilitation - Specialized

Habilitation • Day Habilitation - Supported

Community Connections• Dental – Basic• Dental – Major• Mileage

• Other Public Conveyance• Recreational Facility Fees/Passes• Job Coaching – Individual• Job Coaching – Group• Job Development – Individual• Job Development – Group• Job Placement• Vision

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C.C.R. 2505-10 8.500.94.B

PASRR Level II Notice of Determination for IDD

• The Level II evaluation is reviewed by the State Intellectual Disability Authority (SIDA) for final authorization

• SIDA completes Determination Letter and distributes to all required agencies

NOTE: Nursing Facility is required to maintain a copy of this letter (PASRR Level II Notice of Determination for IDD) in the individual’s file

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Questions

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Contact Information

Karli Altman303-866-4032

Karli.Altman@state.co.us

Department of Health Care Policy & FinancingOffice of Community Living

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Thank you

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