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OREGON HEALTH AUTHORITY,
ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES
DIVISION 48
INTERMEDIATE AND SKILLED NURSING FACILITIES
PASARR — Pre-Admission Screening and Annual Resident Review
309-048-0050
Statement of Purpose
and Statutory Authority
(1) Purpose. These rules prescribe
Division standards and procedures regarding the screening, evaluation and provision
of specialized services to persons with mental illness who apply for or reside in
Medicaid certified nursing facilities. They implement Public Law 100-203 of the
Omnibus Budget Reconciliation Act of 1987 that added Section 1919 to the Social
Security Act.
(2) Statutory authority and
procedure. These rules are authorized by ORS 413.042 and to carry out the provisions
of ORS 410.535, 414.065 & 426.490 to 426.500 and Public Law 100-203.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0060
Definitions
As used in these rules:
(1) “Annual resident review”
means the review of referrals from the annual resident screening process by designees
of the Addictions and Mental Health Division. The purpose of the review is to determine
the need for a Level II psychiatric evaluation.
(2) “Annual resident screening”
means the annual screening by nursing facility staff of all residents for acute
symptoms or indicators of mental illness.
(3) “Categorical determination”
means a decision made by a contractor of the Aging and People with Disabilities
Division (APD) based on a functional assessment. This determination identifies a
person who, despite the presence of mental illness, can be admitted to a nursing
facility. The categories are:
(a) Individuals requiring nursing
facility care for 30 days or less for convalescent care following an acute care
hospitalization for illness or surgery;
(b) Persons with terminal illness
with a prognosis of six months or less; and
(c) Persons with severe medical
condition that precludes participation in or benefit from specialized services.
(4) “Client Process Monitoring
System (CPMS)” means the automated client data system maintained by the Division.
(5) “Community Mental
Health Program (CMHP)” means the organization of all services for persons
experiencing problems related to mental illness, drug and alcohol abuse, and mental
retardation or other developmental disabilities, operated by, or contractually affiliated
with, a local mental health authority operated in a specific geographic area of
the state under an intergovernmental agreement or direct contract with the Division.
(6) “Determination”
means the decision/recommendation made by a designee of the Division regarding an
individual’s eligibility for Level II evaluation, i.e., presence of a serious
mental illness and need for “specialized services” as required by Public Law 100-203. Determinations regarding an individual’s
need for nursing facility services are the responsibility of the APD.
(7) “Division” means the Addictions
and Mental Health Division of the Oregon Health Authority.
(8) “Indicators of mental
illness — applicants.” Applicants to nursing facilities with a diagnosis
of a major mental disorder and a history of treatment related to his diagnosis in
the past two years are considered to have indicators of mental illness. Alzheimer’s
and/or a diagnoses of dementia are excluded from this definition of major mental
disorder.
(9) “Indicators of mental
illness — residents.” Residents of nursing facilities with psychiatric
or behavioral symptoms that indicate a need for “specialized services”
are considered to have indicators of mental illness regardless of diagnosis or history
of treatment.
(10) “Level I” means
the federally required screening for indicators of mental illness process implemented
by APD under OAR 411-070-0043. All applicants to nursing facilities are screened
for indicators of mental illness and a determination made whether the applicant
requires nursing facility care based on a functional assessment.
(11) “Level II”
means the evaluation process conducted by designees of the Division to determine
whether an individual with mental illness requires specialized services. The determination
is based on a current functional assessment, history and physical, psychosocial
evaluation, a mental health assessment and a medication review.
(12) “Level II summary”
means the form approved by OMHS which identifies data to be collected by Division
designees in the Level II evaluation.
(13) “Licensed medical
professional” means a medically trained person who is licensed to practice
in the State of Oregon and has one of the following degrees: MD (Medical Doctor);
DO (Doctor of Osteopathy); NP (Nurse Practitioner); PA (Physician’s Assistant);
or RN (Registered Nurse).
(14) “Nursing facility
(NF)” means a facility that contains Medicaid certified inpatient beds and
provides medical services but excludes hospital/surgical procedures. The facility
must be licensed and certified by APD.
(15) “Office of Mental
Health Services (OMHS)” means that portion of the Division responsible for
mental health services.
(16) “Pre-admission screening
(PAS)” is the state required process used by APD to screen all Medicaid eligible
persons seeking admission to nursing facilities. This screening covers functional,
medical, economic and psychosocial variables and is the basis for making a determination
regarding the individual’s categorical status and his/her need for nursing
facility services.
(17) “Pre-Admission Screening
and Annual Resident Review (PASARR)” is the assessment process conducted by
agencies within the Oregon Health Authority that implements the Omnibus Budget Reconciliation
Act of 1987 (Public Law 100-203), Subsection 1919(e)(7), which prohibits a Medicaid
certified nursing facility from admitting any individual until a screening is completed
to determine mental illness or mental retardation (or related conditions), and whether
the individual requires nursing facility services or specialized services for mental
illness.
(18) “Private admission
assessment” is the process that APD uses to screen for indicators of mental
illness and categorical status in non-Medicaid applicants to nursing facilities.
(19) “Qualified mental
health professional (QMHP)” means a mental health practitioner with qualifications
defined in OAR 309-032-1505.
(20) “Senior and Disabled
Services Division (SDSD)” means the Oregon Health Authority agency responsible
for the provision of nursing facility services as specified in OAR chapter 411.
(21) “Specialized psychiatric
rehabilitative services” means services of a lesser intensity than required
under specialized services for mental illness. The nursing facility may provide
these services directly or make arrangements for their provision with private sector
practitioners or community mental health programs.
(22) “Specialized services
for mental illness” means the implementation of an individualized plan of
care developed, provided and supervised by a physician and qualified mental health
professionals in an inpatient psychiatric hospital. This plan of care shall prescribe
specific therapies and activities for the treatment of persons who are experiencing
an acute episode of severe mental illness. A nursing facility resident requiring
specialized services shall be considered to be eligible for the level of services
provided in an inpatient psychiatric hospital. Residents requiring this level of
care will require relocation to an inpatient facility until the “acute”
nature of their symptoms are stabilized.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0070
Procedures for Level
I, Pre-Admission Screening (PAS)
(1) Nursing facility placement.
A person identified with mental illness indicators who requests placement in a nursing
facility must meet APD-PAS criteria demonstrating a need for nursing facility care.
The person may be placed in a nursing facility without a Level II evaluation if
the person:
(a) Meets criteria of categorical
determinations OAR 309-048-0060; or
(b) Has a primary diagnosis
of dementia; and
(c) Does not require specialized
services OAR 309-048-0060(22).
(2) Level II referrals. Persons
shall be referred to the Division for a Level II evaluation prior to placement in
a nursing facility if:
(a) A Level I pre-admission
screen or a private admission assessment has identified the individual as having
indicators of mental illness; and
(b) The individual is not eligible for a categorical determination.
(3) Level II waiver. The Division
may waive the Level II evaluation requirement if:
(a) The individual does not
need specialized services or has received maximum benefit from specialized services;
and
(b) The individual has been
determined to be in need of nursing facility services by an APD designee or contractor;
and
(c) A facility has been identified
that can meet the individual’s mental health needs.
(4) Level II eligibility. Individuals
may be required by he Division to have a Level II evaluation to determine the need
for specialized services prior to placement in a nursing facility if any of the
above conditions (subsections (3)(a), (b) and (c) of this rule) are not met.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0080
Procedures for Annual
Resident Reviews (ARR)
A resident screened and referred
by a nursing facility as having indicators of mental illness shall be reviewed by
a Division designee using a format approved by the Division.
(1) Timelines. The review shall
be completed by a QMHP within 7 working days of receipt of the referral from the
nursing facility.
(2) Screening and consultation.
The review shall consist of up to two hours of screening and consultation to determine
if the indicators of mental illness require a comprehensive evaluation (Level II).
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0090
Level II Evaluations
(1) Content. A Level II evaluation
shall:
(a) Be completed by a QMHP within
30 calendar days of the annual resident review referral or within seven working
days of the pre-admission screening referral;
(b)
Include a mental health assessment, a psychosocial evaluation, relevant testing
and a review of the medication regime and physical examination by a licensed medical
professional;
(c) Establish a diagnosis and determine
the need for specialized services.
(2) Specialized psychiatric
rehabilitation. If the need for specialized services is not established, the evaluation
shall include treatment recommendations for specialized psychiatric rehabilitation
services whenever indicated.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0100
Documentation
(1) Level II waivers. The Division
shall send a copy of any waiver from the pre-admission requirement for a Level II,
to the APD Level I screener who has determined that the individual needs nursing
facility care pursuant to OAR 309-048-0060.
(2) Nursing facility. CMHP evaluators
shall send copies of the annual resident review and Level II evaluation to the nursing
facility within 7 and 30 days respectively.
(3) Division. CMHP evaluators
shall send copies of the annual resident review, Level II evaluation and the Level
II summary sheet to the OMHS within 30 days of receipt of the nursing facility referral.
(4) Client Process Monitoring
System. CMHP designees shall enter information on all persons receiving a Level
II evaluation into CPMS.
(5) Standards. Level II evaluations
shall follow documentation standards set forth in OAR 309-032-1535.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0110
Specialized Services
for Individuals Residing in Nursing Facilities
(1) Location. Specialized services
for persons with mental illness are provided only in inpatient psychiatric settings
that provide 24 hour coverage by trained mental health professionals who can deliver
mental health services designed by an interdisciplinary team which includes a psychiatrist.
(2) Readmission to nursing facilities.
A person identified by a Level II evaluation as in need of specialized services
shall not enter or remain in a nursing facility. When a client has received maximum
benefit from specialized services, the client can be reconsidered for admission
subject to Level I requirements or return to a nursing facility placement subject
to APD OAR 411-088-0000 to 411-088-0080, Licensing Requirements for Nursing Facilities,
Transfer Rules.
(3) Procurement of specialized
services. When a client is identified to be in need of specialized services, the
Level II evaluator shall:
(a) Assist the nursing facility
or Level I screener in locating an appropriate treatment resource;
(b) Insure that the client in
need of specialized services is informed of his/her treatment options including
the right to refuse treatment;
(c) Inform all parties involved,
of procedures related to precommitment investigation, if the client refuses specialized
services and presents a danger to self or others;
(d) Notify the Division within
72 hours if a client is determined to be in need of specialized services and these
services are not being provided.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0120
Relocation of Persons
with Mental Illness From Nursing Facilities to Other Residential Settings
(1) Coordination of Plans. CMHP,
NF and APD staff shall coordinate relocation plans for residents of nursing facilities
with mental illness found to be ineligible for nursing facility care.
(2) Right of return. All relocations
of residents must comply with nursing facility transfer rules, division 88, OAR
411.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
309-048-0130
Appeals
In accordance with ORS 413.042,
adults with mental illness, and court approved legal guardians for individuals with
mental illness, shall have the right to appeal decisions made by the Division based
on screenings, admission waiver request, discharge and relocation plans.
(1) Appeals. Appeals shall be
submitted to the Children, Adult and Families Division (CAF) Hearings Office and
arrive there within 30 calendar days after receipt of the contested determination/decision.
(2) Negotiations. The CAF Division
Hearings Office shall, when it deems appropriate, refer appealed decisions back
to the Division for efforts to negotiate an agreement. If the Division is unable
to negotiate an agreement within 10 working days, the Division will remand the appeal
back to the CAF Hearings Office for final disposition.
(3) Hearings. The CAF Hearings
Office shall convene a hearing in accordance with OAR 461-025-0300 through 461-025-0375,
and reach a final determination on the appeal within ninety (90) days of the final
day of the hearing.
(4) Determinations. All decisions
of the CAF Hearing Office shall be final.
Stat. Auth.: ORS 413.042 &
426.500
Stats. Implemented: ORS 410.535,
414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. &
cert. ef. 4-6-95
The official copy of an Oregon Administrative Rule is
contained in the Administrative Order filed at the Archives Division,
800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the
published version are satisfied in favor of the Administrative Order.
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