Revision 19-0; Effective July 7, 2019

 

2100 Purpose of PASRR

Revision 19-0; Effective July 7, 2019

 

PASRR screening and evaluation must be administered to identify:

  • people seeking admission to an 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 that considers admission into an NF for a person.

 

2200 Referring Entity

Revision 19-0; Effective July 7, 2019

 

A referring entity (RE) is a person or entity who refers someone to an NF for admission. The most common referring entities are hospital discharge planners. Other referring entities can be:

  • an acute care hospital
  • a psychiatric hospital
  • an NF (limited to when an NF resident is discharging from one NF and admitting directly to another NF)
  • an LAR or a family member
  • a physician (including office staff)
  • an assisted living facility
  • group homes
  • a hospice provider
  • a home health agency
  • an LBHA
  • an LMHA
  • a LIDDA
  • adult protective services staff
  • a state supported living center
  • an emergency placement source (e.g., law enforcement agency)
  • a community healthcare provider

PASRR requires that all people seeking admission to an NF have a PASRR Level 1 Screening (PL1) form completed prior to admission, and the referring entity 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 19-0; Effective July 7, 2019

 

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 19-0; Effective July 7, 2019

 

The PL1 Screening form is designed to identify people seeking admission to an NF who are suspected of having an MI, ID, or DD. The PL1 screens for possible eligibility for PASRR specialized services and is the first step toward enabling people to be appropriately served per their unique needs.

 

2320 PL1 Screening Form

Revision 19-0; Effective July 7, 2019

 

The PL1 Screening form contains the following sections:

  • Section A:
    • Submitter Information (NF/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 an 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/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:
    • Alternative Placement (Preferences) — documents the person’s or LAR’s alternate placement preferences. This section is only available after the PL1 has been submitted on the LTC online portal and is only accessible to the LIDDA/LMHA/LBHA.
    • Alternative Placement (Disposition) — documents to which alternate placement program the person was admitted. This section is only available after the PL1 has been submitted on the LTC online portal and is only accessible to the LIDDA/LMHA/LBHA. The LIDDA/LMHA/LBHA must complete this section within seven business days after the person enrolls in a community program.
  • Section F:
    • Admission Category — documents the NF admission type for the person.

 

2320.1 PL1 Submission

Revision 19-0; Effective July 7, 2019

 

The PL1 Screening form can only be submitted in the LTC online portal by a LIDDA/LMHA/LBHA or NF. Following successful submission, the LTC online portal will issue alerts based on the information contained within Section C of the completed form.

Note: When the PL1 is positive and the admission type is preadmission, the LIDDA/LMHA/LBHA must enter the PL1 in the LTC online portal within three business days of receipt from the RE.

 

2320.2 Positive PL1

Revision 19-0; Effective July 7, 2019

 

If the RE selects “Yes” to any of the fields within Section C, PASRR Screen, then the PL1’s status is considered positive for suspicion of an MI, ID or DD. A positive PL1 will trigger an alert to the LIDDA, LMHA/LBHA, or both, via the LTC online portal to proceed to the next step of the PASRR process — the PASRR evaluation (PE).

 

2320.3 Negative PL1

Revision 19-0; Effective July 7, 2019

 

If the RE selects “No” to all three fields within Section C, PASRR Screen, then the PL1 status is considered negative for suspicion of an MI, ID or DD. A negative PL1 screening will formally end the PASRR process for a person.

 

2330 Admission Types

Revision 19-0; Effective July 7, 2019

 

There are three types of NF admissions:

  • exempted hospital discharge;
  • expedited admission; and
  • preadmission.

 

2330.1 Exempted Hospital Discharge

Revision 19-0; Effective July 7, 2019

 

Exempted hospital discharge occurs when a physician has certified that a person being discharged from an acute care hospital is likely to require less than 30 days of NF services for the condition for which 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 will only require a PASRR evaluation if their stay in the NF exceeds 30 days. If the person's stay exceeds 30 days, the LTC online portal will send an alert to the LIDDA/LMHA/LBHA.

 

2330.2 Expedited Admission

Revision 19-0; Effective July 7, 2019

 

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 will determine when the PE is completed 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 19-0; Effective July 7, 2019

 

Preadmission occurs when a person is being admitted 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/LBHA with a copy of the PL1. The person may not be admitted to an NF until the LIDDA/LMHA/LBHA completes a PASRR evaluation.

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 an NF. It is important to note that the information entered in the PE for a preadmission is used by Texas Medicaid & Healthcare Partnership (TMHP) to determine MN for a person whose PE is positive. An MN determination is critical for people who want to divert from an NF admission directly into a community setting.

 

2340 Admission Type on PL1

Revision 19-0; Effective July 7, 2019

 

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.

Section F from the PL1.

TMHP 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.

After completing the PL1, the RE has the final responsibility of sending the completed paper PL1 Screening form to the appropriate party for submission to the LTC online portal. The chart below summarizes to which party the PL1 is sent depending upon 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 Referring Entity LIDDA if positive for ID/DD LMHA/LBHA if positive for MI
Negative Preadmission Referring Entity NF
Expedited Admission Referring Entity NF
Exempted Hospital Discharge Referring Entity NF
Change of Ownership (CHOW) The old NF contract/vendor number becomes the referring entity to the new contract number. The new contract number
NF to NF Transfers The discharging facility becomes the referring entity to the admitting facility. The admitting facility

 

2400 PASRR Level II Evaluation (PE)

Revision 19-0; Effective July 7, 2019

 

This section provides an overview of the PE form and its purpose in the PASRR process. For detailed information on how to complete a PE, and steps for submitting a PE into the LTC online portal, refer to Appendix I, Resources.

 

2410 Purpose, PASRR Status, and Staff Qualifications

Revision 19-0; Effective July 7, 2019

 

The PE confirms whether a person has a diagnosis of MI, ID or DD through document review and interviews. The PE is conducted for people who have a positive PL1. (If a PL1 indicates a negative PASRR condition, a PE may also be performed upon request from HHSC or an NF.) The PE is administered to identify:

  • whether a person has an MI, ID or DD;
  • the appropriate service setting for a person; and
  • a person’s need for specialized services.

 

2410.1 PASRR Positive

Revision 19-0; Effective July 7, 2019

 

When the PE confirms a person has an MI, ID or DD, the PASRR status for the person is PASRR positive.

 

2410.2 PASRR Negative

Revision 19-0; Effective July 7, 2019

 

When the PE does not confirm a person has an MI, ID or DD, the PASRR status for the person is PASRR negative, even when the PL1 is positive.

 

2410.3 Staff Qualifications

Revision 19-0; Effective July 7, 2019

 

The qualifications for staff completing a PE is contained in 26 TAC, Chapter 303, §303.303 (relating to Qualifications and Requirements for Staff Person Conducting a PE or Resident Review).

 

2420 LTC Online Portal Notification

Revision 19-0; Effective July 7, 2019

 

The LIDDA/LMHA/LBHA will receive an automatic alert notification in the LTC online portal generated by an NF’s submission of a positive PL1 into the LTC online portal for an expedited admission or an exempted hospital discharge.

The LIDDA/LMHA/LBHA will not receive an automatic alert notification if the LIDDA/LMHA/LBHA submitted the positive PL1 for preadmission into the LTC online portal.

 

2420.1 Timing of Alert is Based on Admission Type

Revision 19-0; Effective July 7, 2019

 

The type of admission from the PL1 determines when an alert will be sent to the LIDDA/LMHA/LBHA to conduct a PE. The timings for alerts are explained in the LTC Preadmission Screening and Resident Review (PASRR) User Guide for Local Authorities.

The LIDDA/LMHA/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 (CHOW) Extensions

Revision 19-0; Effective July 7, 2019

 

A CHOW occurs when an 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/LBHA receives multiple alerts to complete a PE. The LIDDA may request an extension to the seven-day time frame to complete the PE. To request an extension, the LIDDA/LMHA/LBHA must contact the HHSC PASRR Unit at PASRR.support@hhsc.state.tx.us.

 

2420.3 Information Gathered by a LIDDA Following an Alert to Conduct a PE

Revision 19-0; Effective July 7, 2019

 

A LIDDA that receives an alert in the LTC online portal to conduct a PE review must determine:

  • if the person has a prior PE*;
  • whether 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 (SSI); or
    • being eligible for Medicaid benefits if institutionalized.

*Information on whether the person has a prior PE is available by checking in the LTC online portal. Note that at this point, a LIDDA can only view a prior PE within the LIDDA’s local service area. If the Client Assignment and Registration (CARE) System shows the person was served by another LIDDA after 2015, the LIDDA receiving the alert should contact the other LIDDA to inquire about previous PEs, diagnostics and service plans.

**If the PL1 indicates 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 19-0; Effective July 7, 2019

 

If the person has full Medicaid benefits and is 21 or older, the LIDDA must be prepared to assign a habilitation coordinator if the person has a positive PE.

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 LIDDA(s).

 

2430 Completing and Submitting the PE

Revision 19-0; Effective July 7, 2019

 

LIDDAs are responsible for completing a PE for people who are suspected of having ID or DD.

LMHAs or LBHAs are responsible for completing a PE for people suspected of having an MI.

Both the LIDDA and LMHA/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, 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:

  1. Conducting a state-wide historical record review in accordance with Section 2430.3, Documentation Review for PE Completion.
  2. Contacting the RE or NF to make sure the person is still in the RE location or the NF before traveling to the RE location or NF to complete the PE and confirming the person is available and alert for the evaluation.
  3. Traveling 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.
  4. Bringing a release of confidential information to obtain the person’s/LAR’s consent to obtain additional information as needed from collateral contacts.
  5. Meeting 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.
  6. Notifying 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.
  7. Using 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.
  8. Submitting the PE into the LTC online portal within seven 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 19-0; Effective July 7, 2019

 

The person/LAR should be given the opportunity for interpreter services. The LIDDA must arrange or work in cooperation with the RE, NF and person/LAR for interpreter services as needed.

 

2430.2 Person/LAR Refuses to Participate in PE

Revision 19-0; Effective July 7, 2019

 

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/LAR in explaining the process to the person/LAR. If the person or LAR continues to refuse, the LIDDA will complete the PE solely from chart review and will document the person’s/LAR’s refusal in a comment field located within Section F1000 of the PE.

 

2430.3 Documentation Review for PE Completion

Revision 19-0; Effective July 7, 2019

 

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 (CMBHS), if available, LTC online portal and Service Authorization System Online (SASO)), 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 such as previous placement in settings, such as:

  • waiver programs (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 but not be limited to:

  • 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 19-0; Effective July 7, 2019

 

Information about most of the community programs listed in Section F0700 of the PE are contained in the documents that are provided to the person and LAR as part of CLO (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 19-0; Effective July 7, 2019

 

Person’s PE is Positive for ID or DD

For a person whose diagnosis of ID or DD has been confirmed, the staff conducting the PE must present community living options (CLO) in accordance with Section 5810.3, CLO Materials Provided to Individual/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 CLOs.

 

If the person wants to pursue community living at the end of the CLO presentation and:

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):

  • receives a copy of the completed CLO; and
  • is informed of the community program selected by the person/LAR.
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 ensures the assigned HC:

  • receives a copy of the completed CLO; and
  • is informed that the person doesn’t know which community program to pursue.
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:

  • to the regional Aging and Disability Resource Center (ADRC); and
  • for a LIDDA intake, if appropriate.

 

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 HC 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 will inform 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 will inform the person and LAR that they may contact the following entities if they want to pursue community living in the future:

  • the regional ADRC; and
  • the LIDDA.

 

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 the person’s LAR, Appendix II, Long Term Services and Supports, in the LIDDA Handbook.

If the person wants to pursue community living after receiving information about long term services and supports, then the PE staff will arrange for the person to be referred to the regional ADRC and, if appropriate, Every Child, Inc.

 

2430.6 PE for Resident Review

Revision 19-0; Effective July 7, 2019

 

When a resident with ID or DD who has been residing in an NF experiences a significant change in medical status, the NF will submit 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 will issue an alert to the LIDDA to conduct a resident review within seven calendar days after receiving the alert.

The LIDDA will use the same form used to conduct a PE and submit the resident review in the same manner as the PE on the LTC online portal. The resident review is conducted to:

  • assess the resident's need for continued care in an NF;
  • assess the resident's need for specialized services as the need may have changed due to the significant change in medical 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.

 

2430.7 When a DID is Required to Adequately Complete the PE

Revision 19-0; Effective July 7, 2019

 

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/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 in accordance with rules governing diagnostic assessment (40 TAC, Chapter 5, Subchapter D).

The LIDDA must, within 30 calendar days after the DID is conducted, submit a copy of the written DID report to the PASRR unit via the Secure File Transfer Protocol (SFTP) file folder named “PASRR Reporting.”

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 notice of:
    • denial of specialized services because the person does not have a diagnosis of ID or DD on accordance with CFR §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.

 

2430.8 PE Submission

Revision 19-0; Effective July 7, 2019

 

The LIDDA will:

  • enter the data recorded from the electronic or paper copy PE into the LTC online portal.
  • retain the original paper copy PE in the person’s record.

 

2430.9 Specialized Services Recommendation Mapping

Revision 19-0; Effective July 7, 2019

 

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. 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 LTC Preadmission Screening and Resident Review (PASRR) User Guide for Local Authorities.

The entity that completes the PE will 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.

 

2430.10 Fair Hearing Related to Negative PE

Revision 19-0; Effective July 7, 2019

 

If a person or LAR of a person whose PE is negative requests a fair hearing, HHSC will notify the LIDDA, which must provide information or material supporting a negative PE determination. The LIDDA must submit to HHSC all requested material or information related to 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.

 

2430.11 PE Retention Period

Revision 19-0; Effective July 7, 2019

 

HHSC currently requires a LIDDA to keep all handwritten PE documentation in the person’s record indefinitely. The electronic version of the PE will be retained in the LTC online portal system.

 

2500 PASRR Initial IDT/SPT Meeting

Revision 19-0; Effective July 7, 2019

 

For any person with a positive PE for ID or DD, the NF will convene 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, LMHA/LBHA representation is also required at the IDT.

The IDT will review the results of the person’s CLO to determine where the person is best served, as well as review and discuss which of the PE’s recommended specialized services that the person/LAR wants to receive.

Note: For a person who is eligible for habilitation coordination, a habilitation coordinator must be present at the IDT meeting.

Excluding a person’s/LAR’s refusal of specialized services, or in cases in which there is no funding for specialized services, if there is not consensus among all IDT members regarding whether a person should receive an NF specialized service, then obtaining an assessment for the NF specialized service is strongly encouraged. The assessment will indicate whether the person can benefit from the specific NF specialized service.

 

2510 NF Enters Initial IDT/SPT Meeting Information

Revision 19-0; Effective July 7, 2019

 

Following the IDT meeting, the NF enters the following information from the IDT meeting in the LTC online portal on the PASRR Comprehensive Service Plan (PCSP) form:

  • 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 individual 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/SPT Meeting Information

Revision 19-0; Effective July 7, 2019

 

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, a LIDDA must check the LTC online portal and take one of the following three actions in the chart below, as appropriate.

Action 1

If a LIDDA representative did not participate in the IDT, the LIDDA must:

  • contact the NF and request that the NF conduct another IDT that includes a LIDDA representative; and
  • document in the LTC online portal in Section A3500 disagreement with the:
    • specialized services listed in the LTC online portal; and
    • LIDDA representative’s attendance at IDT.
Action 2

If a LIDDA representative participated in the IDT, but determines the information the NF entered in the LTC online portal related to the specialized services or the LIDDA’s attendance at the IDT is incorrect, the LIDDA must contact the NF to address the discrepancy and allow seven days for the NF to correct the information in the LTC online portal.

  • If the NF corrected the information in the LTC online portal within seven days, the LIDDA must document in the LTC online portal in Section A3500 agreement with the:
    • specialized services listed in the LTC online portal; and
    • LIDDA representative’s attendance at IDT.
  • If the NF does not correct the information in the LTC online portal within seven days, the LIDDA must document in the LTC online portal in Section A3500 disagreement with whichever of the following that continues to be incorrect:
    • the specialized services listed in the LTC online portal; or
    • the LIDDA representative’s attendance at IDT.
Action 3

If a LIDDA representative participated in the IDT and agrees with the information the NF entered in the LTC online portal related to the specialized services and the LIDDA’s attendance at the IDT, the LIDDA must document in the LTC online portal in Section A3500 agreement with the:

  • specialized services listed in the LTC online portal; and
  • LIDDA representative’s attendance at IDT.

 

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 19-0; Effective July 7, 2019

 

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 and 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 in accordance with NF rules in 40 TAC §19.2754(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.