2000, PL1 and PE
2100, Purpose of PASRR
Revision 22-1; Effective Nov. 28, 2022
PASRR screening and evaluation must be administered to identify:
- people seeking admission to a nursing facility (NF) who have MI, ID or DD;
- the appropriateness of placement in the NF; and
- eligibility for specialized services.
The process begins with the referring entity, the first entity (RE) that considers admission into an NF for a person.
2200, Referring Entity
Revision 22-1; Effective Nov. 28, 2022
An RE is a person or entity who refers someone to a NF for admission. The most common referring entities are hospital discharge planners. Other referring entities can be:
- Acute care hospitals
- Psychiatric hospitals
- NFs (limited to when a NF resident is discharging from one NF and admitting directly to another NF)
- LARs or family members
- Physicians (including office staff)
- Assisted living facilities
- Group homes
- Hospice providers
- Home health agencies
- LBHAs
- LMHAs
- LIDDAs
- Adult protective services staff
- State supported living centers
- Emergency placement sources (e.g., law enforcement agency)
- Community healthcare providers
PASRR requires that all people seeking admission to an NF have a PASRR Level 1 Screening (PL1) form completed prior to admission, and the RE is responsible for completing the paper version of the form.
The PL1 documents the suspicion of an MI, ID or DD based on information available to the RE. The RE responds to the questions regarding a diagnosis provided within Section C of the PL1 form.
2300, PASRR Level 1 Screening (PL1)
Revision 22-1; Effective Nov. 28, 2022
This section provides an overview of the PL1 Screening and its role in the PASRR process. The PL1 Screening form may be downloaded from the Texas Medicaid & Healthcare Partnership (TMHP).
2310 Purpose
Revision 22-1; Effective Nov. 28, 2022
The PL1 Screening form is designed to identify people suspected of having an MI, ID, or DD who are seeking admission to a NF. The PL1 screens for possible eligibility for PASRR specialized services and is the first step toward enabling people to be served per their unique needs.
2320 PL1 Screening Form
Revision 22-1; Effective Nov. 28, 2022
The PL1 Screening form contains the following sections:
- Section A:
- Submitter Information (NF and LA only) — Identifies contact information for the person submitting the PL1 into the LTC online portal.
- Referring Entity Information — Contains information about the person who performed the PL1 Screening.
- Section B:
- Personal Information — Contains information about the person who is being screened. This section also contains fields used to update the PL1 due to a death or discharge.
- Section C:
- PASRR Screen — Completed for all people seeking admission to a NF. The PL1 documents the suspicion of an MI, ID or DD based on information available to the RE.
- Local Authority Information — Documents information about the LIDDA, LMHA, or LBHA associated with the PL1 submission.
- Section D:
- Nursing Facility Choices — Documents the person’s or LAR's choice(s) of NFs for admission.
- Section E:
- Alternate Placement Preferences — Documents the person’s or LAR’s alternate placement preferences.
- Alternate Placement Disposition — Documents to which alternate placement program the person was admitted.
Note: See Section 2320.2, Positive PL1 for more instructions about how to complete Section E of the PL1 if positive.
- Section F:
- Admission Category — Documents the NF admission type for the person.
2320.1 PL1 Submission
Revision 22-1; Effective Nov. 28, 2022
Only LIDDA, LMHA, LBHA, or NF can submit the PL1 Screening form in the LTC online portal. Following successful submission, the LTC online portal will issue alerts based on the information in Section C of the completed form.
Note: When the PL1 is positive and the admission type is preadmission, the LIDDA, LMHA, or LBHA must enter the PL1 in the LTC online portal within three business days of receipt from the RE.
2320.2 Positive PL1
Revision 22-1; Effective Nov. 28, 2022
If the RE selects “Yes” to any of the fields in Section C, PASRR Screen, then the PL1’s status is considered positive for suspicion of an MI, ID or DD. A positive PL1 triggers an alert to the LIDDA, LMHA, or LBHA, or both, via the LTC online portal to proceed to the next step of the PASRR process — the PASRR evaluation (PE).
When the LIDDA, LMHA or LBHA receives a PL1 Screening form from the RE, the LIDDA, LHMA or LBHA must:
- Review the PL1 Screening form to confirm the RE has completed the required fields before submitting the PL1 screening form on the LTC Online Portal.
- If Section E fields E0100-E0400, or any other required field of the PL1 screening form, is not completed, the LIDDA, LMHA, or LBHA should contact the RE for the information needed to complete the required fields.
- Enter the information received for Section E fields E0100-E0400, which are enabled and required for the PL1 screening form to be submitted.
The nursing facility is responsible for entering the RE’s initial report in Section E of the PL1 if the admission type is exempted hospital discharge or expedited admission. If the person’s alternate placement preferences change after the PL1 submission, these changes should be documented in the PE, in the initial CLO done at the time of PE, and on the PCSP form.
Note: If the applicable “Section E” tab fields are not completed for a PL1 screening form submission, the PL1 screening form submission will not submit. The Texas Health and Human Services Commission made these system changes to ensure that the person’s alternate placement disposition is documented and available on the LTC Online Portal at the time of discharge.
2320.3 Negative PL1
Revision 22-1; Effective Nov. 28, 2022
If the RE selects “No” to all three fields in Section C, PASRR Screen, then the PL1 status is considered negative for suspicion of an MI, ID or DD. The NF admits a person with a negative PL1 screening and the PASRR process formally ends.
2320.4 Additional PL1 Responsibilities
Revision 22-1; Effective Nov. 28, 2022
LIDDAs, LMHAs and LBHAs are also responsible for inactivating a PL1 screening form when a person is either not admitted to the NF or passes away before being admitted to the NF. This is the only time LIDDAs, LMHAs, and LBHAs are responsible for inactivating a PL1 screening form.
To inactivate a PL1 screening form, the LIDDA, LMHA and LBHA must:
- Complete Section B fields B0650-0655 – Discharge or deceased.
- If field B0650 indicates that the person is deceased, then the Section E tab will not be enabled for data entry and the P1 screening form will submit.
- If field B0650 indicates the person was discharged, fields E0500-E0900 (Alternate Placement Disposition) are enabled and required for the PL1 Screening form to be submitted.
If the applicable “Section E” tab fields are not completed for a PL1 screening form submission or updated for a discharge, the PL1 screening form submission or update will not submit. The Texas Health and Human Services Commission made these system changes to ensure that the person’s alternate placement disposition is documented and available on the LTC Online Portal at the time of discharge.
2330 Admission Types
Revision 22-1; Effective Nov. 28, 2022
There are three types of NF admissions:
- exempted hospital discharge;
- expedited admission; and
- preadmission.
2330.1 Exempted Hospital Discharge
Revision 22-1; Effective Nov. 28, 2022
Exempted hospital discharge occurs when a physician has certified that a person being discharged from an acute care hospital is likely to need less than 30 days of NF services for the condition that the person was hospitalized. An example of this type of admission would be for a person who falls, breaks a hip and goes into the NF for rehabilitation services.
The RE (acute care hospital) provides the NF with a copy of the PL1. The NF enters the PL1 into the LTC online portal upon the person’s admission.
A person in this category with a positive PL1 only requires a PASRR evaluation if their stay in the NF exceeds 30 days. If the person's stay exceeds 30 days, the LTC online portal sends an alert to the LIDDA, LMHA, or LBHA to complete a PE.
2330.2 Expedited Admission
Revision 22-1; Effective Nov. 28, 2022
Expedited admission occurs when a person meets the criteria for any of the following seven categories:
- Convalescent Care
- Terminal Illness
- Severe Physical Illness
- Delirium
- Emergency Protective Services
- Respite
- Coma
The RE provides the NF with a copy of the PL1. The NF enters the PL1 into the LTC online portal upon the person’s admission.
The length of stay or the type of expedited admission determines when the LTC online portal sends an alert to the LIDDA, LMHA, or LBHA to complete a PE for a person. For example, a person admitted who is in a coma will not receive a PE until they regain consciousness.
2330.3 Preadmission
Revision 22-1; Effective Nov. 28, 2022
Preadmission occurs when admitting a person from a place other than an acute care hospital, such as a community setting like home, hospice, group home, psychiatric hospital or jail. If the RE is a family member, LAR, other personal representative selected by the person or an emergency placement source, the RE may request assistance from the LIDDA, LMHA, LBHA, or NF to complete the PL1.
If the PL1 is positive (see Section 2320.2, Positive PL1), the RE provides the LIDDA, LMHA, or LBHA with a copy of the PL1. The person may not be admitted to a NF until the LIDDA, LMHA, or LBHA completes a PE.
If the PL1 is negative (see Section 2320.3, Negative PL1), the RE provides the NF with a copy of the PL1 when the person presents at the NF for admission.
Medical necessity (MN) is the determination that a person requires the level of care provided at a NF. It is important to note that the information entered in the PE for a preadmission is used by TMHP to determine MN for a person whose PE is positive. An MN determination is critical for people who want to admit to a NF or divert from a NF admission and instead go directly into a community setting.
2340 Admission Type on PL1
Revision 22-1; Effective Nov. 28, 2022
A part of completing the PL1 requires the RE to determine the admission type or category based on the answers to Section F of the PL1 Screening form.
| Admission Type: | PL1 Completed By: | PL1 Submitted By: |
|---|---|---|
| Positive Preadmission | RE | LIDDA if positive for ID/DD, LMHA or LBHA if positive for MI |
| Negative Preadmission | RE | NF |
| Expedited Admission | RE | NF |
| Exempted Hospital Discharge | RE | NF |
| Change of Ownership (CHOW) | The old NF contract or vendor number becomes the RE to the new contract number. | The new contract number |
| NF to NF Transfers | The discharging facility becomes the RE to the admitting facility. | The admitting facility |
The LTC online portal determines admission type or category by responses in Section F of the PL1. If the response in F0100 is “0” (meaning No) and the response in F0200 is “0” (meaning not expedited admission), then the admission category is considered “preadmission” by default.
2350 PL1 Submission
Revision 22-1; Effective Nov. 28, 2022
After completing the PL1, the RE has the final responsibility to send the completed paper PL1 Screening form to the appropriate party for submission to the LTC online portal. The chart below summarizes which party the PL1 is sent depending on the admission type in Section F and positive or negative status in Section C of the PL1 Screening form.
| Admission Type: | PL1 Completed By: | PL1 Submitted By: |
|---|---|---|
| Positive Preadmission | RE | LIDDA if positive for ID/DD, LMHA or LBHA if positive for MI |
| Negative Preadmission | RE | NF |
| Expedited Admission | RE | NF |
| Exempted Hospital Discharge | RE | NF |
| Change of Ownership (CHOW) | The old NF contract/vendor number becomes the RE to the new contract number. | The new contract number |
| NF to NF Transfers | The discharging facility becomes the RE to the admitting facility. | The admitting facility |
2400, PASRR Level II Evaluation
Revision 22-1; Effective Nov. 28, 2022
This section provides an overview of the PE form and its purpose in the PASRR process. Refer to Appendix I, Resources for detailed information on completing a PE, and steps for submitting a PE into the LTC online portal.
2410 Purpose, PASRR Status, and Staff Qualifications
Revision 22-1; Effective Nov. 28, 2022
The PE confirms if a person has a diagnosis of MI, ID or DD through document review and interviews. The PE is conducted for people with a positive PL1. If a PL1 indicates negative suspicion for a PASRR condition, a PE may also be performed upon request from HHSC or a NF. The PE is administered to identify:
- if a person has an MI, ID or DD;
- if a person’s total needs can be met in appropriate community settings;
- a person’s need for specialized services; and
- for preadmissions, if a person meets medical necessity and can be admitted to the NF.
2410.1 PASRR Positive
Revision 22-1; Effective Nov. 28, 2022
When the PE confirms a person has an MI, ID or DD, the PASRR determination for the person is PASRR positive.
2410.2 PASRR Negative
Revision 22-1; Effective Nov. 28, 2022
When the PE does not confirm a person has an MI, ID or DD, the PASRR determination for the person is PASRR negative.
2410.3 Staff Qualifications
Revision 22-1; Effective Nov. 28, 2022
The qualifications for staff completing a PE are in 26 TAC, Chapter 303, Section 303.303, relating to Qualifications and Requirements for Staff Person Conducting a PE or Resident Review.
2420 LTC Online Portal Notification
Revision 22-1; Effective Nov. 28, 2022
The LIDDA, LMHA or LBHA receives an automatic alert notification in the LTC online portal generated by a NF’s submission of a positive PL1 into the LTC online portal for an expedited admission or an exempted hospital discharge.
The LIDDA, LMHA or LBHA will not receive an automatic alert notification if the LIDDA, LMHA or LBHA submitted the positive PL1 for preadmission into the LTC online portal. The RE provides a copy of the PL1 to the LIDDA, LMHA or LBHA. This serves as the alert to the LIDDA, LMHA or LBHA to conduct the PE.
2420.1 Timing of Alert is Based on Admission Type
Revision 22-1; Effective Nov. 28, 2022
The type of admission from the PL1 determines when an alert will be sent to the LIDDA, LMHA or LBHA to conduct a PE. The timings for alerts are explained in the Long-Term Care (LTC) Preadmission Screening and Resident Review (PASRR) User Guide (PDF).
The LIDDA, LMHA or LBHA must:
- check the LTC online portal daily for PE alerts;
- have a single, identified fax line to receive PL1 forms from REs; and
- check the fax line daily to ensure all requests to conduct a PE are acted on promptly.
2420.2 Change of Ownership Extensions
Revision 22-1; Effective Nov. 28, 2022
A change of ownership (CHOW) occurs when a NF is purchased by another facility, entity or corporation. When a CHOW takes place, a new contract number is assigned. Once the new contract number is assigned, the NF being purchased must enter a new PL1 for every resident in the NF within 90 calendar days after the new contract number’s effective date.
Depending on the NF’s census and the number of PASRR positive residents, the LIDDA, LMHA or LBHA may receive multiple alerts to complete PEs. The LIDDA, LMHA or LBHA may request an extension to the seven-day time frame to complete all the PEs for that NF. The LIDDA, LMHA or LBHA must contact the HHSC PASRR Unit at PASRR.support@hhsc.state.tx.us to request an extension.
2420.3 Information Gathered by a LIDDA Following an Alert to Conduct a PE
Revision 22-1; Effective Nov. 28, 2022
A LIDDA that receives an alert in the LTC online portal to conduct a PE or resident review must determine:
- if the person has a prior PE*;
- if the person has transferred from another NF (this information is on the PL1)**; and
- if the person has full Medicaid benefits through***:
- being eligible for Supplemental Security Income; or
- being eligible for Medicaid benefits if institutionalized.
*Information on if the person has a prior PE is available by checking in the LTC online portal. A LIDDA can view a prior PE within the LIDDA’s local service area, as well as PEs completed by other LIDDAs.
Note: The LIDDA staff who completes PEs must use a different email or login from any existing login. The staff given “PE Evaluator” permission can see any form types for a specific person across local service areas. This must be the ONLY permission assigned to this login.
**If the PL1 shows that the person transferred from another NF in Texas, the receiving LIDDA will contact the transferring LIDDA and request relevant records of the person, including previous PEs, assessments and service plans, be sent to the receiving LIDDA.
***Information about whether a person has full Medicaid benefits is available through discussions with the NF’s business office.
2420.4 Using Information Gathered by a LIDDA Following an Alert to Conduct a PE
Revision 22-1; Effective Nov. 28, 2022
If the person has Medicaid benefits* and is 21 or older, the LIDDA must be prepared to assign a habilitation coordinator if the person has a positive PE. *Refer to Section 4910, Medicaid Eligibility Guidelines for information about eligible Medicaid types.
If one LIDDA receives a request for records from another LIDDA that received an alert to conduct a PE, then the LIDDA receiving the request must send all available requested records within two business days after the request was made.
A LIDDA that received an alert to conduct a PE must ensure the staff conducting the PE is provided all relevant records sent by other LIDDAs.
2430 Completing and Submitting the PE
Revision 22-1; Effective Nov. 28, 2022
The LIDDA is responsible for completing a PE for a person whose PL1 indicates the person is suspected of having ID or DD.
The LMHA or LBHA is responsible for completing a PE for a person whose PL1 indicates the person is suspected of having an MI.
Both the LIDDA and LMHA or LBHA are responsible for completing their respective part of a PE for people suspected of having a dual diagnosis (ID/DD and MI).
Note: While an LMHA and LBHA generally have the same responsibilities as a LIDDA for completing and submitting a PE, this handbook is intended to provide instructions and procedures for LIDDAs in implementing PASRR requirements. From this point forward, this handbook will no longer reference LMHA, LBHA or MI unless it is within the context of a person with dual diagnoses, meaning ID/DD and MI.
The LIDDA uses documentation reviews, interviews with the person, family interviews, interviews with others who know or have known the person, and NF staff interviews to complete the PE. The LIDDA has the following responsibilities when completing a PE:
- Conduct a state-wide historical record review per Section 2430.3, Documentation Review for PE Completion.
- Contact the RE or NF to make sure the person is still in the location submitted on the PL1 and is available and alert before traveling to the location to complete the PE.
- Travel to the NF to conduct the PE for exempted hospital discharge admissions and expedited admissions or, for preadmissions, to the location of the person in the community to conduct the PE, and carrying proper identification provided by the LIDDA.
- Bring a release of confidential information to obtain the person’s or LAR’s consent to obtain additional information as needed from collateral contacts.
- Meet face-to-face with the person within 72 hours after notification from the LTC online portal or receiving a copy of the PL1 from the RE.
- Notify HHS Complaint and Incident Intake at 800-458-9858 immediately if they are prevented from seeing a person or reviewing the person’s medical record.
- Use the medical information or documentation in the person’s NF record to confirm whether the person has a diagnosis for ID or DD. The LIDDA should seek assistance and clarification of documentation from available medical staff as needed and record only what is documented in the medical record. The LIDDA must document on the PE what information and documentation were used to complete the evaluation.
- Submit the PE into the LTC online portal within seven calendar days after notification.
The PE can be completed on the paper or electronic version, but ultimately the information collected must be submitted on the LTC online portal by the LIDDA within the seven-day time frame.
2430.1 Interpreter Services
Revision 22-1; Effective Nov. 28, 2022
The person or LAR should be given the opportunity for interpreter services. The LIDDA must arrange or work in cooperation with the RE, NF and person or LAR for interpreter services as needed.
2430.2 Person or LAR Refuses to Participate in PE
Revision 22-1; Effective Nov. 28, 2022
If a person or LAR refuses participation in the PE, the LIDDA should request assistance from NF staff that have the greatest knowledge and rapport with the person or LAR in explaining the process . If the person or LAR continues to refuse to participate, the LIDDA completes the PE solely from chart review and documents the person’s or LAR’s refusal in a comment field located within Section F1000 of the PE.
2430.3 Documentation Review for PE Completion
Revision 22-1; Effective Nov. 28, 2022
When investigating a person’s history for a PE, the LIDDA should search all applicable service records, including those available in online databases (such as CARE System, Clinical Management for Behavioral Health Services , if available, LTC online portal and Service Authorization System Online ), for evidence of previous diagnostic testing or services received in previous settings.
Investigating these systems can provide the LIDDA with insight on where to look for records and may yield valuable information about previous placement in settings, including:
- Home and Community-based Services (HCS);
- Community Living Assistance and Support Services (CLASS);
- Deaf Blind with Multiple Disabilities (DBMD);
- Texas Home Living (TxHmL);
- Home and Community Based Services (HCBS) Waiver/STAR+PLUS Waiver;
- Intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID);
- state supported living center (SSLC);
- state hospital; and
- Department of Family and Protective Services (DFPS) programs and residential operations.
Documentation gathering and record review should include:
- school records;
- diagnostic records;
- medical records;
- previous PEs, service plans and assessments; and
- all relevant records from other LIDDAs.
2430.4 Information about Certain Community Programs in Section F0700 of the PE
Revision 22-1; Effective Nov. 28, 2022
Information about most of the community programs listed in Section F0700 of the PE are in the documents provided to the person and LAR as part of the community living options (CLO) presentation. See Section 2430.5, Presenting Information about Community Services as Part of the PE, below. However, the programs in the bulleted list below that are in F0700 are either no longer available or may not apply to the person. The staff conducting the PE should use the following information to describe those programs to the person and LAR.
- F0700D “Community Based Alternative (CBA) Program” — This program is now called “STAR+PLUS HCBS Program” or “STAR+PLUS Waiver.”
- F0700K “In Home and Family Support Services” — This program no longer exists.
- F0700O “STAR+PLUS” — This is a Medicaid managed care program. Generally, all eligible people are automatically enrolled in STAR+PLUS. For “STAR+PLUS HCBS Program” or “STAR+PLUS Waiver,” use F0700D.
- F0700V “Other community-based services” — An example of this is Community First Choice (CFC) services.
2430.5 Presenting Information about Community Services as Part of the PE
Revision 22-1; Effective Nov. 28, 2022
Person’s PE is Negative for ID or DD
For a person whose PE is negative for ID or DD, the staff conducting the PE must provide and explain to the person and LAR Appendix II, Long Term Services and Supports, in the LIDDA Handbook. Note: This process is in lieu of presenting the full community living options (CLO) required for someone who is PASRR positive.
If the person wants to pursue community living after receiving information about long term services and supports, then the PE staff must arrange for the person to be referred to the regional Aging and Disability Resource Center (ADRC) and, if appropriate, the family-based alternatives contractor.
Person’s PE is Positive for ID or DD
For a person whose diagnosis of ID or DD is confirmed, the staff conducting the PE must present community living options (CLO) per Section 5810.3, CLO Materials Provided to Individual or LAR, and Section 5820, Documenting CLO. The staff must document the CLO discussion on Form 1054, Community Living Options.
CLO must be presented in a manner that allows the person and their LAR to fully understand the options available. Therefore, CLO duration may vary but should last as long as needed to completely and meaningfully present all available community options.
If the person wants to pursue community living at the end of the CLO presentation and: | ||
|---|---|---|
| the person’s admission type is “preadmission” and the person is eligible for a targeted NF HCS diversion slot as described in Section 3210, Criteria for Diverting from NF Admission, then … |
| the PE staff:
|
| the person is eligible for habilitation coordination per Section 4100, Eligibility for Habilitation Coordination Funded by Medicaid, and the person has selected a community program, then … | before the IDT meeting … | the PE staff ensures the assigned habilitation coordinator (HC):
|
| the person is eligible for habilitation coordination per Section 4100 but the person has not selected a community program, then … | before the IDT meeting … | the PE staff arrange assigned habilitation coordinator:
|
| the person is not eligible for habilitation coordination because the person is 20 or younger, then … | immediately following submission of the PE … | the PE staff will arrange for the person to be referred to Every Child, Inc. |
| the person is not eligible for habilitation coordination because the person is not a Medicaid recipient, then … | immediately following submission of the PE … | the PE staff will arrange for the person to be referred:
|
If the person is unsure about, or doesn’t want to pursue, community living at the end of the CLO presentation and: | ||
|---|---|---|
| the person is eligible for habilitation coordination per Section 4100, then … | before the IDT meeting … | the PE staff ensures the assigned habilitation coordinator receives a copy of the completed CLO. |
| the person is not eligible for habilitation coordination because the person is 20 or younger, then … | immediately following completion of the CLO … | the PE staff informs the person and LAR that they may contact Every Child, Inc. if they want to pursue community living in the future. |
| the person is not eligible for habilitation coordination because the person is not a Medicaid recipient, then … | immediately following completion of the CLO … | the PE staff informs the person and LAR that they may contact the following entities if they want to pursue community living in the future:
|
2430.6 Completing Section F, Return to Community Living
Revision 22-1; Effective Nov. 28, 2022
The LIDDA must complete Section F of the PE to record the individual’s:
- previous community living experiences;
- alternate placement preferences;
- alternate placement options;
- barriers to community living;
- supports needed for successful community living; and
- referrals made for alternate placement.
To complete Section F of the PE, the LIDDA selects the program of interest from the available drop-down menu. After the LIDDA has made the referral to the program the individual is interested in, the LIDDA adds the date the referral was made, the phone number of the person the referral was made to, and any other comments related to the referral.
2430.7 PE for Resident Review
Revision 22-1; Effective Nov. 28, 2022
When a resident with ID or DD who has been living in a NF experiences a significant change in condition, the NF submits an updated Minimum Data Set (MDS) assessment referred to as a Significant Change in Status Assessment (SCSA) into the LTC online portal. When an SCSA is submitted, the LTC online portal issues an alert to the LIDDA to conduct a resident review within seven calendar days after receiving the alert.
Before conducting the resident review, the LIDDA must contact the NF to determine if the change affects the resident’s PASRR eligibility or specialized services. A significant change in condition may require new, different, or fewer specialized services than the resident had been receiving. If the change does not meet the definition of a significant change in condition, the LIDDA is not required to conduct a resident review. The LIDDA must determine if a resident review is required based on the information provided by the NF.
If the LIDDA determines the change is not significant and does not conduct a resident review, the LIDDA must document the justification for its decision by adding a note to the history section of the current PE and in a progress note in the individual’s record.
The LIDDA uses the same form used to conduct a PE and submit the resident review the same way as the PE on the LTC online portal. The resident review is conducted to:
- assess the resident's need for continued care in a NF;
- assess the resident's need for specialized services as the need may have changed due to the significant change in condition; and
- identify alternate placement options.
The NF must convene the IDT meeting within 14 calendar days after the LTC online portal generates an automated notification to the LIDDA to conduct a resident review. The LIDDA should coordinate with the NF to schedule the initial IDT and SPT meeting and must document attempts to facilitate timely meetings if the NF convenes the initial IDT meeting after more than 14 calendar days.
2430.8 When a DID is Required to Adequately Complete the PE
Revision 22-1; Effective Nov. 28, 2022
If, during a PE, a LIDDA suspects a person of having a diagnosis of ID or DD but is unable to confirm the diagnosis due to lack of records or access to family history, the LIDDA must ensure compliance with the following procedure.
The LIDDA must ensure staff conducting the PE:
- completes a “referral” in section F1000 of the PE:
- in F1000A, by marking 19 for “Other”;
- in F1000B, by entering a statement that the person/resident is being referred for a determination of intellectual disability (DID);
- in F1000C, by entering the phone number of the LIDDA staff completing the PE or resident review;
- in F1000D, by entering the “date of referral” for the DID; and
- by marking the PE or resident review negative to indicate the person’s or resident’s diagnosis cannot be confirmed (i.e., in Section B, fields B0100 and B0200, enter “No”); and
- does not send the person or LAR a notice of denial of eligibility for specialized services and an opportunity for a fair hearing.
The LIDDA must, within 45 calendar days after the “date of referral” entered in Section F, field F1000D, ensure a DID is conducted for the person per rules governing diagnostic assessment (26 TAC Chapter 304).
The LIDDA must submit a copy of the written DID report to the PASRR unit by the Secure File Transfer Protocol file folder named “PASRR Reporting” within 30 calendar days after the DID is conducted.
If the DID report indicates the person does not have ID or DD, the LIDDA must:
- enter a note on the previously completed negative PE by clicking on the “add note” button on the yellow Form Action bar of the PE and state that the person does not have ID or DD per the result of the DID; and
- send the person or LAR a of:
- denial of specialized services because the person does not have a diagnosis of ID or DD per CFR Section 483.102(b)(1); and
- an opportunity for a fair hearing.
If the DID report indicates the person has ID or DD, then within seven calendar days after the DID report is completed, the LIDDA must complete a new PE for the person and mark it positive to indicate the person has ID or DD.
2430.9 PE Submission
Revision 22-1; Effective Nov. 28, 2022
The LIDDA must:
- Enter the data recorded from the PE into the LTC online portal.
- Retain a copy of the PE in the person’s record.
2430.10 Specialized Services Recommendation Mapping
Revision 22-1; Effective Nov. 28, 2022
When the LIDDA staff enters the PE in the LTC online portal and checks boxes to indicate areas of support the person may need in Section B, Specialized Services Determination/Recommendations, of the PE, the LTC online portal automatically populates the associated specialized services in B0500 Recommended Services Provided/Coordinated by the Local Authority and B0600 Recommended Services Provided/Coordinated by the Nursing Facility.
These auto-populated specialized services help ensure the LIDDA includes all specialized services recommended for the person and are displayed in the Recommended Specialized Services section. For a complete list of the specialized services mapping, refer to the Long-Term Care (LTC) Preadmission Screening and Resident Review (PASRR) User Guide (PDF).
The entity that completes the PE must complete Form 1014, Pre-Admission Screening and Resident Review (PASRR) Evaluation Summary Report. Only one form should be completed per person. For a person whose PE is positive for ID or DD, a LIDDA must complete Form 1014 following the completion of a PE. Form 1014 is used to summarize the recommended specialized services for a person who is eligible for specialized services. For a person who has a dual diagnosis (ID/D and MI), the LIDDA should take the lead on completing Form 1014. Detailed step-by-step instructions on how to complete the form are found at the link to the form above.
2430.11 Fair Hearing Related to Negative PE
Revision 22-1; Effective Nov. 28, 2022
If a person or LAR of a person whose PE is negative requests a fair hearing, HHSC notifies the LIDDA, which must provide information or material supporting a negative PE determination. The LIDDA must submit to HHSC all requested material or information about the fair hearing by the date established by the HHSC staff assembling the PE Fair Hearing Packet. The LIDDA also must attend the fair hearing in person or by phone.
2430.12 PE Retention Period
Revision 22-1; Effective Nov. 28, 2022
HHSC currently requires a LIDDA to keep all handwritten PE documentation in the person’s record indefinitely. The electronic version of the PE is retained in the LTC online portal system.
2430.13 Preadmissions Involving Two LIDDAs
Revision 22-1; Effective Nov. 28, 2022
When a person in one LIDDA’s service area plans to move to a NF in different LIDDA’s service area, follow the following process.
The transferring LIDDA:
- receives a positive PL1 completed by the RE;
- submits the PL1 into the LTC online portal within one business day of receipt;
- completes and submits the PE per rule and policy;
- confirms that medical necessity (MN) is approved in the LTC online portal;
- notifies the admitting NF that it can proceed with the admission; and
- sends copies of the submitted PL1 and PE to the receiving LIDDA and notifies the receiving LIDDA within two business days that the person has been admitted to a NF in the receiving LIDDA’s service area.
After receiving the PL1 and PE from the transferring LIDDA, the receiving LIDDA:
- submits a new PL1 within one business day of receipt, changing only the date of assessment (A0600) and signature date (A1200B) to the current date; and
- completes and submits a new PE per rule and policy, including conducting CLO.
After the NF certifies in the LTC online portal that it can meet the needs of the individual, the receiving LIDDA and admitting NF will have access to view the PL1 and PE in the LTC online portal.
During this process, it is imperative that the LIDDAs and NFs maintain communication about the status of the individual’s move. A person or LAR may change their mind and select an alternate placement or a different NF. All parties involved should be aware of where the person is living.
2500, PASRR Initial IDT and SPT Meeting
Revision 22-1; Effective Nov. 28, 2022
For any person with a positive PE for ID or DD, the NF convenes an IDT meeting. A LIDDA representative is a required member of the IDT, and HHSC strongly encourages the LIDDA representative be the LIDDA staff who conducted the PE. The NF is responsible for scheduling, conducting and documenting the IDT meeting. For a person with a positive PE for ID/DD and MI, both LIDDA and LMHA or LBHA representation is required. However, the LIDDA assumes primary responsibility for completion of required PASRR processes during the initial IDT and SPT meeting.
The IDT reviews the results of the person’s CLO to determine if the person’s total needs can be met in appropriate community settings, as well as reviews and discusses which of the PE’s recommended specialized services the person or LAR wants to receive.
Note: For a person who is eligible for habilitation coordination, the habilitation coordinator must be present at the IDT meeting.
2510 NF Enters Initial IDT and SPT Meeting Information
Revision 22-1; Effective Nov. 28, 2022
The NF enters the following information from the IDT meeting in the LTC online portal on the PASRR Comprehensive Service Plan (PCSP) form after the IDT meeting:
- the date of the IDT meeting;
- the names and titles of the IDT members in attendance;
- all specialized services agreed upon during the IDT meeting, if any; and
- the determination of whether the person is best served in a facility or community setting.
Note: The specialized services agreed upon during the IDT meeting for a person with a positive PE for ID or DD who:
- has Medicaid and is 21 or older are documented on the PCSP form in the Specialized Services Information section, fields A2800 NF Specialized Services, A2900 Durable Medical Equipment (DME), and A3000 IDD Specialized Services, as appropriate, and in field A3100 MI Specialized Services if the person also has MI.
- does not have Medicaid or is 20 or younger are documented on the PCSP form in the Comments section, field A3200 Nursing Facility Comments. If the person will be receiving the service through other funding sources, the NF is responsible for identifying the funding source or entity that will provide the specialized service in the comments field.
2520 Confirmation of IDT and SPT Meeting Information
Revision 22-1; Effective Nov. 28, 2022
A LIDDA must check the LTC online portal and take one of the following three actions in the chart below, as appropriate. They must do this within five business days after receiving notification from the LTC online portal that the NF entered information from an initial or annual IDT meeting into the PCSP form.
| Actions | |
|---|---|
| 1 |
If a LIDDA representative did not participate in the IDT meeting, the LIDDA must:
|
| 2 |
If a LIDDA representative participated in the IDT meeting, but determines the information the NF entered in the LTC online portal about the specialized services or the LIDDA’s attendance at the IDT meeting is incorrect, the LIDDA must contact the NF to address the discrepancy. They must allow seven calendar days for the NF to correct the information in the LTC online portal.
|
| 3 |
If a LIDDA representative participated in the IDT meeting and agrees with the information the NF entered in the LTC online portal about the specialized services and the LIDDA’s attendance at the IDT meeting, the LIDDA must document in the LTC online portal in Section A3500 agreement with the:
|
For instructions on confirming the IDT form, refer to the LTC Preadmission Screening and Resident Review (PASRR) User Guide for Local Authorities.
2600, Initiating NF Specialized Services
Revision 22-1; Effective Nov. 28, 2022
If funding for NF specialized services is available (i.e., Medicaid), the NF is responsible for the successful submission of a complete and accurate prior authorization request for NF specialized services in the LTC online portal within 20 business days after the date of the IDT meeting. The NF must start providing a habilitative therapy service within three business days after receiving approval from HHSC in the LTC online portal. Additionally, the NF must:
- order all DME devices and CMWCs per NF rules in 26 TAC Section 554.2754(e);
- provide ongoing habilitative therapy services as approved by HHSC; and
- document annually on the PCSP form in the LTC online portal all NF specialized services, IDD habilitative specialized services, and MI specialized services being provided to a person.