Preadmission Screening and Annual Resident Review Verification PASRR

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. 10/7/2020 2

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 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 prescreened 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. 131 D, Article 1 to identify beneficiaries with SMI. 10/7/2020 3

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. 10/7/2020 4

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). 10/7/2020 5

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. 10/7/2020 6

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 Mc. Near – CENTRAL – 919 -981 -2580, patricia. mcnear@dhhs. nc. gov Bill Joyce – WEST – 336 -312 -0212, bill. joyce@dhhs. nc. gov Sandee Resnick- Accountability Team Leader - (919) 981 -2580 10/7/2020 7

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 5600 a or 5600 c facility type. 10/7/2020 8

PASRR AND PCS § Clinical Coverage Policy 3 L (3. 2. 3 b) 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. 131 D 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. 10/7/2020 9

PCS REQUESTS AND PASRR Facilities: § If the facility is a 5600 a, 5600 c, 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. 10/7/2020 10

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 10/7/2020 11

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. 10/7/2020 12

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 FL 2 or any other documentation that reflects the admission date or have the facility confirm they are a 5600 a or 5600 c. 10/7/2020 13

THANK YOU FOR YOUR INTEREST IN PASRR