Docstoc

PASRR MANUAL web Area Agency on Aging

Document Sample
PASRR MANUAL web Area Agency on Aging Powered By Docstoc
					RE

DMISSION

CREENING

ESIDENT

EVIEW
     www.areaagency8.org
                              PASRR/LOC Training

                                        Agenda
 l.     Welcome and introductions
 ll.    PASRR Overview
        a. What is PASRR?
        b. Definitions
        c. Completing required forms
        d. Supporting documentation
        e. Scenarios
        f. Process
lll.     Long-Term Care Consultation
        a. Rules
        b. Exemptions
        c. Process
lV.      Timeframes
        a. Area Agency on Aging
        b. Mental Health /MR/DD
                   i. List of Contacts
V.       Convalescent Exemptions
         a. Requirements
         b. Completing required forms
VI.      Resident Review – RR/ID
         a. When is Resident Review appropriate?
         b. Process
Vll.     BREAK
Vlll.    Level of Care
         a. Process
         b. Completing required forms
         c. Supporting documentation
         d. ILOC vs. SLOC
         e. Incomplete request and adverse
lX.      Extended Coverage
X.       Points to Remember
Xl.      Quiz
Xll.     Open Discussion, Questions, Comments
Xlll.    Adjournment
                                             What is PASRR?


PAS identification (PAS/ID) is the process by which individuals who are seeking new admissions to a Nursing
Facility (NF) or PASSPORT Waiver are screened to identify those who have indications of serious mental
illness (SMI) or mental retardation or developmental disabilities (MRDD) and who must be further evaluated by
the Ohio Department of Mental Health (ODMH) and/or the Ohio Department of Mental Retardation and
Developmental Disabilities (ODMRDD) to determine the most appropriate placement to meet their needs.

PAS/ID may be initiated by the individual who is seeking the new admission or by another entity on behalf of
the individual.

Everyone entering a Medicaid-Certified Nursing Facility (NF), no matter what the individual’s payment
source, is required to go through the PAS-ID review process prior to admission.

The only exception to this rule is if the individual is being admitted to the NF for a convalescent stay.



__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________
                                           Definitions


Primary Diagnosis: Means that diagnosis which has a “P” or the word “Primary” written next to it by
                   the physician. If two or more diagnoses have such indication, none of them can
                   be considered to be the primary diagnosis for the purposes of this rule.

Current Diagnosis: Means those diagnoses verified by the individuals attending physician as current
                   in the most recent physical examination report, physician progress notes, or
                   other reevaluation of the current diagnosis performed within one year to the Pre-
                   Admission Screening (PAS).

New Admission: The admission to an Ohio Medicaid certified NF of an individual who was not a
                resident of any Ohio Medicaid certified NF immediately preceding the current NF
                admission NOR immediately preceding a hospital stay from which the individual
                is to be admitted directly to a NF (This includes individuals with no previous NF
                admissions; individuals admitted from other states, regardless of type of prior
                residence; and individuals with prior Ohio NF admissions who have been
                discharged from an Ohio NF and did not have either an intervening hospital or
                other NF stay immediately preceding the current NF admission) NF transfers
                and/or readmissions are not considered to be new admissions for the purpose of
                this rule.

NF Transfer:      A NF transfer occurs when an individual’s place of residence is changed from
                 one Ohio Medicaid Certified NF to another Ohio Medicaid Certified NF with or
                 without an intervening hospital stay.
________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________
                                      DHS Form #3622

                                 PASARR (SMI/MRDD)
                              Identification Screen Form

Section E:     The most common diagnoses that would be entered into this
Question (2)   section are: polio, blindness, deafness, epilepsy, cerebral palsy,
                Seizure disorders, Down’s Syndrome, Muscular Dystrophy,
               Autism, traumatic head/brain injury, Spina Bifida and
                Hydrocephalus, possible Multiple Sclerosis which is not often
                Diagnosed before age 22.


________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________
                       PASRR Documentation Requirements


  1. Documentation can be sent in a letter, H&P, or Transfer/Continuity of Care for and needs to
     include:
         a. Primary Dx marked with a “P” or the word “Primary”,
         b. List of all current dx (date of onset if known),
         c. Prognosis
         d. Medications
  2. Send demographic information (address, contact person, etc.)
      LOC-Supporting documentation requirements
  1. Must use 5 page LOC Assessment Tool (Form 3697) or physician certification with MDS and
     Meds.
  2. LOC’s are required to include:
         a. Name
         b. SS#
         c. DOB
         d. Medicaid Number
         e. Original date of admission
         f. Current address
         g. Name and address of NF
         h. County where Medicaid is active
         i. ALL current Dx with primary Dx indicated
         j. Medications
         k. ADL & IADL information
         l. Rehab and prognosis
         m. Signature of individual who completed the LOC
         n. Physician signature and date of signature

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________
                                    PASRR Scenarios


1. Ann Smith, DOB 4-12-1928, SS# 333-33-3333, Primary dx is HTN, other diagnosis dementia,
   bipolar, no treatment other than meds (Zoloft, Benicar, Aricept).

   ______________________________________________________________________________

   ______________________________________________________________________________

   ______________________________________________________________________________

   ______________________________________________________________________________

   ______________________________________




2. John Doe, DOB 1-11-1941, SS# 222-11-2222, primary dx is seizure d/o onset before age 22, did
   not complete high school and has never lived independently. Has never worked, C also has A-fib,
   HTN. Medications: Dilantin, Coumadin, and Toprol.


   ______________________________________________________________________________

   ______________________________________________________________________________

   ______________________________________________________________________________

   ______________________________________________________________________________

   ______________________________________
Scenario: Resident transfers from another nursing facility but
lacks PASRR records
When a resident moves from one Nursing Facility (NF) to a different NF, their Pre-
Admission Screening Resident Review (PASRR) records follow them. This includes residents
who have a hospital stay between the two NF’s.

Who sends the records?
The discharging NF is responsible for sending PAS/RR records to the admitting NF.

What records are required?
For a PAS… there should be both a Review Results letter and a PASARR (SMI/MRDD)
Identification Screen. You should at a minimum have the Review Results letter.
For a Resident Review… Only the PASRR Screen is required.
If a Further Review for Serious Mental Illness (SMI) or Mental
Retardation/Developmental Disability (MR/DD) was required… there should be a
Determination from ODMH and/or ODMR/DD.

How do you know if the records are still valid?
Unless a resident has experienced a “Significant Change in Condition” related to their
mental health or MR/DD, PAS/RR records are valid until the resident returns to the
community (a setting other than a hospital or an Ohio Medicaid certified NF). This means
you must know where the resident has been living since the date of their last PASRR.

What do you do if there are no records from the previous NF?
Initiate a Resident Review no later than the resident’s 30th day at the admitting NF. A RR
for “No Previous PASARR Records” may be initiated any time after the resident is admitted
to the receiving NF but is due on day 30. If the resident is hospitalized during this 30 day
period, days out at the hospital count towards the tally of 30 days.

How to initiate a Resident Review for NF transfer:
Fill out a new PAS/RR ID Screen (form 3622).
Use code #7 in section “B”.
Make sure to sign and date the bottom of page 2 of the screen. The date by your signature
is the date you are actually filling out and signing the form; writing any other date is
falsification of records.

Does the resident have indications of Serious Mental Illness and/or MR or a Related
Condition?
If not:
Maintain the PAS/RR ID Screen in the resident’s chart. Never discard this information. Do
not send this to Area Agency on Aging on a routine basis. We only need to see this
information if you ask for a Level of Care authorization.
If so:
1. Fill out all 3 pages of the 3622 PAS/RR ID screen
2. Fax the screen to ODMH (614) 466-9653 or ODMR/DD (614) 995-4877. Fax to both
state authorities if the resident has both Serious Mental Illness and MR or a Related
Condition.
3. Keep the fax transmission report or your fax cover sheet to prove the date it was
faxed to the state authority. You will need to show this if you ask for a Level of
Care.
Scenario: Person admitted to an Ohio nursing facility from
another state

You know that pre-admission screening (PAS) is required prior to
the admission of the person to your Ohio facility

You will help the person to move to your facility by:

o Telling the family, hospital or out of state nursing facility that
pre-admission screening is required before the individual can
enter your Ohio facility (Their state screening is not accepted
by an Ohio facility.)

o Facilitating the transfer by filling out the PASRR screen
(called the 3622) for the family, or by faxing the 3622 to the
hospital or nursing facility for them to fill out. You help
complete the form or you give the nursing facility or hospital
the Area Agency on Aging phone number for technical assistance.

o Requiring a history and physical (H&P) completed within the
last year signed and dated by the PHYSICIAN, (not a
physician’s assistant)

o Determining whether there is mental illness or mental
retardation indicated in the history and physical, and if there
are indications, making sure the screen is correct.

o Completing the third page of the PASRR screen (3622)

o Forwarding and /or asking for the 3622 and the H&P to be
forwarded to Area Agency on Aging Pre-Admissions review

o Explaining to family, hospital, nursing facility about further
review and the time it takes for determination by the state
authorities

o Receiving the Review Results letter from Pre-admission
Review before you admit the Person.

Why it matters to you! Your Medicaid payment begins the date the
pre-admission screening is completed. This is your effective date!
                            MOST COMMON SCENARIOS
               WHO NEED PAS/ID (PAS), WHO NEEDS LEVEL OF CARE (LOC)
                     (“NF” means Medicaid –certified nursing facility)

                   Situation                                          Payment Source     PAS     LOC
Community to NF                                                         Medicaid         YES     YES
Community to NF                                                         Other            YES       NO
Community to Hospital to NF (no convalescent exemption)                 Medicaid          YES    YES
Community to Hospital to NF (no convalescent exemption)                 Other            YES       NO
Community to Hospital to NF (convalescent exemption)                    Medicaid         NO      YES
Community to Hospital to NF (convalescent exemption)                    Other            NO       NO
Community to ICF-MR                                                     Medicaid         NO       YES
Community to ICF-MR                                                     Other            NO      NO
Community to Hospital to ICF-MR                                         Medicaid         NO      YES
NF to community (discharged) to any NF                                  Medicaid         YES      YES
NF to community (discharged) to any NF                                  Other            YES      NO
NF to different NF                                                      Medicaid         NO       YES
NF to different NF                                                      Other            NO      NO
NF to Hospital to different NF                                          Medicaid         NO      YES
NF to Hospital to different NF                                          Other            NO      NO
NF to Hospital ( used up leave days) to same NF                         Medicaid         NO      YES
NF to Hospital ( used up leave days) to different NF                    Medicaid         NO      YES
NF Change of Payor to Medicaid                                           Medicaid        NO      YES
NF Change of Payor to Medicaid (Pas requirement not met upon admission) Medicaid         YES     YES
NF to ICF-MR                                                             Medicaid        NO      YES
NF to ICF-MR                                                             Other           NO        NO
ICF-MR to hospital to NF                                                Medicaid         YES     YES
ICF-MR to hospital to NF                                                Other            YES       NO
ICF-MR to NF                                                            Medicaid         YES     YES
ICF-MR to NF                                                            Other             YES     NO
ICF-MR to different ICF-MR                                              Medicaid          NO     YES
ICF-MR to hospital to different ICF-MR                                  Medicaid          NO     YES
ICF-MR to community (used up leave days) to same ICF/MR                 Medicaid          NO     YES
ICF-MR to hospital (used up leave days) to same ICF/MR                  Medicaid          NO     YES
ICF -MR Change of Payor to Medicaid                                     Medicaid          NO     YES
Out of State to Ohio NF                                                 Medicaid          YES    YES
Out of State to Ohio NF                                                 Other             NO     YES
Out of State to ICF-MR                                                 Medicaid          NO      YES
Out of State to ICF-MR                                                 Other              NO     NO

   For admissions to ICF-MR F facilities, submit request to ODJFS

   Even if the Pas/ID is not required due to a change in settings, an RR/ID may be needed if there is a
    significant change in condition

   A PAS/ID is not required for change of payor to Medicaid, UNLESS the PAS requirements were not met
    upon admission.

   This chart does not address when a RR/ID is needed.
                                       PAS/ID Process


1. PAS/ID may be initiated by the individual who is seeking the new admission or by another
    entity on behalf of the individual.
2. PAS/ID must be initiated via the completion, and submission to AAA 8 Pre-Admission Review Unit, of
    a PASRR Identification Screen (ODHS Form 3622) and a Patient Form (JFS 3697).
3. AAA8 Pre-Admission Review Unit shall review the DHS Form 3622 to determine whether the
    individual has indications of SMI or MR/DD
4. Submission of the required forms and information does not constitute completion of the PAS/ID process
5. The individual must not move into an Ohio NF or be enrolled on the PASSPORT HCBS waiver until all
    required PAS determinations have been made.
6. If the Individual requires further review for either SMI or MR/DD, the appropriate state authority must
    approve the NF admission.
7. PAS/ID results will determine whether an individual is subject to further review via the Review Results
    Letter.
8. PAS requirements shall not be considered to be complete until the appropriate State Authority has issued
    the further review determination (for those individuals who require the further review process for SMI
    and/or MR/DD).
9. The admitting NF or PASSPORT agency shall maintain the results of the PAS/ID in the individual’s
    resident record at the facility.
10. Individuals may appeal determination received in accordance with division level designation 5101:6 of
    the Ohio Administrative Code.




______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

_______________________
5101:3-3-151 Preadmission Screening (PAS) requirements f…/or passport waivered services Page 1of 5

5101:3-3-151 Preadmission screening (PAS) requirements for individuals seeking admission to nursing facilities.
(NFs) and/or passport waivered services.
Text of Rule

(A) The purpose of this rule is to set forth the PAS requirements which must be met prior to any new admission (as defined in paragraph (B)(8)
of this rule) in order to comply with section 1919 (e)(7) of the Social Security Act, as amended. NFs and the passport program (defined in
Chapter 5101:3-31 of the Administrative Code) are prohibited from accepting any new admission, unless the individual has met the PAS
requirements specified in this rule.

(B) Definitions:

(1) “Active-treatment,” for purposes of this rule, means a continuous treatment program which includes aggressive, consistent implementation
of a program of specialized and generic training, treatment, health services and related services for individuals with mental retardation and/or
other developmental disabilities that are directed toward the following:

(a) The acquisition of the behaviors necessary for the client to function with as much self determination and independence as possible; and

(b) The prevention or deceleration of regression or loss of current optimal functional status.

(2) “Admissions for a convalescent stay. “ A new admission is considered to be an admission for a convalescent stay if it meets all of the
following criteria:

(a) The individual is admitted directly from a hospital after receiving inpatient care at that hospital; and

(b) The individual requires the level of services provided by a NF for the condition which was treated in the hospital; and

(c) The individual’s attending physician has provided written certification, signed and dated no later than the date of discharge from the
hospital, that the individual is likely to require the level of services provided by a NF for less than thirty days.

(3) “Adverse determination” means a determination made in accordance with sections 1919(b)(3)(F) or 1919(e)(7)(B) of the Social Security Act,
as amended, this rule, and rules 5122-21-03 and 5123:2-14-01 of the Administrative Code, that an individual does not require that level of
services provided by a NF or that an individual does or does not require specialized services. No adverse decision regarding an individual’s
need for the level of services provided by a NF is accepted by the Ohio department of human services (ODHS) as a determination unless both
of the following conditions have been met:

(a) A registered nurse has conducted a face-to-face assessment of the individual and reviewed the medical records that accurately reflect the
individual’s current condition; and

(b) Authorized ODMH and/or Ohio department of mental retardation and development disabilities (ODMR/DD) personnel other than the nurse
who conducted the face-to-face assessment have reviewed the assessment and made the final determination regarding the need for NF
services.

(4) “Current diagnoses” means those diagnoses verified by the individual’s attending physician as current in the most recent physical
examination report, physician progress notes, or other revaluation of current diagnoses performed within one year prior to the PAS.

(5) “Dementia.” An individual is considered to have dementia if he or she meets either of the following criteria:

(a) The individual has a primary diagnosis of a dementia, including Alzheimer’s disease or a related disorder, (as described in the “Diagnostic
and Statistical Manual of Mental Disorders,” third edition, revised in 1987 (DSM-III-R) (or most recent edition); or

(b) The individual has a secondary diagnosis of a dementia, including Alzheimer’s disease or a related disorder, (as described in the DSM-III-R
or most recent edition), and a primary diagnosis which is not a major mental disorder specified in paragraph (B)(16)(a) of the rule.

(6) “Long-term resident” means an individual who has continuously resided in a NF or a consecutive series of NFs and/or medicare skilled
nursing facilities for at least thirty months prior to the first resident review (RR) (defined in rule 5101:3-3-152 NF, and to require specialized
services. The thirty months may include temporary absences for hospitalization or therapeutic leave as defined in rule 5101:3-3-03 of the
Administrative Code.




http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_3/5101_3-3-151.htm 4/24/00
5101:3-3-151 Preadmission Screening (PAS) requirements f…/or passport waivered services Page 2of 5

(7) “Mental retardation and/or other developmental disabilities (MR/DD).” An individual is considered to have mental retardation and/or a
developmental disability if he or she has:

(a) A level of retardation (mild, moderate, severe or profound) described in the “American Association on Mental Retardation’s Manual on
Classification in Mental Retardation” (1989); or

(b) A related condition as defined in paragraph (B)(15) of this rule.

(8) “New admission” means:

(a) The admission, to an Ohio Medicaid-certified NF, of an individual who was not a resident of any Ohio medicaid-certified NF immediately
preceding the current NF admission NOR immediately preceding a hospital stay from which the individual is to be admitted directly to a NF
(This includes individuals with no previous NF admissions; individuals admitted from other states, regardless of type of prior residence; and
individual with prior Ohio NF admissions who had been discharged from an Ohio NF and did not have either an intervening hospital or other NF
stay immediately preceding the current NF admission); and/or

(b) The enrollment of individuals who have applied for home and community based services waiver III (HCBS waiver III or passport waivered
services as defined in Chapter 5101-:3-31 of the Administrative Code.

NF transfers and/or readmissions (as defined in paragraphs (B)(9) and (B)(14) of this rule) are not considered to be new admissions for
purposes of this rule.

(9) “NF transfer.” A NF transfer occurs when an individual’s place of residence is changed from one Ohio medicaid-certified NF to another Ohio
medicaid-certified NF, with or without an intervening hospital stay.

(10) “PAS identification (PAS/ID).” “PAS/ID” is the process by which ODHS, or its designee, screens individuals who are seeking new
admissions to identify those who have indications of serious mental illness (SMI) as defined in paragraph (C) (5) (a) of this rule, and/or MR/DD
as defined in paragraph (C) (5) (b) of this rule; and who, therefore, must be further evaluated by ODMH and/or ODMR/DD.

(11) “PAS-MR-DD.” “PAS-MR-DD.” Is the process by which ODMR/DD determines whether, due to the individual’s physical and mental
condition, an individual who has MR/DD requires the level of services provided by a NF or another type of facility; and, if the level of services
provided by a NF is needed, whether the individual requires specialized services for MR/DD.

(12) “PAS/SMI.” “PAS/SMI.” Is the process by which ODMH determines whether, due to the individual’s physical and mental condition, an
individual who has SMI requires the level of services provided by a NF or another type of facility; and, if the level of services provided by a NF is
needed, whether the individual requires specialized services for serious mental illnesses.

(13) “Primary diagnosis” means that diagnosis which has a “P” or the word “primary” written next to it by the physician. If two or more
diagnoses have such indications, none of them can be considered to be the primary diagnosis for purposes of this rule.

(14) “Readmission” means the individual is readmitted to the same NF, or reenrolled for HCBS waiver III (PASSPORT waivered services),
following a stay in a hospital to which he or she was sent for the purpose of receiving care.

(15) “Related condition” means a severe, chronic disability that meets all of the following conditions:

(a) It is attributable to:

(i) Cerebral palsy, epilepsy; or

(ii) Any other condition other than mental illness, found to be closely related to mental retardation because this condition results in impairment
of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons, and requires treatment or services similar to
those required for those persons;

(b) It is manifested before the person reaches the age of twenty-two;

(c) It is likely to continue indefinitely;

(d) It results in substantial functional limitations in three or more of the following areas of major life activity:

(i) Self-care;




http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_3/5101_3-3-151.htm 4/24/00
5101:3-3-151 Preadmission Screening (PAS) requirements f…/or passport waivered services Page 3of 5
(ii) Understanding and use of language;

(iii) Learning;

(iv) Mobility;

(v) Self-direction;

(vi) Capacity for independent living.

Individuals who have a developmental disability as defined in rule 5123:2-1-02 of the Administrative Code are considered to have a related
condition.

(16) “Serious mental illness (SMI).” An individual is considered to have SMI if the individual meets all of the following criteria on diagnosis, level
of impairment and recent treatment:

(a) Diagnosis. The individual does not have dementia (as defined in paragraph (B)(5) of this rule), but has a major mental disorder diagnosable
under the “Diagnostic and Statistical Manual of Mental Disorders,” third edition, revised in 1987 (DSM-iii-R) (or the most recent edition); and this
mental disorder is one of the following: a schizophrenic, mood, delusional (paranoid), panic or other severe anxiety disorder, somatoform
disorder, personality disorder, other psychotic disorder, or another mental disorder other than mental retardation that may lead to a chronic
disability diagnosable under the DSM-III-R ( or the most recent edition).

(b) Level of impairment. Within the past six months, due to the mental disorder, the individual has experienced functional limitations on a
continuing or intermittent basis in major life activities that would be appropriate for the individual’s developmental stage.

(c) Recent treatment. The treatment history indicates that the individual has experienced at least one of the following:

(i) Psychiatric treatment more intensive than counseling and/or psychotherapy performed on an outpatient basis more than once within the
past two years; or

(ii) Within the last two years, due to the mental disorder, experienced an episode of significant disruption to the usual living arrangement, for
which supportive services were required or which resulted in intervention by housing or law enforcement officials.

(17) “Specialized services for serious mental illness” means those services which, when combined with the types of services available in NFs,
result in the continuous and aggressive implementation of an individualized plan pf care approved by the medical director of ODMH or a
designee that:

(a) Is developed and supervised by an interdisciplinary team which includes a physician, trained mental health professionals and, as
appropriate, other professionals;

(b) Prescribed specific therapies and treatment activities for an individual who is experiencing an acute episode of SMI which necessitates
supervision by trained mental health personnel; and

(c) Is time limited and directed toward diagnosing and reducing the individual’s behavioral symptoms that necessitated intensive and
aggressive intervention, improving the individual’s level of independent functioning, and achieving a functioning level that permits reduction in
the intensity of mental health services to below the level of specialized services at the earliest possible time.

(18) “Specialized services for mental retardation and/or other development disabilities” means the services specified by the PAS-MR or RR-MR
determination and provided or arranged for by ODMR/DD which are integrated with services provided by the NF or other service providers to
result in continuous active treatment. Specialized services shall be made available at the intensity and frequency necessary to meet the needs
of the individual.

(19) “Secondary diagnoses” means all diagnoses other than that which is a primary diagnosis as defined in paragraph (B)(13) of this rule.

(20) “Usual living arrangement” means an individual’s usual living arrangement, including but not limited to homelessness, homeless shelter,
private home, adult care facility licensed by the Ohio department of health (ODH) or ODMH, adult foster home, purchase of service (POS)
home, intermediate care facility for the mentally retarded (ICF-MR), NF, rehabilitation center, jail, or hospital or part of a hospital licensed by
ODMH under section 5119.20 of the Revised Code.




http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_3/5101_3-3-151.htm 4/24/00
5101:3-3-151 Preadmission Screening (PAS) requirements f…/or passport waivered services Page 4of 5


(c) PAS/ID requirements:

(1) PAS/ID must be completed prior to any new admission (defined in paragraph (B)(8) of this rule) unless the admission meets the criteria for
an exempted hospital discharge specified in paragraph (C)(2) of this rule.

(2) Exempted hospital discharge. Individuals seeking new admissions are exempt from PAS/ID requirements if they meet the defining criteria
of an admission for a convalescent stay (set forth in paragraph (B)(2) of this rule) and the admitting NF or for individuals enrolling for HCBS
waiver III (passport waivered services), the responsible passport administrative agency (PAA) (defined in rule 5101:3-3-03 of the Administrative
Code) meets the following requirements:

(a) The admitting NF or, for individuals enrolling for HCBS waiver III (passport waivered services), the responsible PAA must obtain from the
discharging hospital, and/or the individual’s attending physician, written documentation which verifies that each of the defining criteria for an
admission for a convalescent stay have been met; and

(b) The admitting NF shall retain the documentation required by paragraph (C)(2) (a) of this rule in the individual’s resident record at the facility.
For individuals enrolling for HCBS waiver III (passport waivered services), the responsible PAA shall retain such documentation in the
individual’s HCBS waiver III (passport waivered services) record.

(3) PAS/ID may be initiated by the individual who is seeking the new admission, or by another entity on behalf of the individual.

(4) PAS/ID must be initiated via the completion of a PASRR Identification Screen” form (ODHS 3622) and a “Patient Care and Plan of
Treatment “ form (ODHS 3697) or an alternative form approved by ODHS.

(5) ODHS, or its designee, shall review the ODHS 3622 form to determine whether the individual has MR/DD and/or indications of SMI.

(a) An individual shall be determined to have indications of SMI if the individual:

(i) Meets at least two of the three criteria specified in paragraph (B)(16) of this rule; or

(ii) Due to a mental impairment, receives supplemental security income (SSI) authorized under Title XVI of the Social Security Act, as
amended; or

(iii) Due to a mental impairment, receives social security disability insurance (SSDI) authorized under Title II of the Social Security Act.

(b) An individual shall be determined to have indications of MR/DD if the individual’s condition meets the defining criteria set forth in paragraph
(B)(7) of this rule.


(6) PAS/ID results shall determine whether an individual is subject to further review.

(a) Individuals determined to have no indications of SMI and/or MR/DD are not subject to further PAS review.

(b Individuals determined to have indications of SMI shall be subject to further review by ODMH in accordance with rule 5122-21-03 of the
Administrative Code.

(c) Individuals determined to have indications of MR/DD shall be subject to further review by ODMH in accordance with rule 5123:2-14-01 of
the Administrative Code.

(d) Individuals determined to have indications of both SMI and MR/DD shall be subject to further review by both ODMH and ODMR/DD in
accordance with rules 5122-21-03 and 5123:2-14-01 of the Administrative Code.

(7) When an individual has been determined to have indications of SMI and/or MR/DD, ODHS or its designee shall forward the ODHS 3622
form and the ODHS 3697 (or an alternative form specified by ODHS) to ODMH and/or ODMR/DD, as appropriate, so that it may be determined
whether the individual has SMI and/or MR; and if so, for the PAS/SMI and/or PAS-MR/DD review.

(8) ODHS, or its designee, shall report the outcome of the PAS/ID to the individual or other entity who initiated the review and, where
applicable, indicate the department(s) to which the ODHS 3622 was sent for further review.

(9) The admitting NF shall maintain the results of the PAS/ID to the individuals resident record at the facility. For individuals enrolling for HCBS
waiver III (passport waivered services), the PAA shall maintain the results of the PAS/ID in the individuals HCBS waiver III (passport waivered
services) record.



http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_3/5101_3-3-151.htm 4/24/00



5101:3-3-151 Preadmission Screening (PAS) requirements f…/or passport waivered services Page 5of 5
(D) PAS/SMI and PAS-MR/DD determination requirements:

(1) PAS/SMI and PAS-MR/DD must be completed prior to any new admission of an individual determined by ODMH and/or ODMR/DD to have
SMI and/or MR/DD unless the individual is a long-term resident as defined in paragraph (B)(6) of this rule.

(2) For long-term residents, the choice to reside in a NF and to receive specialized services for SMI and/or MR/DD provided by ODMH and/or
ODMR/DD is a portable benefit. Therefore, unless there is evidence that the individual’s condition has changed such that the individual needs
the level of services provided by a NF and/or is no longer in need of specialized services, ODMH and/or ODMR/DD may notify the individual
and the receiving NF of the individual’s status as a long-term resident and make arrangements for the continued provision of specialized
services.

(3) Section 1919 (e)(7) of the Social Security Act prohibits ODMH and ODMR/DD from utilizing criteria relating to the need for NF care or
specialized services that are inconsistent with that statute and the ODHS approved state plan for medicaid. The approved state plan for
medicaid includes level of care criteria, contained in Chapter 5101:3-3 of the Administrative Code. Therefore, ODMH and ODMR/DD may not
use criteria inconsistent with Chapter 5101:3-3 of the Administrative Code in making their determinations regarding whether individuals with
SMI and/or MR/DD need the level of services provided by a NF.

(4) The admitting NF shall retain the written notification of the PAS/SMI and/or PAS-MR/DD determinations received from ODMH and/or
ODMR/DD in the individual’s resident record at the facility. For individuals enrolling for HCBS waiver III (passport waivered services), the
responsible PAA shall retain such determinations in the individual’s HCBS waiver (passport waivered services) record.

(5) Adverse determinations may be appealed in accordance with division level designation 5101:6 of the Administrative Code.

(E) In accordance with Section 1919 (e)(7) of the Social Security Act, there shall be no new admission of any individual with SMI or MR/DD,
regardless of payment source, unless the individual has either been determined, in accordance with the rules 5122-21-03 and/or 5123:2-14-01
of the Administrative Code, to need the level of services provided by a NF, or has qualified for admission under the exempted hospital
discharge provision set forth in paragraph (C)(2) of this rule.


History

History: Eff 5-1-93; 12-30-88 (Emer.); 3-31-89 (Emer.); 6-30-89; 1-4-98
Rule promulgated under:RC 119.
Rule authorized by: RC 5111.02,5101.75,5101.752
Rule amplifies: RC 5111.01, 5101.02, 5101.202, 5101.75, 5101.752 119.032 Review date 1-1-03




TO:         Hospitals and Nursing Homes
RE:         Long-Term Care Consultation Rules
DATE: June, 2007


The Ohio Department of Aging has been working with stakeholders, including the hospital and
Nursing Facility (NF) Association to develop the Long-Term Care Consultation (LTCC) rules. These
rules became effective June 30. 2007.

These rules are not expected to cause any additional delays on NF admissions, and the current Pre
Admission Screening & Resident Rule (PASRR) and Level of Care (LOC) determination requirements
remain in force and unchanged.

These LTCC rules will replace the current process for individuals seeking NF admission with a non-
Medicaid payment source described in rule 5101:3-3-14 of the Administration Code. The rules with
the most impact to hospitals and NF’s are 173-43-02 (Process), 173-43-03 (Required Consultations
and Exemptions), and 173-43-04 (Time Frames). The impact to the process is minimal.

Impact on Hospitals & NFs for Non-Medicaid Individuals
The following 9 criteria are conditions under which an individual seeking admission to a nursing
facility may be determined to be exempt from an in-person LTCC visit (refer to 173-43-03, paragraph
B):
          Admission to a NF under contract for continuing care
          Individual has a contractual right to admission to a NF operated as part of a system of
           continuing care.
          Admission to a facility that is a “Home for the Aged”
          Admission to a facility that is not a Medicaid-Certified NF
          Admission to a NF to receive Hospice services
          NF Transfer – from one Ohio NF to another Ohio NF (with or without an intervening hospital
           stay)
          NF Readmission – readmission to the same NF following hospitalization
          Enrolled in HCBS Waiver
          NF resident being Actively Case Managed


       For individuals who do not meet one of these 9 exemptions, the following information is
       needed by the PASSPORT Administrative Agency. It is less than before, but different in
       nature (some of which will already be included with PASRR and LOC requests).
           Expected length of stay at the NF
           Information known about the individual’s formal, informal supports
           Any known previous NF admissions
           Individual’s (or representative’s) self-report of whether or not his/her resources are likely
             to be depleted within 6 months after NF admission




  Please know that the PASSPORT Administrative Agency (PAA) may need to make follow up contact
for this information if it is not provided.
Hospitals will no longer be able to exempt individuals from an in-person review based on certain
functional deficits. On the other hand, NF will no longer be required to report to the PAA, the
admission of these individuals 24 hours after the admission.

For individuals not exempt from an in-person review under the previous rules, NFs were required to
notify the PAA of non-Medicaid individuals admitted under a convalescent exemption, no later than
the date the on which exemption expires. Under the LTCC rules, NFs will have 72 hours after the
exemption expires to notify the PAA.

In cases of emergency NF admissions, under the previous rules, only the PAA could exempt an
individual from an in-person review. Under the LTCC rules, if an emergency arises when the PAA is
not open for business, the NF will be able to admit the person (provided all PASRR requirements are
met), and notify PAA within 24 hours.

Under the LTCC rules, NF transfers and NF readmissions will be automatic exemptions from the in
person review, whereas previously it depends on whether or not the individual’s condition improved.

Accessing the rules
There are a total of five rules, 173-43-01 through 173-43-05 in the Ohio Administrative Code. The
rules can be found at the Register of Ohio’s web site at:
http://www.registerofohio.state.oh.us/jsps/PublicDisplayRules/listRulesbyFilingDate.jsp?NEXT=50

Please feel free to contact your local PAA if you have any questions.




                        LONG TERM CARE CONSULTATION
                                   FACILITY LETTER HEAD

Patient Name ____________________________________DOB ___________Age_____

Social Security Number ____________________________________________________

Date of Transfer/Admission _________________________TO _____________________

Please check any of the below exemptions that apply:

   □ Admission to a NF under contract for continuing care

   □ Individual has a contractual right to admission to a NF operated as part of a system
     of continuing care

   □ Admission to a facility that is a “Home for the Aged”

   □ Admission to a facility that is not a certified Medicaid NF

   □ Admission to a NF under Hospice services

   □ NF transfer from one Ohio NF to another Ohio NF ( With or Without an intervening hospital
     stay)

   □ NF readmission-readmission to same NF following hospital stay

   □ Enrolled on a HCBS waiver

   □ NF resident is being actively Case Managed Ex: Mental Health MR/DD

   If you checked none of the above, the following information is required:


      1.) Estimated length of stay at a nursing facility _____________________________

      2.) Formal and Informal Supports
          Name of Person(s) or Agency(s) & Phone _______________________________

         ________________________________________________________________

      Put your confidentiality statement at bottom of 1st page




    3.) Any previous Nursing Facility Admission     Yes or No (Circle One)
         If yes, Where, and When & Why ______________________________________

         ________________________________________________________________

     4.) Will patient have depleted financial resources within 6 months based on current
         cost of nursing home ($5,247 monthly) Yes or No (Circle One)


       5.) ADL’S
ADL                    No Help                Supervision             Hands On
Mobility
    1. Bed             1                      2                       3
    2. Transfer        1                      2                       3
    3. Locomotion      1                      2                       3
Bathing                1                      2                       3
Grooming               1                      2                       3
Toileting              1                      2                       3
Dressing               1                      2                       3
Eating                 1                      2                       3

      6.) Can consumer self medicate Yes or No ( Circle one)

      7.)Diagnosis/ Medications Send Copy of History & Physical or Transfer Form

      8.) Did the doctor order any Nursing services or Therapies ( such as, PT,OT,ST
          antibiotics, monitoring wound care etc.)? _______________________________

         _______________________________________________________________

      9.) Mental status ( Is consumer alert, oriented X’s Confused, or Unresponsive?

         ________________________________________________________________


     Form Completed by ___________________________________________________
                              Area Agency on Aging
 TO:

FROM:

SUBJECT: Long Term Care Consultation

           OAC Rule 173-43-03

The Area Agency on Aging has been informed that you recently entered
a nursing facility. The purpose of this letter is to provide you with
information regarding the Long Term Care Consultation that provides
information about options available to meet your needs and factors to
consider when making your long term care decisions.

The assessment process includes a review of your care needs by a
licensed professional. It provides you with the opportunity to become
more knowledgeable and educated about the nature and benefits of
community services that may be available to you, and how to access
them.

This assessment is free of charge. You have been exempted from this
assessment at this time due to the following reason:


If you are interested in receiving an assessment, please contact me or have
somebody else contact our office on your behalf at 1-800-331-2644
or 740-373-6400




            P.O. Box 370, Reno, OH 45773 • (740)3734-9436 •Fax (740)374-8038 • info@buckeyehills.org
                    Serving Athens, Hocking, Meigs, Monroe, Morgan, Noble, Perry, Washington Counties
             Home Care Division • P.O. Box 370, Reno, OH 45773 • (740)373-6400 • Fax (740)373-1594
Chapter 173-43 Long Term Care Consultation Rule

173-43-01 Purpose and definitions.

(A) The purpose of Chapter 173-43 of the Administrative Code is to establish the long-term care
consultation program pursuant to sections 173.42 and 173.43 of the Revised Code. This program
shall provide individuals or their representatives with long-term care consultations that provide
information about options available to meet their long-term care needs and factors to consider when
making long-term care decisions.

(B) As used in this chapter:

(1) “AAA” means “area agency on aging.”

(2) “Individual” means a person who may qualify to receive a consultation.

(3) “Level of care” (“LOC”) means the review and determination process established by rule 5101:3-3-
15 of the Administrative Code.

(4) “Long-term care consultation” (“consultation”) is the face-to-face service defined by division (A)(2)
of section 173.42 of the Revised Code.

(5) “Nursing facility” (“NF”) has the same meaning as division (P) of section 5111.20 of the Revised
Code.

(6) “ODA” means “the Ohio department of aging.”

(7) “ODA’s designee” means the AAA or another entity under contract with ODA to perform
consultations.

(8) “Pre-admission screening and resident review” (“PASRR”) has the same meaning as established
by rules 5101:3-3-15.1 and 5101:3-3-15.2 of the Administrative Code.

(9) “Representative” means a person eighteen years of age or older acting on behalf of an individual
seeking a consultation, applying for admission to a NF, or residing in a NF. A representative may be a
family member, an attorney, a hospital social worker, or any other person chosen by the individual to
act on behalf of the individual.

Effective: 06/30/2007

R.C. 119.032 review dates: 06/30/2011

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.42

Rule Amplifies: 173.42
173-43-02 Process.

(A) Whenever any individual applies for admission to an NF or indicates an intention to apply for
admission to a NF, regardless of the source of payment, and whenever any NF resident applies for
medicaid or indicates an intention to apply for medicaid, either the NF or ODA’s designee shall
determine whether an individual requires a consultation in accordance with rule 173-43-03 of the
Administrative Code.

(B) For an individual who contacts the NF seeking admission or for a current resident of a NF who is
seeking medicaid eligibility, the NF may determine that the individual is exempt according to the
criteria set forth in paragraph (B) of rule 173-43-03 of the Administrative Code.

(1) If the NF determines that ODA’s designee is not required to provide a consultation to an individual,
the NF shall document in the individual’s record the criteria met for the exemption.

(2) If the NF determines that the individual is not exempt from the consultation, the NF shall provide
ODA’s designee with the information required in paragraph (E) of this rule.

(C) For a hospitalized individual who has either contacted the NF and was not determined to be
exempt or who has not contacted the NF, the hospital shall provide ODA’s designee with the
information required in paragraph (E) of this rule.

(D) For an individual who is not covered by paragraph (B) or (C) of this rule, the individual or the
representative of the individual shall provide to ODA’s designee the required information in paragraph
(E) of this rule to initiate the consultation process.

(E) Whenever a NF, hospital, or individual provides ODA’s designee with information in accordance
with paragraphs (B), (C), and (D) of this rule, the NF, hospital, or individual shall provide, at a
minimum, all the following information, whether by telephone, in writing, in person or electronically:

(1) The expected length of stay in the NF;

(2) All known information concerning existing formal support systems, existing informal support
systems, potential formal support systems, and potential informal support systems that are available
to the individual;

(3) Whether the individual has previously been admitted to a NF; and,

(4) For an individual who is not seeking a medicaid payment, a statement demonstrating whether or
not the resources of the individual will be depleted within six months of admission, which may make
the individual financially eligible for medicaid. The individual or representative of the individual shall
base the statement upon knowledge of the current cost for a six-month stay in the NF. If the individual
or the representative of the individual does not know the current cost, the NF shall provide that
information, upon request, to the individual or the representative of the individual.

(F) If ODA’s designee determines that it is not required to provide a consultation to an individual
according to the parameters of paragraphs (B) and (C) of rule 173-43-03 of the Administrative Code,
ODA’s designee shall provide documentation to the individual (or to the individual’s representative, if
any) and to the NF (if known) that identifies the exemption being met.

(G) For an individual for whom ODA’s designee is required to provide a consultation, ODA’s designee
shall determine whether to perform a consultation prior to admission to a NF or after admission to a
NF. ODA’s designee may determine that a consultation may be conducted after admission to a NF if
any of the following applies:

(1) ODA’s designee decides that a limited length of stay in a NF would be beneficial in order for
alternative service arrangements to be put into place, or for the individual to rehabilitate so that
alternative service arrangements are then able to meet the needs of the individual;

(2) The consultation cannot be completed within the required number of days in accordance with rule
173-43-04 of the Administrative Code and ODA’s designee has not exempted the individual from the
requirement to receive a consultation;

(3) ODA or ODA’s designee determines that a individual has an emergency need for admission to a
NF based upon credible information from sources that include, but are not limited to, the following:

(a) An adult protective services worker;

(b) A categorical PAS-SMI, as defined in rule 5122-21-03 of the Administrative Code; or,

(c) A categorical PAS-MR/DD determination as defined in rule 5123:2-14-01 of the Administrative
Code.

(4) If the need for an emergency admission to a NF arises during the time when ODA’s designee is
not open for business and is not able to make the determination that the individual has an emergency
need for admission, the NF may admit the individual (although paragraph (L) of this rule still applies).
The NF shall provide notification of the admission to ODA’s designee no later than twenty-four hours
after the admission.

(H) Only a person who is certified by ODA or ODA’s designee pursuant to rule 173-43-05 of the
Administrative Code may perform a consultation.

(I) At a minimum, every consultation shall provide each of the following components:

(1) Any long-term care options available to the individual (public and private) that may meet the needs
of the individual;

(2) Information explaining the methods to use to apply for the long-term care options mentioned in
accordance with paragraph (I)(1) of this rule;

(3) A personalized list of factors to consider when deliberating over long-term care options mentioned
in accordance with paragraph (I)(1) of this rule, including, but not limited to, any known potential risks
that may be associated with the options and applicable resources that the individual may use to learn
about the quality of services; and,

(4) Information explaining the opportunities and methods for maximizing the independence and self-
reliance of the individual, including information about support services provided by the family, friends,
and community of the individual that may be able to meet the needs of the individual.

(J) At the conclusion of the consultation, ODA’s designee shall provide the individual or the
representative of the individual with a written summary of options and resources available to meet the
needs of the individual.

(K) Although the summary mandated by paragraph (J) of this rule may specify that an alternative
source of long-term care is appropriate and available, the individual is not required to seek the
alternative source. Instead, the individual may be admitted to a NF or continue to reside in a NF,
unless the individual does not meet the applicable requirements under rules 5101:3-3-15.1 and
5101:3-3-15.2 of the Administrative Code.

(L) An individual who is subject to a PASRR and/or a LOC review shall comply with the requirements
of a PASRR and/or a LOC review. This is the case even if ODA’s designee is not required to provide
a consultation to the individual and even if ODA’s designee is not required to provide a consultation
until after admission to a NF.

(M) If a consultation includes any portion of a PASRR and/or a LOC review, any determinations made
in relation to these reviews shall comply with rules 173-43-05, 5101:3-3-15, 5101:3-3-15.1, and
5101:3-3-15.2 of the Administrative Code.

(N) A NF that has a provider agreement with the department of job and family services may only
admit or retain an individual as a resident upon receipt of evidence that the individual is exempt from
or has met the requirements of this rule.

Replaces: 5101:3-3-14

Effective: 06/30/2007

R.C. 119.032 review dates: 06/30/2011

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.42

Rule Amplifies: 173.42

Prior Effective Dates: 1/1/95
173-43-03 Required consultations and exemptions.

This rule sets forth the conditions under which determinations are made concerning whether an
individual is required to be provided a consultation or may be exempt from that requirement. It also
describes the conditions under which a NF or ODA’s designee may exempt an individual from the
requirement to be provided a consultation.

(A) ODA’s designee shall provide each individual in the following categories with a consultation:

(1) An individual who applies or indicates an intention to apply for admission to a NF, regardless of
the source of payment to be used for the care in the NF, so long as the individual is not exempted by
paragraph (B) or (C) of this rule;

(2) A NF resident who applies or indicates an intention to apply for medicaid, so long as the individual
is not exempted by paragraph (B) or (C) of this rule;

(3) An individual who is not seeking medicaid payment and is likely to deplete his or her financial
resources within six months after admission to a NF to a level at which the individual would become
financially eligible for medicaid as described in paragraph (D)(1) of this rule, so long as the individual
is not exempted by paragraph (B) or (C) of this rule;

(4) A NF resident who was admitted under a time-limited convalescent exemption or who was
admitted under a categorical determination in accordance with rule 5101:3-3-15.1, rule 5122-21-03,
or rule 5123:2-14-01 of the Administrative Code, but has since been found to require a stay in a NF
that will exceed the time limits specified in those rules, so long as the individual is not exempted by
paragraph (B) or (C) of this rule. In this case, the NF shall inform ODA’s designee of such an
individual no later than seventy-two hours after the expiration of the time limit. Upon being notified,
ODA’s designee shall determine whether or not a consultation is required; or,

(5) Any individual who requests a consultation.

(B) Either the NF to which the individual is seeking admission, the NF to which the individual is
seeking continued residency, or ODA’s designee shall determine that ODA’s designee is not required
to provide each individual in the following categories with a consultation unless the individual or the
individual’s representative requests a consultation:

(1) An individual who is to receive care in a NF under a contract for continuing care as defined in
section 173.13 of the Revised Code;

(2) An individual who has a contractual right to admission to a NF operated as part of a system of
continuing care in conjunction with one or more facilities that provide a less-intensive level of
services, including a residential care facility licensed under Chapter 3721. of the Revised Code, an
adult care facility licensed under Chapter 3722. of the Revised Code, or an independent living
arrangement;

(3) An individual who is to receive continual care in a home for the aged that is exempt from taxation
under section 5701.13 of the Revised Code;

(4) An individual who is seeking admission to a facility that is not a NF with a provider agreement
under section 5111.22 of the Revised Code;
(5) An individual who is seeking a NF transfer. A NF transfer occurs when an individual’s place of
residence is changed from one Ohio medicaid-certified NF to another Ohio medicaid-certified NF,
with or without an intervening hospital stay;

(6) An individual who is to be readmitted to the same NF following a period of hospitalization;

(7) An individual who is seeking admission to a NF to receive hospice services;

(8) An individual who is currently enrolled in an HCBS waiver, or was enrolled in a HCBS waiver prior
to the NF admission being sought, regardless of the payment source being sought for the NF
admission; or,

(9) An individual who is seeking admission to a NF, or who is already a resident of a NF, who is being
actively case managed by medicare or another funding source that will case manage the individual
while in the NF.

(C) ODA’s designee may determine that it is not required to provide each individual in the following
categories with a consultation unless the individual or the individual’s representative requests a
consultation:

(1) An individual who is being admitted to a NF directly from a hospital and is expected to have a
short length of stay (ninety days or less) . In making this determination, ODA’s designee shall
consider factors such as medical condition, probable need for long-term care services, history of
hospitalizations, availability of informal supports, and awareness of options available;

(2) An individual who has care needs that clearly exceed the services that are available to the
individual in an alternative setting to the NF. To make this determination, ODA’s designee shall
consider the availability of existing formal and informal support systems, the availability of potential
formal and informal support systems, the functional abilities and limitations of the individual, the
individual’s diagnosis, the individual’s prognosis, and the individual’s plan of treatment, placing
special emphasis on end-of-life treatment, because such a treatment is most likely an indicator that
the individual will not benefit from a consultation;

(3) An individual who has been admitted to a NF under a convalescent exemption from PASRR, or
under a time-limited categorical PAS-SMI or PAS-MR/DD determination as defined in rules 5122-21-
03 and 5123:2-14-01 of the Administrative Code; and,

(4) An individual for whom ODA’s designee cannot complete a consultation within the required time
frame, as described in paragraph (D) of rule 173-43-04 of the Administrative Code.

(D) An individual or the representative of an individual may forego the opportunity to participate in a
consultation only if either of the following conditions exist:

(1) The individual has not applied for, or indicated an intent to apply for, medicaid payment for their
NF stay and ODA’s designee has determined that the individual is not likely to spend down his or her
resources within six months of admission. ODA’s designee shall make this determination based upon
a statement demonstrating whether or not the resources of the individual will be depleted within six
months of admission, which may make the individual financially eligible for medicaid. The individual or
representative of the individual shall base the statement upon knowledge of the current cost for a six-
month stay in the NF. If the individual or the representative of the individual does not know the current
cost, the NF shall provide that information, upon request, to the individual or the representative of the
individual; or,
(2) The individual has already received an in-person LTC consultation from the administrative agency;
regardless of the payment source being sought for the NF admission.

(E) At the individual’s request, ODA’s designee may provide written or verbal information regarding
long-term care services even if the individual does not require a consultation.

Effective: 06/30/2007

R.C. 119.032 review dates: 06/30/2011

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.42

Rule Amplifies: 173.42
173-43-04 Time frames.

(A) If an individual has applied for medicaid coverage, ODA’s designee shall complete the
consultation in accordance with the applicable time frame for providing the LOC determination as
specified in rule 5101:3-3-15 of the Administrative Code.

(B) Except for a consultation mentioned in paragraph (A) of this rule, ODA’s designee shall complete
every consultation no later than five calendar days after ODA’s designee receives a request for the
consultation.

(C) An individual or the representative of the individual may request that ODA’s designee provide a
consultation on a date that is later than the date required. In such cases, ODA’s designee shall
provide the consultation at a time that is mutually agreed-upon between the individual (or the
representative of the individual) and ODA’s designee.

(D) If ODA’s designee cannot complete the consultation within the number of days required, or if the
individual was admitted to a NF due to an emergency in accordance with paragraph (G)(4) of rule
173-43-02 of the Administrative Code, ODA’s designee may take the following action:

(1) Exempt the individual from the consultation if it is decided that it would not be beneficial to perform
the consultation after the NF admission;

(2) Provide the consultation as soon as practicable after the individual has been admitted to a NF in
the case of an applicant for admission to a NF; or,

(3) Provide the consultation as soon as practicable in the case of a NF resident for whom ODA’s
designee is required to provide a consultation.

Effective: 06/30/2007

R.C. 119.032 review dates: 06/30/2011

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.42

Rule Amplifies: 173.42
MENTAL HEALTH & MR/DD EVALUATOR TIMELINES:


THE LOCAL MR/DD EVALUATOR HAS 5 WORKING DAYS TO PROCESS THE FURTHER REVIEW
REQUEST THEN FORWARD IT TO OH DEPT OF MR/DD WHICH HAS 7 TO 9 DAYS TO FINISH THE
REQUEST.

THE LOCAL MENTAL HEALTH EVALUATOR HAS 1 WORKING DAY TO RULE OUT THE
INDIVIDUAL OR 5 WORKING DAYS TO PROCESS AN IN DEPTH REVIEW, IF AN IN DEPTH
REVIEW IS DONE THEN LOCAL EVALUATOR SENDS REVIEW TO STATE BOARD AND THEY
HAVE 7 TO 9 DAYS TO FINISIH.
                     PASRR STATE AUTHORITY CONTACTS


Ohio Department of Mental Health

      30 E. Broad Street, 11th Floor
      Columbus, OH 43266


Main Fax:   614-466-9653

      Mike Schroder, PASR Unit Manager              614-752-9857
      Unit Clerk (Secretary) Main Line              614-466-1063



Ohio Department of Mental Retardation & Developmental Disabilities

      35 E Broad Street, 5th Floor
      Columbus, OH 43215


Main Fax:   614-995-4877

      Jane Black                                  614-387-0578
      Contact regarding reviews and case assignments and contacts

      Mary Shafer, Office Clerk                       614-728-2556
      Contact to confirm that faxed information was received




Note: The PASRR Specialists cover the entire state of Ohio
                       MR/DD CONTACTS

                            (UPDATED 12-06)



ATHENS CO. BOARD OF MR/DD

DENNIS LEHMAN
801 WEST UNION
ATHENS, OH 45701
PHONE: 740-592-6006
FAX:   740-594-5048

HOCKING CO. BOARD OF MR/DD

LESLIE JUSTICE
P.O. BOX 387
LOGAN , OH 43138
PHONE: 740-385-2118
FAX:    740-385-5594

MEIGS CO. BOARD OF MR/DD

JOY STEWART
P.O. BOX 307
1310 CARLETON ST
SYRCUSE, OH 45779
PHONE: 740-992-6683
FAX:    740-992-6438

MONROE CO. BOARD OF MR/DD

HELEN RING
P.O. BOX 623
47011 SR 26
WOODSFIELD, OH 43793
PHONE: 740-472-1712
FAX:    740-472-1684
                           MR/DD CONTACTS
                                ( cont.)


MORGAN CO. BOARD OF MR/DD

ANNETTE SHAAD
900 S. RIVERSIDE DR.
MCCONNELSVILLE, OH 43756
PHONE: 740-962-9906
FAX:     740-962-9908

NOBLE CO. BOARD OF MR/DD

LAURA HICKMAN
18506 SR 78 E
CALDWELL, OH 43724
PHONE: 740-732-7144
FAX:    740-732-7361

PERRY CO. BOARD OF MR/DD

MARCI JONES
499 N STATE ST.
NEW LEXINGTON, OH 43764
PHONE: 740-342-0416
FAX:    740-342-5568


WASHINGTON CO. BOARD OF MR/DD

SHARON TILTON
P.O. BOX 702
MARIETTA, OH 45750
PHONE: 740-373-3781
FAX;    373-1373
                          MENTAL HEALTH CONTACTS
UPDATED 12-06

COUNTY            ATHENS

PROVIDER:       TRI-COUNTY MH & COUNSELING
CONTACT:        JERRY SCHAEFFER
ADDRESS:        90 HOSPITAL DRIVE
                ATHENS, OH 45750
PHONE:          740-593-3682
FAX:            740-594-5642

COUNTY            HOCKING

PROVIDER:       TRI-COUNTY MH & COUNSELING
CONTACT:        TRACIE DEARING
ADDRESS:        47 N. MARKET ST.
                P.O. BOX 1145
                LOGAN, OH 43138
PHONE:          740-385-6594
FAX:            740-385-0852

COUNTY            MEIGS

PROVDER:        WOODLAND CENTERS, INC.
CONTACT:        GERI EVANS
ADDRESS:        3086 SR 160
                GALLIPOLIS, OH 45631
PHONE:          740-446-5500
FAX:            740-441-4402

COUNTY             MONROE

PROVIDER:       COMMUNITY MH SERVICES
CONTACT:        GAYLE WESTFALL
ADDRESS:        BOX 508 68353 BANNOCK RD.
                ST. CLAIRSVILLE, OH 43950

PHONE:          740-695-9344
FAX:            740-695-7777
                       MENTAL HEALTH CONTACTS
                                     (continued)


COUNTY              MORGAN

PROVIDER:        JOLINDA MARKLE
CONTACT:        JOLINDA MARKLE

PHONE:          740-439-4428
FAX:            740-439-3389


COUNTY          PERRY
                SAME AS ABOVE


COUNTY          NOBLE
                SIX COUNTY, INC.


COUNTY          WASHINGTON

PROVIDER:       WASHINGTON COUNTY MH
CONTACT:        BRENT PHIPPS

HOME ADDRESS:   L & P SERVICES
                207A COLGATE DR.
                MARIETTA, OH 45750

PHONE:          740-376-0930
FAX:            740-376-0933
                                     PASRR EXEMPTIONS


OAC Rule 5101:3-3-151

Convalescent Stay: All the following criteria must be met in order for the NF admission to be
considered as a convalescent stay.

          1. The individual must be admitted to the NF directly from the hospital;

          2. The individual must require the level of services provided by the NF for the condition
             which was treated in the hospital;

          3. The individual must require less than 30 days of care in the NF as certified by the
             attending physician. The certification must be signed and dated no later than the date
             of the hospital discharge by the attending physician.


 The NF must receive the above documentation from the discharging hospital before they can admit

                                            the individual.




Categorical Determinations- OAC Rules 5122-21-03 and 5123:2-14-01

         A categorical Determination that NF services are needed may be made
         when:
         A. The individual is being admitted for up to fourteen days for respite for the caregiver and
            plans to return to the caregiver at the end of the NF stay or

         B. The individual is being admitted pending further assessment in
            emergency situations requiring protective services with placement
            not to exceed seven days
                                           (Your letterhead)


             Convalescent Exemption of PASRR – Hospital Discharge to Nursing Facility)




Date



To whom it May Concern:


Mr./Mrs. ______________________ has been a patient in _______________
Hospital from ________________ to ______________.
                    Admit date           Discharge date


Mr./Mrs. _____________________ requires the level of service provided by a Nursing Facility for the
Primary Diagnosis of _____________________________
that was treated during this hospital admission.
Mr./Mrs. _____________________ is likely to require the services provided by a nursing facility for
less than thirty days.




                                                               _______________________________
                                                               Physician Signature               Date
Scenario: Resident admitted to nursing facility from the hospital
for Convalescent stay

(This means the resident will be at the nursing facility for less than
30 days and therefore will not be reviewed for mental illness or
mental retardation by the pre-admission screening process)

Before you admit the resident:

Do you know and/or did you check whether:

o Resident was a person admitted to the hospital, so was
discharged from the hospital to your facility and is a new
nursing facility admission?

o The continuity of care form indicates the resident has less
than a 30 day stay at the nursing facility?

o The attending physician signed the continuity of care form
and dated it before the resident left the hospital?

o The continuity of care form was signed by a physician and not
a physician’s assistant? Or was not authorized by a verbal
order obtained by a nurse because you know it has to be
signed by the physician?

Why this matters to you!

If the individual does not have a valid convalescent stay as
described above, then pre-admission screening is required. If the
pre-admission screening was not done, and the resident has a
Medicaid payment source, your nursing facility will be paid the date
the PAS is completed.
RR/ID Process
OAC 5101:3-3-152


1. The NF completes the ODJFS 3622 form

2. The NF reviews the ODJFS 3622 to determine if the resident requires Further Review

3. If the resident does not have indications of SMI and/or MRDD, the ODJFS 3622 is to be retained
   in the resident’s record along with supporting evidence; (It does not get sent to PAA)

4. If there are indications of SMI, the individual is subject to Further Review and should be faxed to
   ODMH;

5. If there are any indications of MR/DD, the individual is subject to Further Review and should be
   faxed to ODMR/ DD;

   6. If there are indications of SMI and MR/DD, the individual is subject to Further Review and
   should be faxed to both ODMH and ODMR/DD;

   7. When Further Review is required the NF will submit the following items to ODMH and/or
   ODMR/DD:

     o The completed ODJFS 3622
     o Supportive documentation- including current condition, evidence of individual’s need for NF
       services
        o ODMH and ODMRDD use the Medicaid LOC criteria to determine the need for NF
            services



PAAs are not involved with the Resident Review process

other than to provide technical assistance!
    Key Terms

    OAC 5101:3-3-152      Resident Review (RR) Requirements


    “RESIDENT REVIEW (RR)”
    The resident review portion of the preadmission screening and resident review (PASRR)
    requirements mandated by Section 1919(e)(7) of the Social Security Act, as mended, which must
    be implemented in accordance with the provisions of this rule and rules 5122-21-03 and OR
    5123-14-01 of the Administrative Code.


“SIGNIFICANT CHANGE IN CONDITION”
    “Significant change of condition” has same meaning used in administering the routine resident
    assessment requirements specified in rule 5101:3-3-40 of the Administrative Code and that at
    least one of the following criteria is met:

          (a) There is a change in the individual’s current diagnosis(es), mental health Treatment,
              functional capacity, or behavior such that, as a result of the change, the individual who
              did not previously have indications of SM, or who did not previously have indications of
              MR/DD, now has such indications(as defined in paragraph ( C ) (5) of rule 5101:3-3-151
              of the Administrative Code) (this includes any individual who may have indications of
              one or the other but not has indications of both SMI and MR/DD), or who was
              previously determined by ODMH not to have SMI but who now meets all three of the
              defining criteria for SMI (set forth in paragraph ( B) (16) of the rule 5101:3-3-151 of the
              Administrative Code): or
          (b) The change is such that it may impact the mental health treatment or placement options
              of an individual previously identified as having SMI and/or may result in a change in the
              specialized services needs of an individual previously identified as having MR/DD.


“RESIDENT REVIEW IDENTIFICATION (RR/ID)”
The process by which individuals are identified who, pursuant to the provisions
of paragraphs ( D ) and ( C ) of this rule, are subject to RR.

RR/ID is required for all individuals who meet any of the following criteria:
             C1        The individual was admitted under the exempted hospital discharge provision
                       set forth in paragraph (C) (2) of rule
                       5101:3-3-151 of the Administrative Code, and has since been found to require
                       more than thirty days of service at the NF level;

             C2 The individual’s admission is a NF transfer, as defined in   paragraph (B) (9)
                   of rule 5101:3-3-151 of the Administrative Code, and there are no PASRR
                   records available from the previous NF placement;
              C3     The individual had been in a different NF and was admitted                   directly
                       following an intervening hospital stay for psychiatric
                       treatment (as defined in paragraph (B) (8) of this rule), or was readmitted to
                       the same NF directly following a hospital stay for psychiatric treatment, and has
                       experienced a significant change in condition since the last PASRR
                       determination.

                C4     The individual has experienced a significant change in condition (as defined in
                       paragraph (B)(7) of this rule); or


                C5 The individual received a categorical PAS-SMI or PAS-MR/DD determination (as
                     defined in rules 5122-21-03 and 5123:2-14-01 of the Administrative Code) and
                     the stay has exceeded the specified time limit for that category.



“LONG TERM RESIDENT”
An individual who has continuously resided in a NF or a consecutive series of NFs and/or Medicare
skilled nursing facilities for at least thirty months prior to the first resident review (RR) (defined in rule
5101:3-3-152 of the Administrative Code) determination in which the individual was found not to
require the level of services provided by a NF, and to require specialized services. The thirty months
may include temporary absences for hospitalization or therapeutic leave as defined in rule 5101:3-3-
03 of the Administrative Code.
TIMELINES FOR SUBMISSIONS


  For those individuals specified in paragraphs C1 to C2 of this rule (5101:3-3-152), RR/ID must be
  initiated not more than thirty days following the date of the current admission.

  For those individuals specified in paragraphs C3 and C4 of this rule (5101:3-3-152), the RR/ID
  must be initiated promptly upon identification of this significant change.

  For those individuals specified in paragraph c5 of this rule (5101:3-3-152), the RR/ID must be
  initiated no later than the expiration date of the categorical determination.

  NF’s must initiate the RR/ID.
  RR/ID must be initiated via the completion of a PASRR Identification Screen From (ODHS 3622)

  PAS/ID’s of individuals determined to have indications of SMI or MRDD must be sent to the
  appropriate State Authority.

  PAS/ID’s with no indications of SMI or MR/DD must be placed on individual’s medical record.

  Medicaid vendor payment is available for the provision of NF services to Medicaid ineligible
  individuals subject to RR/SMI and / or RR/MRDD only when the individuals have met the criteria
  for retention as follows:

  The individual needs the level of services provided by a NF or

  The individual had resided in a NF for at least thirty months at the time of the first RR
  determination that the individual does not require the level of services provided by a NF and
  requires specialized services only; and the individual has chosen to remain in a NF in accordance
  with the federal regulations set forth in 42 CFR 483.118 (C) 1.



  Please do not send RR/ID to PAA
Scenario: Resident’s time limit for Emergency or Respite
Admission has expired

This situation applies only to a resident with Serious Mental Illness
(SMI) and/or Mental Retardation/Developmental Disability (MR/DD).
This applies to a resident who was admitted with a Pre-Admission
Screening (PAS) but was only approved for a 7-day emergency
admission or a 14-day respite admission in the further review
process. If the resident needs to remain at the Nursing Facility (NF)
longer than their approved stay, another review, called a Resident
Review (RR), is needed.

Initiate a Resident Review (RR) no later than the resident’s 7th
day for the Emergency Admission or the resident’s 14th day for a
Respite Admission. The RR may be initiated any time after the
resident is admitted but is due no later than day 7 of the NF stay for
an emergency admission or on day 14 for a respite admission. If the
resident is hospitalized during this time period, days at the hospital
count towards the tally of days.

How to initiate the Resident Review stay:
     o Fill out all three pages of a new PAS/RR ID Screen (form
        3622).
     o In section “B” use code #4 for an Emergency Admission or
        code #5 for a Respite Admission.
     o Make sure to sign and date the bottom of page 2 of the
       screen. The date by your signature is the date you are
       actually filling out and signing the form.
     o Fax the screen to ODMH (614) 466-9653 or ODMR/DD (614)
       995-4877. Fax to both state authorities if the resident has
       both SMI and MR/DD.
     o Keep the fax transmission report or your fax cover sheet to
        prove the date it was faxed to the state authority. You will
        need to show this if you ask for a Level of Care.
                                           PHYSICIAN CERTIFICTION FORM


Consumer Name: ____________________________________________________________

Reason for request:
      Transfer to: ___________________________________________________________
      If transfer, was resident in previous facility more than 180 days? Yes_____ No_____

       Change of payment: Private pay/Medicare to Medicaid: ________________________
       Last covered day of Medicare or other payment source: ________________________

Original date of admission to any to any NF without return to community: _______________

Active /Pending Medicaid number: _______________________________________________
            County Medicaid active: ______________________________________________

Can resident self medicate? Yes _____ No _____

Does resident require 24 hour supervision due to cognitive impairment? Yes _____ No _____
           If yes, please explain _________________________________________________

Authorized Representative: _____________________________________________________
   (family /friend)        _____________________________________________________
                               _________________________________________________

PRIMARY DX: (only one)

Estimated length of stay: ________________________________________________________

I have reviewed the enclosed MDS and certify that it is an accurate statement of the resident’s
Current physical, mental, social and emotional status.

I certify that the resident requires:
             Intermediate Level of Care (ILOC): ___________________
             Skilled Level of Care     (SLOC): ___________________


REHAP POTENTIAL: GOOD ____ FAIR ____ POOR ____
PROGNOSIS:       GOOD ____ FAIR ____ POOR ____

PHYSICIAN SIGNATURE: __________________________________DATE: _____________

FORM COMPLETED BY: _______________________________________________________
PHONE NUMBER:_____________________________________________________________
If resident was admitted under convalescent exemption, please send exemption form and resident
Review.

                                      A program of Buckeye Hills-Hocking Valley Regional Development district
                            P.O. Box 370, Reno, Ohio 45773 ·Fax (740) 373-1594 or (740)373-0087·info@areaagency8.org
                                 Serving Athens, Hocking, Meigs, Monroe, Morgan, Noble, Perry, Washington Counties
  …:3-3-152 Resident review (RR) requirements for individuals residing in nursing facilities                           (NPage 1 of 4)


 5101:3-3-152 Resident review (RR) requirements for individuals residing in nursing facilities (NFs).
 Text of Rule

 (A) The purpose of this rule is to set forth the RR requirements which must be met in order to comply with Section 1919 (e) (7) of the
 Social Security Act, as amended. NFs are prohibited from retaining any individual who has serious mental illness (SMI) (as defined in
 paragraph (B) (16) of rule 5101:3-3-151 of the Administrative Code) or mental retardation and/or other developmental disabilities (MR/DD)
 (as defined in paragraph (B) (7) of rule 5101:3-3-151 of the Administrative Code) unless the RR requirements specified in this rule have
 been met.

 (B) Definitions:

  (1) “Resident review (RR)” means the resident review portion of the preadmission screening and resident review(PASRR) requirements
 mandated by Section 1919(e)(7) of the Social Security Act, as amended, which must be implemented accordance with the provisions of
 this rule and rules 5122-21-03 and OR 5123:2-14-01 of the Administrative Code.

 (2) RR identification (RR/ID). “RR/ID” is the process by which individuals are identified who, pursuant to the provisions of paragraphs (D)
 and (E) of this rule, are subject to RR.

 (3) Resident review for serious mental illness (RR/SMI) “means the process, set forth in rule 5122-21-03 of the Administrative Code, by
 which the Ohio department of mental health (ODMH) determines whether, due to the individual’s physical and mental condition, an
 individual who is subject to RR, and who has serious mental illness (SMI) (as defined in paragraph (B) (16) of rule 5101:3-3-151 of the
 Administrative Code) requires the level of services provided by a NF or another type of facility: and whether that individual requires
 specialized services for serious mental illness (as defined in paragraph (B)(17) of rule 5101:3-3-151of the Administrative Code.

 (4) Resident review for mental retardation/developmental disabilities (RR-MR/DD) “means the process, set forth in rule 5123:2-14-01 of
 the Administrative Code, by which the Ohio department of mental retardation and developmental disabilities (ODMR/DD) determines
 whether, due to the individual’s physical and mental condition, an individual who is subject to RR, and who has mental
 retardation/developmental disabilities (MR/DD) (as defined in paragraph (B)(7) of rule 5101:3-3-151 of the Administrative Code) requires
 the level of services provided by a NF or another type of facility; and, whether the individual requires specialized services for MR/DD.

 (5) “Current diagnoses” means those diagnoses verified by the individual’s attending physician as current in the most recent physical
 examination report, physician progress notes, or annual reevaluation of current diagnoses performed while the individual is a NF resident.

 (6) “Individual.” for purposes of this rule, individual means a person, regardless of payment source, who resides in a NF.

 (7) “Significant change of condition.” For purposes of this rule, “significant change of condition” has the same meaning used in
 administering the routine resident assessment requirements specified in rule 5101:3-3-40 of the Administrative Code and that at least one
 of the following criteria is met:

 (a) There is a change in the individual’s current diagnosis (es), mental health treatment, functional capacity, or behavior such that, as a
 result of the change, the individual who did not previously have indications of SMI, or who did not previously have indications of MR/DD,
 now has such indications (as defined in paragraph (C) (5) of rule 5101:3-3-151 of the Administrative Code) (this includes any individual
 who may have had indications of one or the other but now has indications of both SMI and MR/DD), or who was previously determined by
 ODMH not to have SMI but who now meets all three of the defining criteria for SMI (set forth in paragraph (B) (16) of rule 5101:3-3-151 of
 the Administrative Code); or

 (b) The change is such that it may impact the mental health treatment or placement options of an individual previously identified as having
 SMI and/or may result in a change in the specialized services needs of an individual previously identified as having MR/DD.

(8) “Hospital stay for psychiatric treatment” means the admission of an individual to a psychiatric hospital operated by ODMH, or a
psychiatric hospital or psychiatric unit of a hospital licensed by ODMH under section 5119.20 of the Revised Code.

(C) RR/ID is required for all individuals who meet any of the following criteria:

(1) The individual was admitted under the exempted hospital discharge provision set forth in paragraph (c) (2) of rule 5101:3-3-151 of the
Administrative Code, and has since been found to require more than thirty days of services at the NF level;

(2) The individual’s admission is a NF transfer, as defined in paragraph (B) (9) of rule 5101:3-3-151 of the Administrative Code, and there
    are no PASRR records available from the previous NF placement;




http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_35101_33152.htm 4/24/00
   …:3-3-152 Resident review (RR) requirements for individuals residing in nursing facilities (NPage 2 of 4)



   (3) The individual had been in a different NF and was admitted directly following an intervening hospital stay for psychiatric treatment (as
   defined in paragraph (B)(8) of this rule), or was readmitted to the same NF directly following a hospital stay for psychiatric treatment, and
   has experienced a significant change of condition since the last PASRR determination;

   (4) The individual has experienced a significant change in condition (as defined in paragraph (B)(7) of this rule.: or

   (5) The individual received a categorical PAS-SMI or PAS-MR/DD determination (as defined in rules5122-21-03 and 5123:2-14-01 of the
   Administrative Code) and the stay has exceeded the specified time limit for that category.

   (D) RR/ID requirements:

   (1) Timelines for submission:

   (a) For those individuals specified in paragraph (C)(1) to (C)(2) of this rule, RR/ID must be initiated not more than thirty days following the
   date of the current admission.

   (b) For those individuals specified in paragraph (C)(3) and (C)(4) of this rule, the RR/ID must be initiated promptly upon identification of
   the significant change.

   (c) For those individuals specified in paragraph (C)(5) of this rule, the RR/ID must be initiated no later than the expiration date of the
   categorical determination.

   (2) The NF must initiate the RR/ID.

   (3) RR/ID must be initiated via the completion of a PASRR Identification Screen” form (ODHS 3622)

   (4) The NF shall review the completed ODHS 3622 form to determine whether the individual has indications of having SMI and/or MR/DD
   (as defined in paragraphs (C)(5)(a) and (C)(5)(b) of rule 5101:3-3-151 of the Administrative Code).

   (5) RR/ID results shall determine whether an individual is subject to further review.

   (a) Individuals determined to have no indications of SMI and/or MR/DD are not subject to further RR review.

   (b) Individuals determined to have indications of SMI shall be subject to further review by ODMH in accordance with rule 5122-21-03 of
   the Administrative Code.

   (c) Individuals determined to have indications of MR/DD shall be subject to further review by ODMR/DD in accordance with rule 5123:2-
   14-01 of the Administrative Code.

   (d) Individuals determined to have indications of both SMI and MR/DD shall be subject to further review by both ODMH and ODMR/DD in
   accordance with rules 5122-21-03 and 5123:2-14-01 of the Administrative Code.

   (6) Routing of completed forms:

   (a) For individuals determined to have no indications of either MR/DD or SMI, the NF shall place and maintain the ODHS 3622 and all
   supporting evidence in the resident’s record at the facility;.

   (b) For individuals determined to have indications of SMI and/or MR/DD, the NF shall submit the ODHS 3622, documentation supporting
   the ODHS 3622, as well as documentation of the individual’s current condition and evidence of the individual’s need for services at the NF
   level to ODMH and/or ODMR/DD so that it may be determined whether the individual has SMI and/or MR/DD; and if so, for the RR/SMI
   and/or RR-MR/DD review.

   (c) ODMH and/or ODMR/DD, may request any additional information required in order to make an RR/ID determination, and shall report
   the outcome of the RR/ID to the NF that initiated the review and, where applicable, indicate the agency to which the individual was referred
   for further evaluation.


   (d) The NF shall maintain the results of the RR/ID in the individual’s resident record at the facility.


   (E)   RR/SMI and RR-MR/DD requirements:




http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_3/5101_3-3152.htm 4/24/00
    …:3-3-152 Resident review (RR) requirements for individuals residing in nursing facilities (NPage 3 of 4)


   (1) RR/SMI is required for all individuals who were determined by ODMH during the RR/ID, in accordance with this rule and RULE 5122-
   21-03 of the Administrative Code, to have SMI.

   (2) RR-MR/DD is required for all individuals who were determined by ODMR/DD during the RR/ID, in accordance with this rule and RULE
   5123:2-14-01 of the Administrative Code, to have MR/DD.

   (3) Individuals with both SMI and MR/DD are subject to both RR/SMI and RR-MR/DD.

   (4) If the individual is subject to RR/SMI and/or RR-MR/DD and there is no record of the determinations in the medical record and/or no
   indication that they are in progress, the NF shall notify ODMH and/or ODMR/DD.

   (5) Section 1919(e)(7) of the Social Security Act prohibits ODMH and/or ODMR/DD from utilizing criteria relating to the need for NF care
   or specialized services that are inconsistent with that statue and the ODHS approved state plan for medicaid. The approved state plan for
   medicaid includes level of care criteria, contained in Chapter 5101:3-3 of the Administrative Code. Therefore, ODMH and ODMR/DD may
   not use criteria inconsistent with Chapter 5101:3-3 of the Administrative Code in making their determinations regarding whether individuals
   with SMI and/or MR/DD need the level of services provided by a NF.

   (6) ODMH and/or ODMR/DD shall provide written notification of all RR/SMI and/or RR-MR/DD determinations made.

   (a) Such written notice shall be provided to:

   (i) The evaluated individual and his or her legal representative;

   (ii) The NF in which the individual is a resident; and

   (iii) The individual’s attending physician.

   (b) Such written notice shall include all of the following components:

   (i) The determination as to whether the individual requires the level of services provided by a NF;

   (ii) The determination as to whether the individual requires specialized services for SMI and/or MR/DD;

   (iii) The placement and/or service options that are available to the individual consistent with those determinations; and

   (iv) The individual’s right to appeal the determination(s).

   (7) The NF shall retain the written notification of the RR/SMI and/or RR-MR/DD determinations received from ODMH and/or ODMR/DD in
   the individual’s resident record at the facility.

   (8) Adverse determinations may be appealed in accordance with division level designation 5101:6 of the Administrative Code.

   (F) In accordance with section 1919(e)(7) of the Social Security Act, no individual with SMI or MR/DD shall be retained as a resident in a
   NF, regardless of payment source, unless it has been determined, in accordance with rules 5101:6 of the Administrative Code.

   (F) In accordance with section 1919(e)(7) of the Social Security Act, no individual with SMI or MR/DD shall be retained as a resident in a
   NF, regardless of payment source, unless it has been determined, in accordance with rules 5122-21-03 and/or 5123:2-14-01 of the
   Administrative Code, that:

   (1) The individual needs the level of services provided by a NF; OR

   (2) The individual had resided in a NF for at least thirty months at the time of the first RR determination that the individual does not require
   the level of services provided by a NF and requires specialized services only; and the individual has chosen to remain in a NF in
   accordance with the federal regulations set forth in 42 CFR 483.118(c)(1);.

   (G) Medicaid vendor payment.

   (1) Medicaid vendor payment is not available for the provision of specialized services for SMI and/or MR/DD.




http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_3/5101_3-3-152.htm 4/24/00
    …:3-3-152 Resident review (RR) requirements for individuals residing in nursing facilities (NPage 4 of 4)


   (2) Medicaid vendor payment is available for the provision of NF services to Medicaid-eligible individuals subject to RR/SMI and/or RR-
   MR/DD only when the individual has met the criteria for retention set forth in paragraph (F) of this rule.

   (3) For those medicaid-eligible individuals subject to RR/SMI and/or RR-MR/DD who do not meet the retention criteria set forth in
   paragraph (F) of this rule, medicaid vendor payment shall be available for no more than thirty days following the date of the adverse
   determination or thirty days following the date of a hearing decision upholding an adverse determination, whichever is later.

   (4) When an RR/ID is not initiated by the NF within the timeframes specified in paragraph (D)(1) of this rule, but is performed at a later
   date, Medicaid vendor payment is not available for services furnished to the eligible individual from the date the RR/ID was due through
   the seventh calendar day following the receipt of the ODHS 3622 form by ODMH or ODMR/DD or the date of the RR is earlier.

   History

   HISTORY: Eff 5-1-93; 1-1-98
   Rule promulgated under: RC 119.
   Rule authorized by: RC 5111.02, 5101.75, 5101.752
   Rule amplifies: RC 5111.01, 5101.02, 5101.202, 5101.75, 5101.752 119.032 Review Date: 1-1-03




http://onlinedocs.andersonpublishing.com/oac/division-51/chapter-5101_3/5101_3-3-152.htm 4/24/00
                                  LEVEL OF CARE DEFINTIONS
(1) “Supervision” either of the following:
            a) reminding the individual to perform or complete an activity; OR
            b) observing while an individual performs an activity to ensure the individual’s health and safety.
(2) “Assistance” means the hands-on provision of help in the initiation and/or completetion of a task.
(3) “Activity of Daily Living” (ADL) means a personal or self-care skill performed, with or without the use of
    assistive devices, on a regular basis that enables the individual to meet basic life needs for food, hygiene,
    and appearance. For purposes of this rule, the term ADL may refer to any of the following:
            a) “mobility” is the ability to use fine and gross motor skills to reposition or move oneself from
                place to place, with or without the use of assistive devices. Mobility includes all of the following:
                      I)      Bed mobility is the ability to move to and/or from a lying position, turn from side to
                              side, or otherwise position the body while in bed;
                      II)     Transfer is the ability to move between surfaces (e.g to/from bed, chair,
                              wheelchair, standing position, etc.); and
                      III)    Locomotion is the ability to move between locations by ambulation or by other
                              means;
            b) “bathing” is the ability to cleanse one’s body by showering, tub, or sponge bath, or any other
                generally accepted method, and may be performed with or without the use of assistive devices.
            c) “grooming” is the ability to perform the tasks associated with oral hygiene, hair care, and nail
                care.
            d) “Toileting” is the ability to appropriately eliminate and dispose of bodily waste, with or without
                the use of assistive devices or appliances. Toileting may include the use of a commode, bedpan,
                or urinal, the ability to change an absorbent pad, and to appropiately cleanse the perineum,
                and/or the ability to manage an ostomy or catheter.
            e) “Dressing” is the ability to put on, fasten, and take off all items of clothing, including the donning
                and/or removal of prostheses.
            f) “eating” is the ability to feed oneself, eating includes the processes of getting food into one’s
                mouth, chewing, and swallowing, and/or ability to use and self manage a feeding tube.

4) “Instrumental Activity of Daily Living” (IADL) means a community living skill performed, with or without the
use of assistive devices, on a regular basis that enables the individual to independently manage the individual’s
living arrangement. For the purposes of this rule, the term IADL may refer to any of the following:

            a) “shopping” is the ability to perpare a shopping list and purchase groceries, clothing,
                and household items;

            b) “meal preparation” is the ability to plan nutritional meals and cook any type of food;

            c) “environmental management” is the ability to maintain the living arrangement in a
                 manner that ensures the health and safety of the individual, environmental
                 management includes all of the following;

           I) “house cleaning” is the ability to make beds, clean the bathroom, sweep and mop
                floors, dust, clean and store dishes, pick up clutter, and take trash out;

           II) “heavy chores” the ability to move heavy furniture and appliances for cleaning, turn
                mattresses, and wash windows and walls, and
          III) “yard work and/or maintenance” the ability to care for the lawn, rake leaves, shovel
                snow, complete minor home repairs, and paint.

               d) “personal laundry” is the ability to wash and dry clothing and household items by
                   machine or hand.
               e) “accessing community services” is the ability to interface with the community.
                   Accessing community services includes all of the following:

                        I) “telephoning” the ability to make and answer telephone calls;

                        II) “accessing transportation” the ability to acquire and use transportation;
                             and
                  III) “managing legal and/or financial affairs”, the ability to pay bills, write
                         checks, balance a checkbook, access insurance and public benefits, and
                         interact with the legal system.

(5)“Medication Self-Administration” means the ability to prepare and self-administer all forms of over the
counter and prescription medication.

 (6) “Instability of the individuals’ condition” means that due to rapid, and/or frequent changes in the
individual’s condition, constant monitoring and/or the frequent adjustment of treatment regimens is
required in order to prevent serious deleterious consequences.

 (7) “ Skilled Care Level” means the provision on the premises of the individual’s residential setting of at
least one physician ordered skilled nursing service on a seven-days-per-week basis, if that service must be
delivered on that basis in order to be effective, and when the specific task must be delivered by the licensed
or certified professional due to the complexity of the prescribed service, the presence of special medical
complications, and/or the instability of the individual’s condition.

(8) “Skilled nursing services” – are those specific task which must, in accordance with chapter 4723 of the
rivised code be dilivered by a licensed practical nurse under the direct supervision of a registered nurse, or
by an RN.

(9) “Skilled Rehabilitation Services” are those specific tasks which must in accordance with title 47 or the
revised code be delivered directly by licensed or other certified professional staff.

(10) “Skilled care Level” means that an individual receives at least one skilled nursing service at least seven
days per week, and/or a skilled rehabilitation service at least five days per week. For the delivery of skilled
services to qualify for the skilled care level. The services must be ordered by a physician, and must be
delivered by the licensed or certified professional due to either

           (a.) The instability of the individual’s condition and the complexity of the
                of the perscribed service:

           (b.) The instability of the individual’s condition and the presence of
                special medical complications.
5101:3-3-06 Intermediate level of care (ILOC).
(A) This rule sets forth the criteria used to determine whether an individual who is seeking medicaid payment
for long term care services needs an intermediate level of care (ILOC).

(B) Definitions.

(1) “Activity of daily living (ADL)” means a personal or self-care skill performed, with or without the use of
assistive devices, on a regular basis that enables the individual to meet basic life needs for food, hygiene, and
appearance. For purposes of this rule, the term “ADL” may refer to any of the following:

(a) “Mobility” is the ability to use fine and gross motor skills to reposition or move oneself from place to place,
with or without the use of assistive devices. Mobility includes all of the following:

(i) “Bed mobility,” the ability to move to and/or from a lying position, turn from side to side, or otherwise
position the body while in bed;

(ii) “Transfer,” the ability to move between surfaces (e.g. to/from bed, chair, wheelchair, standing position,
etc.); or

(iii) “Locomotion,” the ability to move between locations by ambulation or by other means.

(b) “Bathing” is the ability to cleanse one’s body by showering, tub or sponge bath, or any other generally
accepted method, and may be performed with or without the use of assistive devices.

(c) “Grooming” is the ability to perform the tasks associated with oral hygiene, hair care, and nail care.

(d) “Toileting” is the ability to appropriately eliminate and dispose of bodily waste, with or without the use of
assistive devices or appliances. Toileting may include the use of a commode, bedpan, or urinal, the ability to
change an absorbent pad, and to appropriately cleanse the perineum; and/or the ability to manage an ostomy
or catheter;

(e) “Dressing” is the ability to put on, fasten, and take off all items of clothing, including the donning and/or
removal of prostheses;

(f) “Eating” is the ability to feed oneself. Eating includes the processes of getting food into one’s mouth,
chewing, and swallowing, and/or the ability to use and self-manage a feeding tube.

(2) “Assistance” means the hands-on provision of help in the initiation and/or completion of a task.

(3) “Individual” has the same meaning as in rule 5101:3-3-15 of the Administrative Code.

(4) “Medication administration” means the ability to prepare and self-administer all forms of over the counter
and prescription medication.

(5) “Supervision” means either of the following:

(a) Reminding an individual to perform or complete an activity; or

(b) Observing while an individual performs an activity to ensure the individual’s health and safety.

(C) An individual may be determined to require an intermediate level of care (ILOC) only if both of the following
conditions are met:

(1) The individual’s physical and mental condition and resulting service needs have been evaluated and
compared to all of the possible levels of care (in accordance with rule 5101:3-3-15 of the Administrative Code)
and it has been determined that:
(a) The individual requires services beyond the minimum required for a protective level of care (set forth in rule
5101:3-3-08 of the Administrative Code); but,

(b) The individual’s condition and/or corresponding service needs do not meet the minimum criteria for a skilled
level of care set forth in rule 5101:3-3-05 of the Administrative Code; and,

(c) The individual’s condition and/or service needs do not meet the criteria for an ICF-MR/DD LOC set forth in
rule 5101:3-3-07 of the Administrative Code; and

(2) At least one of the following applies:

(a) The individual requires hands-on assistance with the completion of at least two activities of daily living;

(b) The individual requires hands-on assistance with the completion of at least one activity of daily living; and is
unable to perform self-administration of medication and requires that medication administration be performed
by another person;

(c) The individual requires one or more skilled nursing or skilled rehabilitation services (as defined in
paragraphs (B)(4) and (B)(5) of rule 5101:3-3-05 of the Administrative Code) at less than a skilled care level
(as defined in paragraph (B)(3) of rule 5101:3-3-05 of the Administrative Code); or

(d) Due to a cognitive impairment, including but not limited to dementia (as defined in rule 5101:3-3-151 of the
Administrative Code), the individual requires the presence of another person, on a twenty-four-hour-a-day basis
for the purpose of supervision to prevent harm.

Replaces: 5101:3-3-06

R.C. 119.032 review dates: 4/24/2002 and 04/24/2007

Promulgated Under: 119.03

Statutory Authority: RC 5111.02

Rule Amplifies: RC 5111.01, 5111.02, 5111.204

Prior Effective Dates: 11/10/83, 10/1/93 (Emer.), 12/31/93.
5101:3-3-05 Skilled level of care (SLOC).
(A) This rule sets forth the criteria used to determine whether an individual who is seeking medicaid payment
for long term care needs services at the skilled care level. The term “skilled care”, as defined and used in this
rule, has no relationship to the provision of either skilled nursing services under the rules governing private
duty nursing set forth in Chapter 5101:3-8 of the Administrative Code or skilled care as defined under the
medicare program provisions of the Social Security Act.

(B) Definitions.

(1) “Individual” has the same meaning as in rule 5101:3-3-15 of the Administrative Code.

(2) “Instability of the individual’s condition” means that an individual’s condition changes frequently and/or
rapidly, so that constant monitoring and/or the frequent adjustment of treatment regimens is required. An
individual is considered to have an unstable medical condition if one of the following conditions is met:

(a) The physician has ordered that the nurse or therapist monitor and evaluate the individual’s condition on an
ongoing basis and make any necessary adjustments to the treatment regimen, and the nursing or therapist’s
progress notes indicate that such interventions or adjustments have been both necessary and made; or

(b) The physician’s orders dealing with the individual’s unstable condition reflect that changes and/or
adjustments have been made at least monthly.

(3) “Skilled care level” means that an individual receives at least one skilled nursing service at least seven days
per week, and/or a skilled rehabilitation service at least five days per week. For the delivery of skilled services
to qualify for the skilled care level, the services must be ordered by a physician, and must be delivered by the
licensed or certified professional due to either:

(a) The instability of the individual’s condition and the complexity of the prescribed service; or

(b) The instability of the individual’s condition and the presence of special medical complications.

(4) “Skilled nursing services” are those specific tasks which must, in accordance with Chapter 4723. of the
Revised Code, be delivered by a licensed practical nurse (LPN) under the supervision of a registered nurse (RN),
or by an RN.

(5) “Skilled rehabilitation services” are those specific tasks which must, in accordance with Title 47 of the
Revised Code, be delivered directly by licensed or other appropriately certified technical or professional health
care personnel.

(C) An individual may be determined to require a skilled level of care (SLOC) only if both of the following
conditions are met:

(1) The individual’s physical and mental condition and resulting service needs have been evaluated and
compared to all of the possible levels of care (in accordance with rule 5101:3-3-15 of the Administrative Code)
and it has been determined that:

(a) The individual requires services beyond the minimum of those of protective care (set forth in rule 5101:3-3-
08 of the Administrative Code); and

(b) The individual requires services beyond the minimum of those of intermediate care (set forth in rule 5101:3-
3-06 of the Administrative Code); and/or

(c) The individual requires services beyond the minimum of those of an ICF-MR/DD LOC (set forth in rule
5101:3-3-07 of the Administrative Code); and
(2) At least one of the following applies:

(a) The individual’s condition necessitates, and the individual’s physician has ordered, that at least one skilled
nursing service (as defined in paragraph (B)(4) of this rule) be provided at the skilled care level (as defined in
paragraph (B)(3) of this rule);

(b) The individual’s condition necessitates, and the individual’s physician has ordered, that at least one skilled
rehabilitation service (as defined in paragraph (B)(5) of this rule) be provided at the skilled care level (as
defined in paragraph (B)(3) of this rule); however

(3) An individual who meets the requirements of paragraphs (C)(1)(c) and (C)(2) of this rule may be
determined to require an SLOC unless the individual has applied to a specific ICF-MR that is equipped to provide
services at the skilled care level (as defined in paragraph (B)(3) of this rule). An individual who has applied to
an ICF-MR that is equipped to provide services at the skilled care level may be determined to require an ICF-
MR/DD LOC if there is written certification that the facility can meet the individual’s skilled care needs.

Replaces: 5101:3-3-05

R.C. 119.032 review dates: 4/24/2002 and 04/24/2007

Promulgated Under: 119.03

Statutory Authority: RC 5111.02

Rule Amplifies: RC 5111.01, 5111.02, 5111.204

Prior Effective Dates: 7/1/80, 10/1/93 (Emer.), 12/31/93.
PAA’S ARE CHECKING TO SEE IF PAS REQUIREMENTS HAVE
BEEN MET PRIOR TO ASSIGNING LOC EFFECTIVE DATES!

New Admission:
“Evidence” of the PAS requirements may include items such as:
       Documentation showing that they met the criteria for a
         convalescent stay (Hospital Discharge Exemption)
       Documentation of further review determination by ODMH or ODMRRD
       PAA Review Results Letter
RR/ID
“Evidence” of the initiation of an RR/ID would be:
       A copy of the ODJFS 3622 (PASRR Screen)
       If the screen showed indication of SMI or MRDD then documentation showing a
         determination of ODMRDD or ODMH determination

“Evidence” that the PAS requirements have been met may be in the form of documentation
found in the PAA records (i.e. files or computer system)

If the PAS requirements were not met upon admission, then a PAS/ID review by the PAA must
be conducted, and RR/ID is not relevant. If submitted PAS is not complete, PAA incomplete
process will be followed. Assuming receipt of the PASRR screen is complete, the LOC
effective date would be the date the PAS review was completed.

If the RR/ID requirements were not met within the required time frames, but were met at a later
date, then there may be a gap in payment to the NF according to OAC 5101:3-3-152 G4

Please note: The use of terms “payment may (or may not) be available is only in reference to
what effective date is to be used when issuing the LOC determination is not an authorization for
Medicaid nursing facility payment. NFs need to consult with their local County Department of
Job and Family Services for the decision on nursing facility payment.
                    Buckeye Hills / Area Agency on Aging
                                   PSA – 8

                Pre – Admission Review Unit ( Desk Review)

                     Monday - Friday 8:30am – 4:30pm

                           Phone: (740)373-6400
                        Fax: (740)373-0087




                 Extended Pre- Admission Review Coverage
                          PSA – 7 in Rio Grande

                              Fax: (740) 245-5977
(This fax number along with instructions as to when to send reviews to extended
        coverage is located on PAA–8 answering machine message also.)




                          PAA Review Timeframes

   Emergency: 1 calendar day
   NF Change of payor/transfer: 5 calendar days
   Community: 5 calendar days
   Hospital: 1 working day
   Extended PAR coverage: 1 calendar day
            PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) SUMMERY


1.       POINTS TO REMEMBER



        PAS is the process by which individuals are screened for indications of serious mental illness
         and retardation or developmental disabilities.



        Every “new admission” to a Medicaid certified nursing facility must be reviewed through the
         PAS Process. Refer to Rule 5101:3-3-151 for definition of new admission.



        All PAS/ID Screens must have supportive documentation attached.



        All PAS/ID Screens and supportive documentation are to be forwarded to the local PAA for
         review.



        All PAS requirements must be met prior to LOC determinations for individuals seeking
         Medicaid as their payment source.



        The effective date of the LOC determination will be no sooner than the date the PAS
         requirements have been met.
             PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) SUMMERY


ll.       NF RESPONSIBILITIES:

         Inform prospective residents of the PASRR requirement. May assist in the completion and
          submission of ODHS 3622 form and supporting documentation.

         MUST HAVE PASRR DOCUMNETATION TO ADMIT: Don’t admit anyone, regardless of
          payment source without PASRR results or documentation of exempt hospital discharge.

            a. New admissions – required to undergo PAS/ID prior to admission; get results from PAA
            b. Exempt hospital discharge – get written documentation from physician

          MAINTAIN ALL PASARR RECORDS IN RESIDENT’S MEDICAL RECORD AT THE NF. For
          transfers, the sending NF must provide copies of prior PAS and any RR results to the
          receiving NF. (PAS/ID results, PAS/SMI and /or PAS/MR/DD determinations if required, RR/ID
          if required, RR/SMI and/or RR-MR/DD determinations if required.

         MUST MEET RR REQUIREMENTS TO RETAIN RESIDENTS:

            a. COMPLETE RR/ID if required:

                Exempt hospital discharge – Initiate RR/ID not more than 30 days following the date of
                the current admission if the individual will require more than the initial 30 day stay.

                Transfers – Initiate RR/ID not more than 30 days following the date of the current
                admission if there are no PASRR records available from the previous NF.

                Significant change of condition – Initiate RR/ID promptly upon identification of the
                significant change

                Categorical determinations – Initiate RR/ID no later than the expiration date of the
                categorical determination it the stay will exceed the time limit for that category (respite –
                14 days, emergency -- 7 days)

            b. SUBMISSION OF RR/ID FOR FURTHER REVIEW: Submit the ODHS 3622,
               documentation supporting the ODHS 3622, documentation of the individual’s current
               condition and evidence of the individual’s need for NF services to ODHS and/or
               ODMR/DD for individuals with indications of SMI and/or MR/DD.
                 A Program of Buckeye Hills-Hocking Valley Regional Development District


                                 PASRR/LEVEL OF CARE WITHDRAWAL FORM


Applicant’s Name _________________________________________________________________

I _______________________________________________ state that I want to withdraw my
            (Submitter’s Name)

PASRR/Level of Care application.


I am doing this of my own free choice and no one is forcing me to do so.


Date ____________________________________________ Signature ________________________
                                                               ( Submitter’s Name)


                                            Address ___________________________________________

                                                        ___________________________________________




                  Home Care Division – P.O. Box 368 Reno, Ohio 45773 – (740) 373-6400 – 1-800-331-2644 Fax: (740) 373-0087
                                      PASRR/LOC QUIZ

1. An individual in which of the following situations needs to have a PASRR completed:
      a. consumer applying to ICF-MR facility
      b. consumer is transferring from one nursing facility to another nursing facility
      c. private pay, requesting a short term stay from home, to a nursing facility
      d. Medicaid or insurance pay from out of state wanting to come into nursing facility
      e. Both c and d

2. An individual may enter a nursing home under a convalescent exemption if the
   Following conditions are met:
       a. The individual must go directly from hospital into nursing facility
       b. The individual requires the level of services provided by the Nursing Facility for the
          condition treated in the hospital
       c. A physician must sign and date the exemption stating less than 30 days not later than
          date of discharge
       d. The individual must have been admitted to hospital, cannot be in emergency room or in
          observation
       e. C & D only
       f. All of the above

3. TRUE OF FALSE
   The fact an individual has a diagnosis of schizophrenia alone would result in the c having to
   undergo the further review process.

4. YES OR NO
   The individual has a primary diagnosis of dementia, and a secondary diagnosis of Bipolar
   disorder in which he/she receives SSI/SSDI for the diagnosis. Will the individual have
   indications of serious mental illness and have to undergo further review process?

5. TRUE OR FALSE
   An individual who is admitted to a hospital from a NF can return from the hospital to the same
   NF from which he/she was admitted without being subject to a new PASRR.

6. TRUE OR FALSE
   If a consumer has been approved a 14 days respite stay or 7 days emergency admission from
   either mental health or MR/DD, then the NF is responsible for completing an RR/DD before the
   expiration date and submitting it to appropriate board to request an extended stay. This could
   be done the day of admission.


7. TRUE OR FALSE
When submitting a PASRR for review there must a primary Dx indicated with the letter “p” or word
primary, and only one diagnosis can be considered primary.
8. TRUE OR FALSE
   An individual meets intermediate level of care If they need hands on assistance with 2
   activities of daily living and hands on help with at least 3 instrumental activities of daily living.

9. TRUE OR FALSE
   In order for an individual to be skilled level of care they must be considered to have an
   unstable condition and need skilled nursing seven days a week and/or skilled rehab five days a
   week.

10. YES OR NO
    If and individual was admitted to your NF under Medicaid then went out to a hospital and used
    all his/her bed hold days then wanted to come back to your facility would you have to do a new
    PASRR?
   P.O. Box 370
 Reno, Ohio 45773
   740-373-6400
   800-331-2644
 Fax 740-373-0087
www.areaagency8.org