Provider PASRR Training
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Preadmission Screening and Annual Resident Review Verification (PASRR) May 2014
Transcript of Provider PASRR Training
Preadmission Screening and Annual Resident Review Verification (PASRR)
May 2014
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.
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WHAT IS PASRR?
§ The Preadmission Screening and Annual Resident Review (PASRR) is a review of any individual who is being considered for admission into a Medicaid CerKfied Adult Care Home.
§ As required by the US Department of JusKce SeQlement Agreement effecKve January 1, 2013, individuals requesKng 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 for all applicants to Adult Care Homes licensed under G.S. 131D, ArKcle 1 to idenKfy beneficiaries with SMI.
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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 compleKng the MUST form must be familiar enough with the beneficiary’s mental health status and history to provide accurate informaKon required by the screening form.
§ If there is clearly no evidence of SMI, a PASRR number will be generated automaKcally 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.
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PASRR: APPLICATION PROCESS; LEVEL 2 SCREENING
§ If there is any indicaKon of SMI, addiKonal informaKon will be required through a manual review process, in which the applicant will be referred for a level II face-‐to-‐face evaluaKon.
§ If a Level II evaluaKon is needed, the PASRR contractor noKfies the referral source that a Level II PASRR evaluaKon is required and requests, if applicable, that medical records be available for the on-‐site evaluaKon by a qualified mental health professional (QMHP).
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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 evaluaKon with recommendaKons is
then forwarded to DHHS. § AZer the compleKon of the Level II evaluaKon, DHHS
makes the final determinaKon 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 cerKfied noKficaKon of the determinaKon and other available opKons are mailed by the PASRR contractor to the beneficiary/responsible party.
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PASRR: APPLICATION PROCESS: CONTACTS
Questions? § PASRR contractor: The Division of Mental Health,
Developmental DisabiliKes, and Substance Abuse Services (DMH/DD/SAS)
§ N.C. Division of Mental Health/Developmental DisabiliKes/Substance Abuse Services (DMH/DD/SAS) has idenKfied staff to serve as liaisons to provide technical assistance, answer quesKons, and assist with locaKng PASRR Level I Screeners:
Barbara Flood – EAST -‐ 919-‐218-‐3872, [email protected] Patricia McNear – CENTRAL – 919-‐981-‐2580, [email protected] Bill Joyce – WEST – 336-‐312-‐0212, [email protected]
Sandee Resnick-‐ Accountability Team Leader -‐ (919) 981-‐2580
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WHO DOES NOT NEED A PASRR?
The following beneficiaries do NOT require a PASRR:
§ Beneficiaries who have been admiQed 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.
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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 verificaKon of a PASRR number.
Important Note: This is not required for beneficiaries residing in an ACH who are currently receiving PCS.
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PCS REQUESTS AND PASRR
§ If the facility is a 5600a, 5600c, or the beneficiary was admiQed 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.
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Facilities:
RECOMMENDATIONS FOR ENTERING PASRR NUMBER ON DMA 3051
§ Enter in SecKon A: Recipient Demographics in blank space to the right of Medicaid ID #
§ Print Legibly: PASRR # 10-‐digit Alpha and effecKve date
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PASRR AND PA EFFECTIVE DATES
For beneficiaries requiring a PASRR, PAs become effective when:
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§ If a PASRR is effecKve on the date the PCS request is received or prior, PAs will be effecKve the date of the request.
§ If the PASRR is received within 30 days from the request received date, then the PAs will become effecKve the date the PASRR became effecKve.
§ If no PASRR is received within 30 days of the PCS request, then Liberty will send a technical denial for PCS.
PASRR VERIFICATION
§ Liberty Healthcare will verify a PASRR has been approved on every new ACH PCS request.
§ VerificaKon is confirmed through the NCMust system. § If unable to verify a PASRR through the NCMust system, Liberty will call the facility in an aQempt 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 documentaKon that reflects the admission date or have the facility confirm they are a 5600a or 5600c.
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THANK YOU FOR YOUR INTEREST IN PASRR
