Commonwealth of Massachusetts Executive Office of Health and Human Services Division of Medical Assistance 600 Washington Street Boston, MA 02111 MassHealth Nursing Facility Bulletin 118 June 2000 TO: Nursing Facilities Participating in MassHealth FROM: Jean C. Sullivan, Acting Commissioner RE: Revision to Nursing Facility Pre-Admission Screening and Annual Resident Review (PASARR) Process and Reporting Requirements Background Section 1919(e)(7) of the Social Security Act, as amended by the Omnibus Reconciliation Act of 1987 (OBRA-87), requires assessment of all prospective nursing facility residents with mental illness, mental retardation, and/or other developmental disabilities. This assessment requirement is met through the Pre-Admission Screening and Annual Resident Review (PASARR). As required under OBRA-87, the PASARR Evaluation assesses and determines whether an individual: • has mental illness, mental retardation, and/or other developmental disabilities; • requires the level of services provided by a nursing facility; and • requires specialized services for mental illness, mental retardation, and/or other developmental disabilities. The purpose of this bulletin is to emphasize the necessity of completing a PASARR of all prospective nursing facility residents with mental illness, mental retardation, and/or other developmental disability. OBRA-87 Overview Either the Department of Mental Health (DMH) or the Department of Mental Retardation (DMR) is responsible for assessing current nursing facility residents, and all applicants for admission to nursing facilities to determine whether they have a mental illness, mental retardation, and/or other developmental disability that requires specialized services. A Level I assessment must be completed before admission to a nursing facility for all prospective applicants. A Level II assessment must also be completed before admission when indications of mental illness, mental retardation, and/or other developmental disability are present. However, if the admission meets the federal requirements as an exempted hospital discharge, the Level II assessment is not required before admission. MassHealth Nursing Facility Bulletin 118 June 2000 Page 2 Nursing Facility Responsibility Before admission, a nursing facility must complete a Level I Pre-Admission Screening Form (see attached) to screen for mental illness, mental retardation, and/or other developmental disability for every prospective resident, regardless of payment source. The Level I Pre- Admission Screening Form must be completed and permanently filed in the resident’s medical record at the facility, in accordance with 130 CMR 456.410(B). If the Level I screening shows indications of mental illness, mental retardation, and/or other developmental disability, the nursing facility must make a referral for a Level II screening to DMR or DMH, or their agents. The Level II PASARR assessment, if required, must also be completed before admission, unless the admission meets the federal requirements as an exempted hospital discharge. A copy of the Level II approval determination must be permanently filed in the resident’s medical record at the facility. Reporting and Documentation Requirements Mental Illness The documentation and reporting requirements for nursing facilities remain the same as those identified in Nursing Facility Bulletin 112, dated October 1996. Mental Retardation and/or Other Developmental Disability For admissions of all individuals with mental retardation and/or other developmental disabilities, the nursing facility must contact DMR on the day of admission or the first business day following admission, regardless of the anticipated length of stay. The nursing facility must notify DMR by telephone (see DMR contact provided below) of all residents admitted with mental retardation and/or other developmental disabilities. Within 48 hours of a resident’s admission, the nursing facility must fax to DMR (see fax number below) the following information about the resident: • name; • home address; • date of birth; • diagnosis; • date of Level II PASARR, if applicable; • date of admission; (continued on next page) MassHealth Nursing Facility Bulletin 118 June 2000 Page 3 Reporting and Documentation Requirements (cont.) • type of admission anticipated (long-term—more than 30 days/short- term—less than 30 days); • MassHealth identification number and/or social security number; • name, location, and vendor provider number of nursing facility; • name and relationship of person signing admission papers; and • name and telephone number of contact person. This constitutes the Level II referral for those admissions anticipated to be less than 30 days for which the stay exceeds 30 days. Each facility is required to document this information and the referral date in the resident’s medical record so that it is available to the Division. DMR Contact: Jack Riley (617) 624-7811 Fax: 617-624-7577 Compliance Nursing facilities are required to keep timely, complete, and accurate documentation. The Division audits for OBRA-87 compliance on a periodic basis. Nursing facilities that fail to comply with these requirements may be subject to administrative action, including the imposition of fines, in accordance with 130 CMR 450.238. Effective Date These revised procedures are effective July 1, 2000. Questions If you have any questions about the information in this bulletin, contact the Unisys Provider Services Department at (617) 628-4141 or 1-800-325-5231.