Revision 20-0; Effective August 25, 2020 

 

2100 Referring Entity 

Revision 20-0; Effective August 25, 2020 

 

The Preadmission Screening and Resident Review (PASRR) process begins with the referring entity (RE). An RE is a person or entity who refers someone to a nursing facility (NF) for admission. The most common REs are hospital discharge planners. Other REs can be, but are not limited to: 

  • an acute care hospital; 
  • a psychiatric hospital; 
  • an NF (limited to when a person in an NF is discharging from one NF and admitting directly to another NF); 
  • a Legally Authorized Representative (LAR) or a family member; 
  • a physician (including office staff); 
  • an assisted living facility; 
  • group homes; 
  • a hospice provider; 
  • a home health agency; 
  • adult protective services staff; 
  • a state supported living center; 
  • an emergency placement source (e.g., law enforcement agency); and 
  • a community health care 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 a mental illness (MI), intellectual disability (ID) or developmental disability (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. 

 

2110 PASRR Level 1 Screening 

Revision 20-0; Effective August 25, 2020 

 

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 and Healthcare Partnership (TMHP) website at https://www.tmhp.com/programs/ltc/forms.

 

2120 PL1 Screening Form Purpose 

Revision 20-0; Effective August 25, 2020 

 

The PL1 Screening form is designed to identify people seeking admission to an NF who are suspected of having an MI, ID or DD.  

 

2130 PL1 Screening Form Sections 

Revision 20-0; Effective August 25, 2020 

 

The PL1 Screening form contains the following sections: 

  • Section A: 
    • Submitter Information identifies contact information for the person from the local behavioral health authority (LBHA)/local mental health authority (LMHA) submitting the PL1 into the TMHP Long Term Care Online Portal (LTCOP). 
    • 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 later, if necessary, to update the PL1 due to a death or discharge. It is essential the LMHA/LBHA enter and verify the person’s demographic information correctly prior to submitting the PL1. The demographic information can be found in the medical chart, including the person’s Social Security number, Medicaid and Medicare information, birth date, proper name and other information that may be needed. 
  • Section C: 
    • PASRR Screen Section C documents answers to the questions related to whether the person completing the form believes there is evidence or indicators of mental illness (C0100), intellectual disability (C0200) or developmental disability (C0300). The person will document either yes or no to each of the three questions. 
    • Local Authority (LA) Information documents the LMHA/LBHA/LIDDA information associated with the PL1 submission. This section will auto-populate based on the LMHA/LBHA/LIDDA vendor number. 
  • Section D: 
    • Nursing Facility Choices documents the person’s or LAR's choice(s) of NFs for admission. 
  • Section E: 
    • This section is only available for data entry to the LA after the PL1 has been submitted on the LTCOP. 
    • Alternative Placement (Preferences) documents the person’s or LAR’s alternate placement preferences and should be completed by the referring entity (RE).   
    • Alternative Placement (Disposition) documents to which alternate placement program the person was admitted. For a person transitioning out of the NF, the LA must complete this section before the person is discharged on the PL1 (B0650 and B0655) and within seven business days after the person enrolls in a community program. 
    • For diversions, the LA completes this section after Medical Necessity (MN) is approved and will also discharge the person on the PL1 (B0650 and B0655). 
  • Section F: 
    • Documents the person’s PASRR Admission Category and must be completed by the RE. There are four types of NF admissions: 
      • Exempted hospital discharge 
      • Expedited admission 
      • Preadmission 
      • Negative 

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. 

 

2140 Exempted Hospital Discharge 

Revision 20-0; Effective August 25, 2020 

 

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 nursing facility (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 referring entity (RE) [acute care hospital] provides the NF with a copy of the PL1. The NF enters the PL1 into the TMHP Long Term Care Online Portal (LTCOP) immediately upon the person’s admission. 

A person in this category with a positive PL1 will only require a PASRR evaluation (PE) if a stay in the NF exceeds 30 days. If the person's stay exceeds 30 days, the LTCOP will send an alert to the LMHA/LBHA/LIDDA to conduct the PE. 

  

2141 Expedited Admission 

Revision 20-0; Effective August 25, 2020 

 

Expedited admission occurs when a person meets the criteria for any of the following seven categories: 

  • Convalescent Care: Person is admitted from an acute care hospital to an NF for convalescent care with an acute physical illness or injury which required hospitalization and is expected to remain in the NF for greater than 30 days. 
  • Terminal Illness: Person has a medical prognosis that his or her life expectancy is six months or less if the illness runs its normal course. A person’s medical prognosis is documented by a physician’s certification, which is kept in the person’s medical record maintained by the NF. 
  • Severe Physical Illness: An illness resulting in ventilator dependence or diagnosis, such as chronic obstructive pulmonary disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis or congestive heart failure, which result in a level of impairment so severe that the person could not be expected to benefit from specialized services. 
  • Delirium: Provisional admission pending further assessment in case of delirium where an accurate diagnosis cannot be made until the delirium clears. 
  • Emergency Protective Services: Provisional admission pending further assessment in emergency situations requiring protective services, with placement in the NF not to exceed seven days. 
  • Respite: Very brief and finite stay of up to a fixed number of days to provide respite to in-home caregivers to whom the person with MI or ID is expected to return following the brief NF stay. 
  • Coma: Severe illness or injury resulting in the inability to respond to external communication or stimuli, such as coma or functioning at brain stem level. 

The RE provides the NF with a copy of the PL1. The NF enters the PL1 into the LTCOP immediately upon a 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. 

 

2142 Preadmission 

Revision 20-0; Effective August 25, 2020 

 

The preadmission process starts when an NF admission is from an RE in the community (such as the person’s home, group home, psychiatric hospital, assisted living or jail) but not an acute care hospital or another NF. When the RE is a family member, the RE may request assistance from the NF to complete the PL1. The NF is not allowed to submit preadmission PL1s. If the PL1 is negative, the negative admission process is followed (see Section 2233, Documentation Review for PE Completion).    

If the PL1 is positive: 

  • The RE faxes the PL1 Screening form to the LMHA/LBHA/LIDDA (this serves as the notification to complete the PE). 
  • The LMHA/LBHA/LIDDA submits the PL1 Screening form on the LTCOP. 
  • The LMHA/LBHA/LIDDA initiates face-to-face contact for the PE within 72 hours of notification by the RE. 
  • The LMHA/LBHA/LIDDA submits the PE on the LTCOP within seven calendar days of notification by the RE.   

Texas Medicaid & Healthcare Partnership (TMHP) is responsible for reviewing successfully submitted preadmission PEs to determine medical necessity (MN) for people who are PASRR positive. The initial Minimum Data Set (MDS) assessment will inherit the MN determination from the PE, if the MDS assessment effective date is within 30 days (plus or minus) of the date of assessment of the PE. 

The NF reviews the PE, including recommended specialized services, and certifies on the PL1 Screening form, Section D, if able or unable to serve the person, and MN must be established before the person can be admitted to the NF. 

 

2143 Negative Admission  

Revision 20-0; Effective August 25, 2020

 

If the RE determines the answer is “No” to all three questions within Section C, PASRR Screen, then the PL1 screening status is considered negative for suspicion of an MI, ID or DD. The RE sends the PL1 to the admitting NF with the person. The NF enters the negative PL1 into the LTCOP upon the person’s admission. The PASRR process ends for the person after admission. 

 

2150 PL1 Submission 

Revision 20-0; Effective August 25, 2020 

 

The PL1 Screening form can only be submitted in the LTCOP by an LA or NF depending on the admission type. 

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 LTCOP.  

The table below summarizes who completes the PL1 and to which party the PL1 is sent based 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 Referring Entity (RE) LMHA/LBHA if positive for MI; LIDDA if positive for ID/DD
Negative Preadmission RE NF
Expedited Admission RE NF
Exempted Hospital Discharge RE NF
Change of Ownership (CHOW) NF with the old contract/vendor number becomes the RE to the new contract number NF with the new contract number
NF to NF Transfers Discharging NF becomes the RE to the admitting NF Admitting NF

 

2200 PASRR Level II Evaluation (PE) 

Revision 20-0; Effective August 25, 2020 

 

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 LTCOP, refer to the Intellectual and Developmental Disability Preadmission Screening and Resident Review (IDD-PASRR) Handbook, Appendix I, Resources, “Detailed Item by Item Guide for Completing the PASRR Evaluation,” online at https://hhs.texas.gov/laws-regulations/handbooks/idd-pasrr/appendices/appendix-i-resources.  

 

2210 PE Purpose 

Revision 20-0; Effective August 25, 2020 

 

A PE is a face-to-face evaluation of the person and/or interview with the LAR and is performed by the LMHA, LBHA or LIDDA. If the PL1 is positive, a PE is completed to confirm the suspicion of MI, ID or DD. Medical records, interviews with the person and/or LAR, school records and any statewide historical records that are available are used to complete the PE. The PE is administered to identify: 

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

To complete a PE for a person suspected of having both an MI and ID/DD diagnosis, refer to Section 2320, NF Enters Initial IDT/SPT Meeting Information. 

 

2211 PASRR Positive 

Revision 20-0; Effective August 25, 2020 

 

When the PE confirms a person has an MI, ID or DD, the PASRR status for the person is PASRR positive. For guidance on determining whether a person is PASRR positive for MI, refer to Section 2234, Determining the MI PASRR Condition. 

 

2212 PASRR Negative Status 

Revision 20-0; Effective August 25, 2020 

 

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. This ends the PASRR process for a person whose PE determines if the person is PASRR negative.   

 

2213 Staff Qualifications for Completing a PE 

Revision 20-0; Effective August 25, 2020 

 

The qualifications for staff completing a PE are contained in 26 Texas Administrative Code, Chapter 303, §303.303 (relating to Qualifications and Requirements for Staff Person Conducting a PE or Resident Review). For more information on resident reviews, see Section 2237, PE for Resident Review. 

An LMHA/LBHA must ensure a PE or resident review is conducted by a person who is a:  

  • Qualified Mental Health Professional – Community Service;  
  • Registered Nurse (RN); 
  • Licensed Clinical Social Worker; 
  • Licensed Professional Counselor; 
  • Licensed Marriage and Family Therapist; 
  • Licensed Psychologist; 
  • Advanced Practice Registered Nurse;  
  • Physician; or 
  • Physician Assistant.  

Before a staff person conducts a PE or resident review, an LMHA/LBHA must ensure the staff person receives HHSC-developed training about how to conduct a PE and resident review and demonstrates competency in completing a PE and resident review. Additionally, the LMHA/LBHA must maintain documentation of the training received by a staff person who conducts a PE or resident review.  

 

2220 LTCOP Notification 

Revision 20-0; Effective August 25, 2020 

 

The LA will receive an automatic alert notification to complete a PE in the LTCOP generated by an NF’s submission of a positive PL1 into the LTCOP for an expedited admission or an exempted hospital discharge. 

For preadmissions, the receipt of the faxed PL1 serves as notification for the LA to complete a PE. 

 

2221 Notifications for Dually Diagnosed Individuals  

Revision 20-0; Effective August 25, 2020 

 

Dually diagnosed individuals are people who show signs of both MI and IDD, MI and ID, or MI and DD. There are two sections on one PASRR evaluation (PE) and two payments for the PE if performed by separate local authorities (LAs) [a LIDDA side and an LMHA/LBHA side].   

When two LAs are involved, the LA that initiates submitting a PE is responsible for completing common sections of the PE. All sections of the PE are common except Section B, which is specific to IDD and Section C, which is specific to MI.  

The PE is not considered complete until both sections (MI and IDD) are completed when the person is dually diagnosed. If only one part of the PE is completed, a system-generated alert is sent to the LA responsible for completion. 

 

2222 Timing of Alert is Based on Admission Type 

Revision 20-0; Effective August 25, 2020 

 

The type of admission from the PL1 determines when an alert will be sent to the LA to conduct a PE. The timing for alerts are explained in Section 2330, Confirmation of IDT/SPT Meeting Information. 

The LA must: 

  • check the LTCOP 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 preadmission PE are promptly acted on. 

 

2223 Change of Ownership Extensions 

Revision 20-0; Effective August 25, 2020

 

A Change of Ownership (CHOW) occurs when an NF is purchased by another facility, entity or corporation. When a CHOW happens, a new contract number is assigned to the NF. Once the new contract number is assigned, the NF being purchased must enter a new PL1 for every person in the NF within 90 calendar days after the new contract number’s effective date. 

Depending on the number of persons that are PASRR positive and need a new PE completed, extensions may be granted when an LA receives eight or more alerts from the same NF to complete a PE. The due date for the extension is calculated based upon the total number of alerts and calculating the LA completing four PEs per week. The LA may request an extension to the seven-day time frame to complete the PE. To request an extension, the LA must contact the HHSC PASRR Unit at PASRR.support@hhsc.state.tx.us

 

2230 Completing and Submitting the PE 

Revision 20-0; Effective August 25, 2020

 

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

Both the LMHA/LBHA and the LIDDA are responsible for completing their respective part of a PE for people suspected of having a dual diagnosis (MI and ID/DD). 

Note: While an LMHA and LBHA will generally have the same responsibilities as a LIDDA for completing and submitting a PE, this handbook is intended to provide instructions and procedures for LMHAs/LBHAs in implementing PASRR requirements. From this point forward, this handbook will no longer reference LIDDAs unless it is within the context of a person with dual diagnoses, meaning MI and ID/DD. 

The Qualified Mental Health Professional-Community Services (QMHP-CS) must meet face to face with the person within 72 hours of receiving the PL1 to begin the process of completing the PE.   

The LMHA/LBHA uses documentation reviews, family interviews, interviews with others who know or have known the person, and NF staff interviews to complete the PE. The LMHA/LBHA has the following responsibilities when completing a PE: 

  1. Conducting a historical record review. See Section 2233, 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. It is advisable at this point to determine if the person needs translator services. See Section 2231, Interpreter Services. 
  3. Meeting face to face with the person within 72 hours after notification from the LTCOP online portal or receiving a copy of the PL1 from the RE. 
  4. 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 LMHA/LBHA. 
  5. Bringing a release of confidential information to obtain the person’s/LAR’s consent to obtain additional information, as needed, from collateral contacts. 
  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 MI and meets the criteria for MI specialized services. The LMHA/LBHA should seek assistance and clarification of documentation from available medical staff, as needed, and record only what is documented in the medical record.  
  8. The LMHA/LBHA must document on the PE what information and documentation were used to complete the evaluation. In the event the LMHA/LBHA is not satisfied with the diagnostic information available, it may be more appropriate to schedule a diagnostic interview with the LMHA’s/LBHA’s psychiatrist. This can be done either in person or via telemedicine. 
  9. Submitting the PE into the LTCOP within seven calendar days after notification. 

The PE can be completed on paper or electronic versions, but ultimately the information collected must be submitted on the LTCOP by the LA within the seven-day time frame. 

 

2231 Interpreter Services 

Revision 20-0; Effective August 25, 2020 

 

To complete the PE, the person/LAR should be given the opportunity for interpreter services, if needed. The LMHA/LBHA must arrange or work in cooperation with the RE, NF and person/LAR for interpreter services, if needed. 

 

2232 Person/LAR Refuses to Participate in PE 

Revision 20-0; Effective August 25, 2020 

 

If a person or LAR refuses participation in the PE, the LMHA/LBHA should request assistance from NF staff who 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 LMHA/LBHA 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. 

 

2233 Documentation Review for PE Completion 

Revision 20-0; Effective August 25, 2020 

 

When investigating a person’s history for a PE, the LMHA/LBHA should search all applicable service and medical records, including those available in online databases, such as the Client Assignment and Registration (CARE) system, Clinical Management for Behavioral Health Services (CMBHS) and if available, LTCOP.  

Investigating these systems can provide the LMHA/LBHA with insight on where to look for records and can yield valuable information, such as previous placement in settings of: 

  • State psychiatric hospitals; 
  • Private psychiatric hospitals; 
  • Other state facilities; 
  • Criminal justice facilities; 
  • Waiver programs, Home and Community Based Services (HCBS), STAR+PLUS; 
  • State supported living centers; and 
  • Intermediate care facilities (ICFs). 

Documentation gathering, and record review should include, but not be limited to: 

  • Diagnostic records; 
  • Medical records; 
  • Previous PEs, service plans and assessments; and 
  • All relevant records from other LMHAs/LBHAs. 

 

2234 Determining the MI PASRR Condition 

Revision 20-0; Effective August 25, 2020 

 

To determine whether a person is PASRR positive for MI, there are several things the evaluator must take into consideration when responding to the following questions in Section C of the PE. 

Section C0100 Primary Diagnosis of Dementia – Does this person have a primary diagnosis of dementia? The primary diagnosis is the most serious and/or resource-intensive diagnosis.  Secondary diagnoses are other diagnosis that require attention. 

To determine if the person has a primary diagnosis of dementia, review the NF’s medical record for documentation by the physician that dementia is the primary diagnosis with a secondary diagnosis of MI (if MI diagnosis as per Section C0300 of the PE).   

If a person has a primary diagnosis of dementia and no MI diagnosis, the PASRR evaluator would respond “Yes” to the question in this section. If there is no documentation in the medical record that states the person has a primary diagnosis of dementia, then the correct response for this question would be “No.”   

Some of the most common types of dementia diagnoses to look for are: 

  • Alzheimer’s disease; 
  • Vascular dementia; 
  • Frontotemporal dementia; 
  • Lewy body dementia; and 
  • Dementia from Parkinson’s disease and similar disorders. 

Once “Yes” is checked in C0100, the rest of Section C will automatically be disabled within the form, but the evaluator must still complete Sections D, E and F of the PE. If the PASRR evaluator responds “Yes” in this section, the evaluator must ensure a diagnosis of dementia is recorded in Section D under Diagnosis. 

If the evaluator responds “No” to this question, the evaluator will complete the remainder of Section C.   

C0200 Severe Dementia Symptoms – Are the individual’s dementia symptoms so severe that they cannot be expected to benefit from PASRR specialized services? 

This determination must be based on documentation in the medical record that the person’s symptoms are resulting from the dementia diagnosis and not for any other reason. The PASRR evaluator may also talk with NF staff to find out more about the person’s dementia symptoms and the evaluator can take into consideration how the person responded or engaged during the PASRR evaluation.  

If the person does not have a dementia diagnosis, then the response to this question should be “No.”   

Persons with a diagnosis of dementia, that is not their primary diagnosis and the response to C0200 is “Yes,” may potentially be determined PASRR positive for MI once Section C is completed. 

Note:  If this section is checked “Yes,” there must be a diagnosis of dementia (not primary) in Section D for this response to be legitimate.  

For persons whose dementia symptoms are so severe that they cannot be expected to benefit from PASRR specialized services and are determined to be PASRR positive for MI, it is important to discuss whether this person would benefit from MI PASRR services during the interdisciplinary team (IDT) meeting.  

If the IDT (including the person and/or their LAR, NF RN and the LMHA/LBHA) agrees that “at this time” the person would not benefit from specialized services because of their current medical condition, this decision must be documented as specialized services “not needed.” A note must be added to the comment section of the PASRR Comprehensive Service Plan (PCSP) explaining why the person will not be receiving services.   

C0300 Mental Illness – In this section, the LMHA/LBHA documents whether a person has an MI diagnosis. If something other than “None of the Above Apply” is selected, the LMHA/LBHA needs to make sure an MI diagnosis is documented in Section D.  

The LMHA/LBHA must review the medical record for a diagnosis of MI. Examples of MI are:  

  • Schizophrenia; 
  • Mood disorder (Bipolar disorder, major depression or other mood disorder); 
  • Paranoid disorder; 
  • Panic or other severe anxiety disorder; 
  • Somatoform disorder; 
  • Schizoaffective disorder; and 
  • Panic or other disorder that may lead to a chronic disability diagnosable under the current Diagnostic and Statistical Manual of Mental Disorders. 

Documenting “None of the Above Apply” in this section, indicates that the PASRR evaluator’s medical record review resulted in the person not having an MI diagnosis and is therefore PASRR negative for MI.    

 

2235 Determining When Diagnosis is MI or Symptom Co-occurring with Dementia 

Revision 20-0; Effective August 25, 2020 

 

Many common signs and symptoms caused by dementia (i.e., Alzheimer’s disease, vascular dementia, Lewy body dementia and frontotemporal dementia) may be confused with a mental illness (MI) diagnosis.   

Dementia symptoms vary depending on the cause but are not an MI. Examples of common signs and symptoms of dementia include: 

  • Cognitive changes: 
    • Memory loss, which is usually noticed by a spouse or someone else; 
    • Difficulty communicating or finding words; 
    • Difficulty with visual and spatial abilities, such as getting lost while driving; 
    • Difficulty reasoning or problem-solving; 
    • Difficulty handling complex tasks; 
    • Difficulty with planning and organizing; 
    • Difficulty with coordination and motor functions; and 
    • Confusion and disorientation; and 
  • Psychological changes: 
    • Personality changes; 
    • Depression; 
    • Anxiety; 
    • Inappropriate behavior; 
    • Paranoia; 
    • Agitation; 
    • Hallucinations; and 
    • Psychosis. 

Unless the individual had an MI prior to their dementia diagnosis, these changes/symptoms are caused by their dementia. Therefore, the individual does not have MI.  

Examples of medical conditions not considered MI are:  

    •   Huntington’s disease; 
    •   Traumatic brain injury; and 
    •   Parkinson’s disease. 

Depression, unless diagnosed as a major depressive disorder in the medical record by the physician, is not considered an MI.   

C0400 Functional Limitation – It is important to thoroughly research the responses to this section.  Refer to the Intellectual and Developmental Disability Preadmission Screening and Resident Review (IDD-PASRR) Handbook, Appendix I, Resources, “Detailed Item by Item Guide for Completing the PASRR Evaluation,” online at https://hhs.texas.gov/laws-regulations/handbooks/idd-pasrr/appendices/appendix-i-resources, for more information on each choice in this section. 

Documenting “None of the Above Apply” in this section indicates that the PASRR evaluator’s medical record review resulted in the person not having any functional limitations and is, therefore, PASRR negative for MI even if they have selected “Yes” as a response in Sections C0500 – C0700.      

C0500 – C0700 Recent Occurrences – For a person to meet the federal PASRR definition of MI, they must have an MI diagnosis listed under C0300, a functional limitation documented in C0400 and had at least one of the following experiences listed in C0500, C0600 and C0700.  

After a thorough record review, if the response to any of these three questions is “Yes,” then C0800 is auto-populated to show that this person is PASRR positive for MI. If all selected are “No,” then C0800 auto-populates to show that this person is PASRR negative for MI even if this person has a diagnosis of MI. 

C0500 Inpatient Psychiatric Treatment – Has this individual experienced a psychiatric treatment more intensive than outpatient care more than once in the past two years? 

This means that a person must have had more than one inpatient stay in a psychiatric hospital or more than one partial psychiatric hospitalization (when a person resides at home, but commutes to a treatment center up to seven days a week). This includes the Intensive Outpatient Program (IOP) where the person goes daily to the psychiatric hospital or crisis treatment center.   

C0600 Disruption to Normal Living Situation – Has this individual experienced a significant disruption to their normal living situation requiring supportive services (e.g., residential or respite services) in the last two years due to MI? 

Were supportive services required to maintain functioning at home or in a residential treatment environment (i.e., psychiatric home health nurse or the LMHA/LBHA provide in-home psychiatric services to assist the person in staying in their own home). If so, then the PASRR evaluator would respond “Yes.” 

If a person has only had one inpatient or partial psychiatric hospitalization (C0500), the response would be “No.” But, disruption to normal living situations (C0600) would be “Yes” as they had a disruption to their normal living situation due to their MI.   

C0700 Intervention by Law Enforcement – Has this individual experienced intervention by law enforcement, protective services agencies or other housing officials in the last two years due to MI? 

Has law enforcement, protective agencies or a housing official’s person been contacted due to behaviors caused by their MI or because this person was a danger to themselves or others due to their MI? This also includes any interventions by an LMHA/LBHA crisis team.   

C0800 Based on the QMHP-CS assessment, does this individual meet the PASRR definition of mental illness? – There must be at least one “Yes” response to the questions in C0500 – C0700 for a PE to determine if the person is PASRR positive for MI. On the LTCOP, this question on the PE is auto-populated based on the responses in Sections C0500 – C0700.   

Section C, Specialized Services and Recommendations – The purpose of this section is to determine what types of specialized services, provided by the LMHA/LBHA, a person may benefit from receiving. 

When completing this section, consideration must be given to any additional support this person may need, not only while they are residing in the NF, but to help prepare persons whose goal is to transition out of the NF.   

A person who is PASRR positive for MI is not only eligible for the specialized services listed on the PE, but all Texas Resilience and Recovery (TRR) services their LMHA/LBHA offers.   

C0900 Does the individual need assistance in any of the following areas? – This section lists areas that a person may need assistance with and how these needs correspond with the services listed in C1000. But, as stated above, the person is eligible for all TRR services; not just those listed on the PE.   

If Section C0900 does not list all the needs a person being evaluated may require assistance with, it is important for the PASRR evaluator to list these needs in C0900M, Other Areas, along with the TRR services that would address these needs. 

Examples: 

  • Relief of post-traumatic stress disorder (PTSD) symptoms – Cognitive processing therapy; 
  • Relief of symptoms of persistent serious MI – Counseling services (CBT – individual or group); 
  • Suspected of, or are using, alcohol or other substances – Screening, brief intervention and referral to treatment (SBIRT) – Brief intervention provided; and  
  • Transitioning to the community – Supported housing. 

C01000 Recommended Services Provided/Coordinated by the LMHA/LBHA – The LMHA/LBHA must take into consideration when deciding which services to recommend for a person who is PASRR positive for MI, that the services are not limited to those listed on the PE. The person is eligible for all TRR services offered by a center. 

 

2236 PE Section F, Certain Community Programs Information 

Revision 20-0; Effective August 25, 2020 

 

All the community programs listed in Section F0700 of the PE may not apply to the person. The staff conducting the PE should determine which program the person may be eligible for and use the following information to describe these two programs to the person and LAR. 

  • F0700O STAR+PLUS is a Medicaid managed care program. Generally, all eligible people are automatically enrolled in STAR+PLUS. For the STAR+PLUS Home and Community Based Services (HCBS) Program or STAR+PLUS Waiver, use F0700D. 
  • F0700V Other community-based services is an example of the various housing programs offered at the LMHAs/LBHAs.  

 

2237 PE for Resident Review 

Revision 20-0; Effective August 25, 2020 

 

When a person with MI and/or IDD who has been residing in an NF experiences a significant change in medical status, the NF will submit an updated MDS assessment referred to as a Significant Change in Status Assessment (SCSA) into the LTCOP. When an SCSA is submitted, the LTCOP will issue an alert to the LA to conduct a resident review within seven calendar days after receiving the alert. 

Before initiating a new PE, the LA should contact the NF to confirm what the change of condition is, and will it affect their current PASRR status (i.e., is the change of condition medical only, placed on hospice or hospital stay?). If it is determined that the change of condition will not affect the current PASRR status, then the LA should note this on the PE in the history section documenting who they spoke with, date, time and results of conversation.   

If it is determined that a new PE is warranted, the LMHA/LBHA/LIDDA will initiate a new PE from the current PL1 and submit the resident review in the same manner as the PE on the LTCOP. The resident review is conducted to: 

  • assess the person's need for continued care in an NF; 
  • assess the person's need for specialized services as the need may have changed due to the significant change in mental or medical condition; and 
  • identify alternate placement options. 

Form 1012, Mental Illness/Dementia Resident Review, is used by the NF for a person who has been residing in an NF and has a negative PL1 for MI. Form 1012 assists the NF in determining whether the person may meet the Code of Federal Regulations definition of MI, if there is a dementia diagnosis and whether the person’s dementia is the primary diagnosis. After completing the form, the NF may submit another PL1 for the person, only this time the PL1 will be positive. Submitting a new positive PL1 will alert the LA to complete a resident review (new PE).  

Form 1012 also provides NFs the documentation for medical records as to why a new positive PL1 was not needed. 

The NF must convene the IDT meeting within 14 calendar days after the LTCOP generates an automated notification to the LA to conduct a resident review. The LA must attend the IDT in person or by phone. 

When a person who is a resident in an NF who has a negative PL1 for MI and has a significant change of condition that could indicate the person may be PASRR positive for MI, 26 Texas Administrative Code §303.102 requires that a resident review be conducted. When this occurs, Form 1012 is used by the NF for a person who has a negative PL1 for MI. This form assists the NF in determining whether the person may meet the Code of Federal Regulations definition of MI, if there is a dementia diagnosis and whether the person’s dementia diagnosis is the primary diagnosis. After completing Form 1012, the NF must submit a positive PL1 for the resident. The positive PL1, once entered by the NF into the LTCOP, will trigger the process to conduct a PE by the LMHA/LBHA. 

Form 1012 also provides NFs the documentation for medical records as to why a new positive PL1 was not needed. 

 

2238 PE Submission  

Revision 20-0; Effective August 25, 2020 

 

The LMHA/LBHA will: 

  • enter the data recorded from the electronic or paper copy PE into the LTCOP; 
  • retain the original paper copy PE in the person’s record; and 
  • reference the Texas Medicaid & Healthcare Partnership (TMHP) PASRR User Guide. 

 

2239 Specialized Services Recommendation  

Revision 20-0; Effective August 25, 2020 

 

Form 1014, Pre-Admission Screening and Resident Review (PASRR) Evaluation Summary Report, is used to summarize the recommended specialized services for a person who is eligible for specialized services following the completion of a PE, but prior to the IDT meeting. The entity that completes the PE will complete Form 1014.  

Only one Form 1014 should be completed per person. For a person whose PE is positive for: 

  • MI only, an LMHA/LBHA must complete Form 1014.  
  • MI and ID/DD (dual diagnosis), the LIDDA should take the lead on completing Form 1014.  

Form 1014 is a summary of the results of a person’s positive PE listing the recommended specialized services. The LA completes and provides a copy of the form to the person or LAR after completing a PE, but before the IDT meeting. The form must be signed by the person or LAR to indicate receipt of the form. The LA must keep a signed copy in the person’s LMHA/LBHA record. 

Detailed step-by-step instructions on how to complete the form are found on the HHS website with Form 1014

 

2240 Fair Hearing Related to Negative PE 

Revision 20-0; Effective August 25, 2020 

 

Based on the PE determination, a negative PE will result in the person not being eligible for PASRR specialized services which are funded through Medicaid. A negative PE does not affect the person’s eligibility for nursing facility services.  

An LMHA/LBHA must notify the person and their LAR about the negative PASRR determination using Form 2360, Negative PASRR Evaluation Letter. This form informs the person or their LAR of their PASRR determination and their right to request a Medicaid fair hearing to contest the denial of the specialized services. 

If a person or LAR requests a fair hearing, HHSC will notify the LMHA/LBHA, which must provide information or material supporting a negative PE determination. The LMHA/LBHA must submit all requested material or information related to the fair hearing by the date established by HHSC staff assembling the PE fair hearing packet. The LMHA/LBHA must also attend the fair hearing in person or by phone as a representative of HHSC to defend the negative PE determination. 

After the PE fair hearing, the person or LAR will receive a letter from the hearing officer informing them of the hearing results. LMHAs/LBHAs will also receive a copy of the letter with the hearing outcome. 

 

2250 PE Retention Period 

Revision 20-0; Effective August 25, 2020 

 

HHSC currently requires an LMHA/LBHA/LIDDA to keep all handwritten PE documentation indefinitely in the person’s record. The electronic version of the PE will be retained in the LTCOP system. 

 

2300 PASRR Initial IDT/SPT Meeting 

Revision 20-0; Effective August 25, 2020 

 

For any person with a positive PE for MI, ID or DD, the NF will convene an interdisciplinary team (IDT) meeting within 14 calendar days of the person’s NF admission, or for a resident review, within 14 calendar days after the LTCOP generated an alert to the LMHA/LBHA to complete a PE. The NF is responsible for scheduling, conducting and documenting the IDT meeting on the LTCOP. By participating in the IDT meeting, the LMHA/LBHA staff assists IDT members in accomplishing the goals of the IDT meeting, which are to: 

  • identify which of the MI specialized services recommended for the resident, or LAR on the resident's behalf, wants to receive by: 
    • ensuring the person, regardless of whether he or she has an LAR, participates in the IDT to the extent possible and receives the support necessary to do so; 
    • reviewing all available assessments, prior to the IDT meeting;  
    • explaining the Uniform Assessment (UA) and how it will determine a Level of Care (LOC); and 
    • explaining the need to schedule an LA update meeting once the UA is completed; and 
  • determine whether the resident is best served in a facility or community setting. 

The IDT will review and discuss which of the PE’s recommended specialized services the person wants and the LAR consents to being provided. 

PASRR specialized services and the funding source should be discussed during the meeting. For example, if the person is under the age of 21, specialized services could be accessed through Texas Health Steps. Funding sources other than Medicaid for persons age 21 and older should be discussed and recorded in the IDT meeting.  

If barriers are identified that would limit the provision of specialized services, the IDT members should determine whether provision of any specialized service could help eliminate barriers. If so, those specialized services should also be recommended and must be identified as such on the PASRR Comprehensive Service Plan (PCSP) form. It is important to remember a person has the right to accept or refuse any or all recommended specialized services and the acceptance or refusal of services must be documented in the PCSP form. 

Excluding a person’s/LAR’s refusal of specialized services, if there is not consensus among all IDT members regarding whether a person should receive an NF specialized service, 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. 

Note: Persons who are PASRR positive for MI only do not have quarterly service planning team (SPT) meetings, but an LA update meeting may be held anytime there is a need for acceptance of services after refusing in the IDT meeting, changes in services, etc. This LA update is documented on the PCSP form in the LTCOP.  

 

2310 Attendance at Initial IDT/SPT Meeting 

Revision 20-0; Effective August 25, 2020 

 

At the initial IDT meeting for a person, LMHA/LBHA staff are required to be in attendance either in person or by phone. 

If the LMHA/LBHA staff, as an IDT member participates by phone, the LMHA/LBHA staff must ensure their name is included on the meeting sign-in sheet. 

The Qualified Mental Health Professional-Community Services (QMHP-CS) must review any other available supporting documentation prior to the IDT meeting. This could include diagnostic information and previous uniform assessments (UAs) in Clinical Management for Behavioral Health Services (CMBHS), previous LMHA/LBHA services in the Mental and Behavioral Health Outpatient Warehouse (MBOW) and previous recovery plans in the LMHA/LBHA medical record. 

The LMHA/LBHA strongly encourages the LMHA/LBHA QMHP-CS, who completed the PE, to attend the person’s initial IDT meeting. The QMHP-CS must be prepared to discuss the person’s needed MI specialized services and make those recommendations, as well as ensure the recommended services are entered in the PASRR Comprehensive Service Plan (PCSP) form.   

For a person with a positive PE for MI and ID/DD, the LIDDA representative is also required at the IDT meeting and the LIDDA takes the lead for coordinating all specialized services discussed during the initial IDT meeting. If the person is eligible for habilitation coordination, a habilitation coordinator attends as well.  

Attendance at the initial IDT meeting as a required IDT member is an activity that is included in the PE reimbursement rate regardless of whether the person accepts or refuses services. 

 

2320 NF Enters Initial IDT/SPT Meeting Information 

Revision 20-0; Effective August 25, 2020 

 

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

  • Date of the IDT meeting; 
  • Names and titles of the required IDT members in attendance; 
  • All specialized services agreed upon during the IDT meeting, if any; and 
  • Determination of whether the person is best served in a facility or community setting. 

 

2321 Specialized Services Funding Considerations 

Revision 20-0; Effective August 25, 2020 

 

The specialized services agreed upon during the IDT meeting for a person with a positive PE for MI and/or IDD who: 

  • has Medicaid and is age 21 or older, are documented on the PCSP form in the Specialized Services Information section, Field A3100, MI Specialized Services, and in Fields A2800, NF Specialized Services, A2900, Durable Medical Equipment (DME), and A3000, IDD Specialized Services, if the person also has ID/DD. 
  • does not have Medicaid or is age 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 LMHA/LBHA is responsible for identifying the funding source for MI specialized services; 
  • The LIDDA is responsible for identifying the funding source for IDD specialized services; and 
  • The NF is responsible for identifying the funding source for NF specialized services.   

 

2330 Confirmation of IDT/SPT Meeting Information 

Revision 20-0; Effective August 25, 2020 

 

Within five business days after receiving notification from the LTCOP that the NF entered information from an initial or annual IDT meeting into the PCSP form, an LMHA/LBHA must log into the LTCOP and take one of the following three actions in the chart below, as appropriate: 

1. If an LMHA/LBHA representative participated in the IDT and agrees with the information the NF entered in the LTC online portal related to the specialized services at the IDT, the LMHA/LBHA must confirm in the LTCOP in Section A3400 agreement with the: 

  • specialized services listed in the LTCOP; and 
  • LMHA/LBHA representative’s attendance at the IDT. 

    For instructions on confirming the IDT form, refer to the LTC User Guide for Preadmission Screening and Resident Review (PASRR)

2.  If an LMHA/LBHA representative participated in the IDT but determines the information the NF entered in the PCSP form related to the specialized services agreed to at the IDT is incorrect, the LMHA/LBHA must contact the NF and ask the NF to address the discrepancy. The LMHA/LBHA will allow seven calendar days for the NF to correct the information in the PCSP form. 

  • If the NF corrects the information in the LTCOP within seven days, the LMHA/LBHA must confirm in the LTCOP in Section A3400 agreement with the: 
    • specialized services listed in the LTCOP; and 
    • LMHA/LBHA representative’s attendance at the IDT. 
  • If the NF does not correct the information in the LTCOP within seven days, the LMHA/LBHA must document in the LTCOP in Section A3400 disagreement with whichever of the following that continues to be incorrect: 
    • specialized services listed in the LTCOP; and 
    • LMHA/LBHA representative’s attendance at the IDT. 

3.  If an LMHA/LBHA representative did not participate in the IDT, the LMHA/LBHA must: 

  • contact the NF and request that the NF conduct another IDT that includes an LMHA/LBHA representative; and 
  • document in the LTCOP in Section A3500 disagreement with the LMHA/LBHA representative’s attendance at the IDT.