DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Developmental Disabilities Administration)

This chapter explains the duties of the developmental disabilities administration (DDA) and the rights of individuals regarding "preadmission screening and resident review" (PASRR). PASRR is a process required by federal law to ensure that individuals with serious mental illness or intellectual disability are not inappropriately admitted to medicaid-certified nursing facilities (NF or nursing facility), and to ensure that when such individuals are appropriately admitted they receive the specialized services they require.

The rules in this chapter affect individuals who are:

(1) Being referred to a medicaid-certified nursing facility who have, or may have, an intellectual disability or related condition as defined in this chapter; and

(2) Individuals who have been determined to have an intellectual disability or related condition and who are residing in a medicaid-certified nursing facility.

"Appropriate placement" is the placement of an individual with mental illness and/or intellectual disability or related condition in a NF when the individual's needs meet the minimum standards for admission to a NF and do not exceed the level of services which can be delivered in the particular NF to which the individual is admitted. A particular NF is not an appropriate placement either when its normal nursing services are inadequate to meet the needs of the individual, or when the individual is unable to access necessary specialized services at that facility.

"DDA PASRR assessor" is a DDA employee who performs PASRR level II evaluations, as described in section 388-834-0020 WAC.

"Intellectual disability or related condition" means a condition that meets the criteria listed in 42 C.F.R. §483.102 (b)(3) and 42 C.F.R. §435.1010. A client enrolled in DDA is already determined to have a condition meeting these criteria, but eligibility for DDA is not required for a determination that an individual has an intellectual disability or related condition.

"PASRR level I screening" means a screening that is completed when an individual is referred to a medicaid-certified nursing facility by a physician, hospital, or other referring entity or when a NF resident experiences a significant change of condition.

"PASRR level II evaluation" means an evaluation that is completed when a possible intellectual disability or related condition or serious mental illness is identified by the PASRR level I screening. The level II determines whether the person: has an intellectual disability or related condition, needs nursing facility care, and needs specialized services for intellectual disability or related condition or serious mental illness while in the nursing facility.

"Specialized service" means a service or device, in addition to nursing facility care, required by a nursing facility resident who has an intellectual disability or related condition to function with as much self-determination and independence as possible and/or to preserve or increase the individual's functional status per 42 C.F.R. §483.120.

When an individual is referred to a medicaid-certified nursing facility, a PASRR level I screening is completed to determine if the individual has a serious mental illness, an intellectual disability or related condition, or both.

(1) A readmission occurs when an individual is readmitted to a nursing facility from a hospital to which he or she was transferred for the purpose of receiving care. Readmissions are not subject to preadmission screening if the PASRR process was completed upon the initial admission and the information remains accurate.

(2) An interfacility transfer occurs when an individual is transferred from one NF to another NF, with or without an intervening hospital stay. Transfers are not subject to preadmission screening if the PASRR process was completed upon the initial admission and the information remains accurate. The sending facility is responsible for ensuring that copies of the resident's most recent PASRR and resident assessment reports accompany the transferring resident.

(1) If a PASRR level I screening indicates that the individual either has or may have a serious mental illness, an intellectual disability or related condition, or both, the screener must refer the individual to a contracted mental health PASRR evaluator (for serious mental illness) and/or a DDA PASRR evaluator (for intellectual disability or related condition) for a PASRR level II evaluation.

(2) If a person meets the criteria for both serious mental illness and intellectual disability or related condition, both evaluations must be completed.

(3) If a NF resident who has a serious mental illness or an intellectual disability or related condition experiences a significant change of condition, a new level II evaluation is completed.

When an individual is referred to a DDA PASRR evaluator for a level II evaluation, the DDA PASRR evaluator reviews the individual's records and speaks with the individual and others who have relevant information. The DDA PASRR evaluator determines:

(1) Whether the individual does in fact have an intellectual disability or related condition;

(2) If so, whether nursing facility placement is appropriate to meet his or her needs; and

(3) If so, whether the individual will require specialized services while at the nursing facility.

(1) If a level I screening does not identify a possible serious mental illness or intellectual disability or related condition, the individual may be admitted to a nursing facility directly.

(2) If a level I screener has referred an individual for a level II evaluation, the individual cannot be admitted to a nursing facility until the level II evaluation is completed, except when:

(a) The individual is admitted directly from a hospital after receiving acute inpatient care;

(b) The individual requires nursing facility services for the condition for which he or she received care in the hospital; and

(c) The individual's attending physician has certified in the PASRR level I that the individual is likely to require fewer than thirty days of nursing facility services.

(3) A DDA PASRR evaluator may do an abbreviated evaluation that is sufficient to determine whether the individual has an intellectual disability or related condition, whether the individual meets nursing facility level of care requirements, and whether the individual needs specialized services at that time, with the full PASRR level II report to follow.

(4) A DDA PASRR evaluator may categorically determine that specialized services are not needed for the following types of admission:

(a) Protective services stay of not more than seven days;

(b) Respite in a NF for not more than thirty days.

(5) Categorical determinations for DDA clients can only be made by a DDA PASRR evaluator.

When a DDA PASRR evaluator determines through a level II evaluation that a nursing facility is an appropriate placement for an individual, and that the individual will require specialized services while residing in the nursing facility, the evaluator:

(1) Informs the individual and his or her family or guardian (as appropriate) of the determinations and the individual's appeal rights;

(2) Provides the nursing facility with a copy of the PASRR level II evaluation; and

(3) Coordinates with the individual, nursing facility, and service provider to ensure that the recommended specialized services are provided.

(1) DDA provides written notice of all PASRR determinations to the following entities:

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

(b) The admitting or retaining nursing facility;

(c) The individual or resident's attending physician; and

(d) The discharging hospital, unless the individual is exempt from preadmission screening as provided for at 388-834-0035 (1), (2), or (4).

(2) The written notice will include:

(a) Whether a nursing facility level of service is needed;

(b) Whether specialized services are needed;

(c) The placement options that are available to the individual consistent with these determinations;

(d) The rights of the individual to appeal the determinations; and

(e) A copy of the full PASRR report.

(1) Individuals who have been evaluated by a DDA PASRR evaluator have the right to an administrative hearing to dispute the following determinations by the evaluator:

(a) That nursing facility placement is not appropriate to meet the individual's needs;

(b) That the individual does not require specialized services.

(2) Any decision rendered by the office of administrative hearings (OAH) is an initial decision appealable to the HCA's board of appeals (BOA).

PASRR requirements for medicaid-certified nursing facilities may be found in chapter 388-97 WAC, as well as in 42 C.F.R. §483 Subpart C 483.100 – 483.138.