PASRR Status Change

A status change is defined by the presence of newly emerging or changing conditions or needs. These should be reported to NC Medicaid PASRR department by submitting a Level I screen and may occur in one of three ways:

  1. If the individual's physical status changes significantly, such that his/her Intellectual or Developmental Disabilities needs are more likely to respond to treatment, the facility should report such changes to NC Medicaid for an screening of need for further assessment (Level II)
  2. If a serious mental illness or Intellectual or Developmental Disabilities/ related condition was not discovered at the preadmission screen, and that condition later emerged or was discovered, the facility should report those symptoms, diagnoses, etc., to the NC Medicaid PASRR department to assess for further screening needs. The facility should monitor data on the MDS to identify any issues which might be positive indicators of a mental disability
  3. If an individual has been previously screened for the PASRR population, begins to exhibit increased symptoms or behavioral problems, these should be reported to NC Medicaid to assess for further screening needs

NC Medicaid may request additional medical record information to determine further need for an early Level II ARR

Time Limited Admissions Which Require Level I Updates

The referral source completes the North Carolina Level I Screening Form and contacts the NC Medicaid for a PASRR number:

  • If a Level II screening is not needed, a time limit and a PASRR number is assigned by the NC Medicaid with an alpha character ending of D, E, or F.
  • If the individual is a Medicaid recipient, the referral source contacts Medicaid's fiscal agent (1-800-688-6696 or 1-919-851-8888) and proceeds with the Medicaid nursing facility prior approval process (refer to Chapter 3, Prior Approval). The receiving nursing facility submits the North Carolina Nursing Facilities Tracking Form to the NC Medicaid.
  • If the resident is to remain beyond the authorized time frame, the receiving facility contacts the NC Medicaid prior to the end-date to update the Level I information (contact within 5 days for a 7-day authorization; contact within 25 days for a 30-day authorization; contact within 50 days for a 60-day authorization)
  • If approved, the NC Medicaid issues the new PASRR number.
  • If a Level II screen is needed, the NC Medicaid completes the Level II evaluation.
  • If approved through the Level II process, the facility contacts Medicaid's fiscal agent to update the prior approval

The following situations define temporary time-limited nursing facility admissions for MI/ IDD/ RC applicants meeting federal and state specified criteria. These admissions will be permitted following submission of the Level I screen by the referral source. A subsequent NC Medicaid authorization number is issued with an "end-date" for the time limited stay. Prior to expiration of that time period, the receiving facility must update the Level I screen if the individual's stay is expected to exceed the allotted time frame. This may result in a Level II face to face assessment.

  1. Convalescent Care admissions are Federally allowed without a Level II screen, as long as all of the following conditions are met: 1) Admission to a NF occurs directly from a general hospital after receiving acute inpatient medical care, and; 2) NF services are required for the hospitalized condition, and; 3) the attending physician has certified that NF care is unlikely to exceed 30 calendar days. This physician certification must be provided to NC Medicaid at the time of the screen. Clearly, persons whose admission for convalescence is likely to exceed 30 days should not apply for this exemption. If at any time it appears that the individual's stay may exceed 30 days, and no later than the 25th calendar day, the receiving facility must submit an updated Level I screen to determine whether the person will continue to require NF care and to assess for further screening needs (Level II process)
  2. Provisional Admission allows for temporary (7 day) admission of persons whose delirium precluded the ability to make an accurate diagnosis. Facilities with admissions approved under this category must follow Level I screening procedures for an update, at such time that the delirium clears or no later than the 5th calendar day following admission. The submission of an updated Level I screen on the 5th calendar day will determine need for continued care and for further assessment under the Level II process
  3. Emergency Admission applies to Nursing Facility Applicants who have evidence of MI and/or IDD/RC and require temporary nursing facility admission in an emergency protective services situation (NF care is approved for no greater than 7 calendar days). If at any time it appears that the individual's stay may exceed 7 days (Provisional & Emergency admissions), no later than the 5th calendar day, the receiving facility must submit an updated Level I screen to NC Medicaid to determine whether the person continues to require NF care and to assess whether further screening under the Level II process may be necessary. This standard applies if:
    • based on the MI/IDD/RC individual's physical and/ or environmental status, there is a sudden and unexpected need for immediate NF placement; and
    • the above need requires temporary placement until alternative services/ placement can be secured and no other placement options are available
  4. Respite allows temporary (7 day) care for an individual with MI/IDD/RC to allow respite for the caretaker to whom the individual will return following the temporary stay. If at any time it appears that the individual's stay may exceed 7 days, no later than the 5th calendar day, the receiving facility must submit an updated Level I screen.

Transferred/ Discharged/ Deceased MI/ IDD/ RC Residents which Require Updated Level I Screens

Information in this category must be reported to NC Medicaid for all residents enrolled in the PASRR process who meet criteria below:

  1. Transfer/Discharge of MI/IDD/RC residents: NFs must report to NC Medicaid any persons with MI, IDD, or conditions related to IDD (RC) who are discharged from the facility. Unless there has been a significant change in their status, tracking information, (submitted via a tracking form discussed in detail in Section IV.B of this document), is the only information that will be required. Status changes for both MI and IDD/RC residents must be reported to NC Medicaid through the process described in Section II.D.i of this document
  2. Deceased MI/IDD residents: NFs must report deceased MI/IDD resident information to NC Medicaid using the tracking process discussed in Section IV.B of this document.State of North Carolina PASRR Screening Requirements

Conditions Which Do Not Reqiure An Updated Level I Screen

The following circumstances do not require an update to the Level I process for nursing home residents:

  1. Re-admissions after hospitalization or temporary leave for persons who have had a PASRR screen do not require a Level I or Level II screen before the readmission occurs. Under PASRR regulations, a temporary absence is defined as one in which the individual planned to return to that facility or to another facility at the end of the absence

    Although a re-admission does not require a PAS (Level II) screen before admission, any significant change in status should prompt such a referral following the individual's return to the facility. For example, a resident with MI who is treated in a psychiatric unit receives a new resident assessment at readmission. That resident assessment should trigger an updated Level I referral, to determine whether the individual's annual PASRR review should be performed sooner than its annual due date. While not required, in some cases it may be advisable that a Level II be requested before the resident's return to the nursing facility. If an evaluation is performed earlier than the annual due date, the individual's anniversary date for subsequent reviews will be one year following the change in status evaluation. Status change procedures are discussed in Section II.D.i.
  2. Transfers who have had a prior Level I and did not require a Level II evaluation do not require an update to the Level I, unless there has been a significant change in status as addressed earlier in this document

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