OBRA PAS Screens OBRA Omnibus Budget Reconciliation Act

OBRA & PAS Screens

OBRA �Omnibus Budget Reconciliation Act of 1987 (OBRA) is a federal regulation mandating that all patients/residents (age 18 and older) entering Medicaid/Medicare funded nursing facilities must receive a comprehensive assessment prior to admission. �The purpose of these assessments is to verify medical necessity for a nursing facility. �During this evaluation, a resident is given a DON score (Determination of Need), the minimum score needed to qualify for SNF services is 29

PAS �Pre-Admission Screening is necessary for those patients with a: Developmental Disability Mental Illness �PAS screens are completed to determine the specific service needs and prevent inappropriate admissions to long-term care facilities Level 2 � Developmental Disability (prior to the age of 22) Completed by DD PAS Agency Level 3 � Mental Illness (Excludes Dementia, DD, Et. OH/Substance Abuse) Completed by MH PAS Agency

Tracking & Collecting �In an effort to simplify the collection of OBRA screens, new protocols have mandated that when an OBRA is completed in the hospital, the screener/agency will provide a copy of the OBRA with the hospital discharge planner. Once the patient is discharged to a SNF, the hospital is responsible for sending a copy of the OBRA along with the patient. �We must be diligent in requesting and tracking all OBRA and PAS screens for all of our residents. Work closely with your local screening agency and be sure to request a post-screen if you are having trouble getting a screen for a particular patient.

Tracking Form Date of Admit Patient Name D. O. B. Social Security Number Admitted From OBRA/PAS Agency Date Requested Received 11/2/15 John Doe 5/17/44 111 -22 -3333 Kindred – Sycamore Elder Care Services 11/2/15 11/3/15 11/4/15 Lisa Frank 6/24/30 444 -55 -6666 OSF St. Anthony VNA 11/4/15 11/6/15 11/8/15 Tom Smith 9/18/51 777 -88 -9999 Home POST requested from LSSI 11/8/15

No OBRA? �If an OBRA screen has not been completed and the state catches this during survey, the building can be penalized and fined. �No Screen = No Medicaid Payment

However… �Once you have verified the screen has been completed by an agency, you can admit the Medicaid/Medicaid pending patient Secure the screen ASAP – you don’t have to have it in hand to admit – if you verified it does exist It may be at the prior nursing home �You have time to get the DON screen IF – The payer is anything other than Medicaid � Request the post screen immediately � The agency can take 2 weeks to do the screen

Did you know…? �OBRA screens are good for 60 days. . �OBRA screens can transfer from facility to facility �Respite Care patients do not need an OBRA screen if the stay is 15 days or less. �Hospice does not require OBRA – however if patient improves and comes off hospice a screen will be needed

Post Screens � When requesting POST screens, if the patient is: Between the ages of 18 to 59 - the screen must be completed by the Division of Rehabilitation Services (DORS) Age 60 and older - screens should be completed by your local Department of Aging � There are only three circumstances in which an OBRA screen will be back dated to the day of admission and/or the date a screen is requested: 1. Admission due to loss of caregiver 2. Out of state admission 3. Direct admission from the ER