1. PASARR TRAINING 2018 Amy Hubbard, MSW Director of Clinical Services
Behavioral Consulting Services

2. CONTACT INFORMATION
Behavioral Consulting Services
1533 Wisconsin Avenue
Grafton, WI
BCS website:
Phone:
Fax:
Donna Wrenn, PASARR Contract Administrator
Website to download Level I screens: dhs.wisconsin.gov/forms
Search for form number: F-22191
For PASRR definitions and resources go to dhs.wisconsin.gov and search PASRR.

3. Per State of Wisconsin DHS website:
Preadmission Screening and Resident Review (PASRR) ensures sure that people are placed in the appropriate environment when they need intensive treatment and services.
In brief, PASRR requires all applicants to Medicaid-certified nursing facilities be assessed to determine whether they might have an intellectual disability or mental illness. This is called a Level I screen. The purpose of a Level I screen is to identify individuals whose total needs require that they receive additional services for their intellectual disabilities or serious mental illness. Individuals who test positive at Level I are then evaluated in depth to confirm the determination of an intellectual disability or mental illness for PASRR purposes. This is a Level II screen. This assessment produces a set of recommendations for necessary services that are meant to inform the individual's plan of care.

4. Per State of Wisconsin DHS website:
PASRR Regulations
On November 30, 1992, the federal Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), published final rules to implement Preadmission Screening and Annual Resident Review (PASRR) requirements for all current and prospective nursing facility residents. The regulations are published at 42 CFR Parts 405, 431, 433, and 483.
PASRR requirements apply only to Medicaid-certified nursing facilities, and do not apply to Medicare-only skilled nursing facilities (SNFs), intermediate care facilities for individuals with intellectual disabilities (ICFs/IID), or community-based residential facilities (CBRFs).

5. Per State of Wisconsin DHS website:
PASRR REQUIREMENTS
Purpose: To ensure that individuals who have a mental illness or who have an intellectual/developmental disability (mental retardation):
Are placed in a nursing facility only when their needs:
a) Cannot be met in an appropriate community placement (note: there are many persons who may qualify for a Title 19 care level whose needs can be met in an appropriate community placement --- PASRR prohibits the admission or retention of such individuals in a nursing facility under circumstances described later); and
b) Do not require the specialized care and treatment of an inpatient psychiatric hospital or ICF/IID placement.
2) Receive appropriate treatment (specialized services) for their mental illness or developmental disability if their independent functioning is limited due to their disability.
Applicability: The federal PASRR statutes and regulations apply to all individuals who are seeking admission to a nursing facility and all residents of a nursing facility, irrespective of source of payment. The PASRR process only applies to Medicaid certified (Title 19) nursing facilities. PASRR does not apply to hospitals, Medicare certified only nursing facilities, DHS 132 licensed only nursing homes, ICFs/IID, or group homes (CBRFs and adult family homes). PASRR will apply to individuals who are seeking admission to a nursing facility, but currently reside in a group home, ICF/IID, etc.

6. OUTLINE FOR TODAY Why are Level I screens necessary?
Who is responsible for the completion of Level I screens?
When should a Level I referral be made for a Level II? (diagnoses and time-frames)
Discuss encrypted s (how is this going?)
Should situational depression (also known as adjustment disorder or reactive depression)be referred for a Level II?
When should anxiety with a PRN medication be referred?
Should dementia with depression (anxiety/psychosis) be referred for a Level II?
What are Specialized Services/Specialized Psychiatric Rehabilitative Services. Where to find resources for these determinations on the state website.
What documentation is needed for a Level II? (Level I, dx list, med list, psych eval/notes, nursing notes, social history, face-sheet, H&P, parts of MDS)

7. PASARR reminders
The PASARR process is to screen for a mental illness (MI) or intellectual disability (ID), not a review process for medications.
The PASARR process makes 2 determinations: ) Nursing Home placement (yes or no) ) Specialized Services (yes or no - whether or not an individual is in need of intensive psychiatric services for for their MI or ID while in the NH.)
Nursing Homes need a corresponding diagnosis for every medication that is prescribed. This should be clearly documented prior to NH admission.

12. Case examples Myocardial infarct ESRD Diabetes
History of breast and bladder cancer
Degenerative joint disease
Osteoporosis
Depression – receives prozac
Arthritis

13. Case examples
Anxiety – receives ativan PRN (about 10x in past 30 days)
Depression – receives celexa
Hypertension
Congestive heart failure
Parkinson’s
Cardiomyopathy
Chronic obstructive pulmonary disease

14. Case examples Osteopenia Anemia Congestive heart failure
Chronic obstructive pulmonary disease
Myocardial infarct
Hypertension
Aortic aneurysm
Cardiomegaly
Depression – no meds, no signs or symptoms

15. Case examples Dementia with hallucinations – receives haldol
Chronic obstructive pulmonary disease
Degenerative joint disease
Congestive heart failure

16. Case examples Congestive heart failure
Chronic obstructive pulmonary disease
Atrial fib.
Dementia
Chronic kidney disease
Diabetes
Anxiety – receives ativan PRN (15/22 days)

17. Case examples Alcohol abuse / withdrawal – receives ativan
Dementia with behaviors – receives haldol and celexa
Cirrhosis
Chronic kidney disease
Degenerative joint disease
Hypertension
Anemia

18. Case examples Diabetes Hypertension Congestive heart failure
End stage dementia
Receives trazadone for sleep

19. Case examples Cancer ESRD Hyperlipidemia Spinal stenosis
Osteoarthritis
Receives remeron for appetite

20. Case examples Schizophrenia – receives zyprexa Parkinson’s Diabetes
Hypertension
Degenerative joint disease
Cardiomyopathy
Receiving hospice services

21. Case examples Osteopenia Osteoarthritis
Dementia with depression – receives celexa
Chronic obstructive pulmonary disease
Congestive heart failure
Spinal stenosis
Kyphosis

22. Case examples Prostate cancer with mets Hospice is involved Osteopenia
Arthritis
Hypertension
Anxiety – recevies PRN ativan 2x in 30 days

23. Case examples Diabetes Cerebrovascular accident Osteoporosis
Degenerative joint disease
Hypertension
Situational depression – receives citalopram (diagnosed 1 ½ years ago)
Dementia with anxiety – receives xanax

24. Case examples Diabetes Cerebrovascular accident Hypertension
Osteopenia
Depression – no meds (symptoms are present)
Congestive heart failure
Chronic obstructive pulmonary disease
Atrial fib.

25. Case examples Right hip fracture Recent fall Cerebrovascular accident
Myocardial infarct
Situational depression – receives zoloft (diagnosed 1 month ago)
Osteoarthritis

26. Case examples Alcohol dementia Atrial fib.
Anxiety - receives xanax on a routine basis
Osteoarthritis
Congestive heart failure
Cardiomegaly

27. Case examples Schizophrenia – no medications, no symptoms
Degenerative joint disease
Cancer
ESRD
Fractured right hip