Instruction manual for completing PASRR MI, MR, …

1 2013 Bock Associates Instruction manual FOR completing PASRR LEVEL II ASSESSMENTS [Created by Bock Associates for use in the State of Missouri.] TABLE OF CONTENTS Historical Development of PASRR .. 1 Introduction to Bock Associates .. 3 Key Personnel .. 3 Missouri PASRR Program .. 5 PASRR Level I Screening Process .. 5 PASRR Level II Evaluation Process .. 5 Assessor 6 PASRR Level II Evaluation Protocols .. 6 Quality Assurance Program .. 8 Basic Instructions for Assessors .. 9 Scheduling Appointments .. 9 Reporting of Abuse or Neglect .. 10 Invoicing .. 10 Evaluation Types.

2 10 Technical Instructions for completing Level II Evaluations .. 12 Important Documents .. 12 completing the PASRR /MI Level II Evaluation .. 15 Section I: Identification .. 15 Section II: Psychiatric Assessment/History .. 16 Section III: Psychosocial Assessment .. 17 Section IV: Level of Functioning .. 18 Section V: Cognitive/Behavioral Assessment .. 18 Section VI: Medical History .. 19 Section VII: Physical Assessment .. 20 Section VIII: Mental Status Examination .. 21 A: Cognitive 22 B: Mood .. 22 C: Content of Thought .. 24 D: 27 Section IX: Affective Behavioral Observations.

3 27 Section X: Determination Formulation .. 27 Section XI: Assessment Indicators for Nursing Facility Level of Service .. 30 Section XII: Specialized and Lesser Intensity Service Needs .. 34 Addendum .. 34 Section XIII: Conclusion .. 35 completing the PASRR /ID Level II Evaluation .. 37 Section I: Identification .. 37 Section II: Confirmation of Diagnosis .. 38 Section III: Psychosocial Assessment .. 42 Section IV: Level of Functioning .. 43 Section V: Cognitive/Behavioral Assessment .. 43 Section VI: Medical History .. 44 Section VII: Physical Assessment .. 45 Section VIII: Assessment Indicators for Nursing Facility Level of Service.

4 46 Section IX: Specialized and Lesser Intensity Service Needs .. 50 Addendum .. 52 Section X: Conclusion .. 52 completing the PASRR /DUAL Level II Evaluation .. 55 Section I: Identification .. 55 Section II: Psychiatric Assessment/History and Confirmation of Diagnosis .. 56 Section III: Psychosocial Assessment .. 61 Section IV: Level of Functioning .. 62 Section V: Cognitive/Behavioral Assessment .. 62 Section VI: Medical History .. 63 Section VII: Physical Assessment .. 64 Section VIII: Mental Status Examination .. 65 Cognitive Capacities .. 66 Mood .. 66 Content of Thought .. 68 Observations.

5 71 Section IX: Affective Behavioral Observations .. 71 Section X: Determination Formulation .. 71 Section XI: Assessment Indicators for Nursing Facility Level of Service .. 74 Section XII: Specialized and Lesser Intensity Service Needs .. 78 Section XIII: Conclusion .. 81 completing the PASRR /ID Partial Level II evaluation .. 82 Section I: Identification .. 82 Section II: Confirmation of Diagnosis .. 83 Section III: Conclusion .. 86 completing the PASRR /Retrospective Level II evaluation .. 87 Section I: Identification .. 87 Section VII (MI/DU Forms) and Section VIII (ID FORM): Assessment Indicators for Nursing Facililty Level of 87 completing the PASRR /Update Level II Evaluation.

6 88 Section II: Psychiatric Assessment/History (MI/DU FORMS) or Confirmation of Diagnosis (ID/DU Forms) .. 88 Section III: Status Update Summary .. 89 completing the PASRR /Special Admission Level II evaluation .. 90 Section II: Special Admission Category .. 90 Attachment A: Glossary .. 91 Attachment B: 101 Attachment C: Ideal Body Weight .. 113 Attachment D: Adobe Form Instructions .. 115 Attachment E: DA 124 forms .. 117 Attachment F: HIPPA policy .. 118 Attachment G: Contractor Invoice Instructions .. 122 Bock Associates | Historical Development of PASRR 1 HISTORICAL DEVELOPMENT OF PASRR In 1982, the Department of Health and Human Services proposed significant changes in the nursing facility survey and certification program, the mechanism by which nursing facilities are monitored for compliance with federal Medicaid regulations.

7 The proposal was very controversial and its implementation was delayed until the National Academy of Sciences' Institute of Medicine (IOM) Committee on Nursing Home Regulation completed a comprehensive study of nursing facility regulations. The IOM Committee sponsored and conducted research, solicited advice from state survey and certification program directors, and held numerous public hearings. After three years, the IOM Committee published a 415-page monograph entitled, Improving the Quality of Care in Nursing Homes (March 1986).

8 Although the monograph included recommendations about evaluation and care planning practices for individuals who were residing in nursing facilities, it did not address nursing facility placement or services for individuals who were residing in nursing facilities and who had diagnoses of serious mental illness (SMI), intellectual disability (ID), or a related condition/developmental disability (DD). The Center for Medicare and Medicaid Services (CMS) (formerly known as the Health Care Financing Administration (HCFA)), accepted the majority of the IOM Committee's recommendations.

9 Two members of the IOM Committee also served on Emeritus Corporation s original technical advisory board. Concurrent with the development of the IOM Committee's monograph, CMS identified three mid-western states in which there were thought to be large numbers of individuals with Developmental Disabilities (ID/DD) who were residing in nursing facilities. These three states were ordered to identify residents who had, or were suspected of having, a diagnosis of ID/DD or related condition, assess their needs for active treatment and other habilitation services, and develop active treatment plans and alternative placements for those individuals who had been inappropriately placed in nursing facilities.

10 In addition, the states were informed that failure to comply with CMS s directives would result in de-certification from participation in the Medicaid program. Bock Associates played a central role in assisting two of the states, Illinois and Indiana, in complying with CMS s directives. In 1987, Congress relied heavily on the recommendations in Improving the Quality of Care in Nursing Homes , and on CMS's experiences in the mid-western states, to develop amendments to Section 1919(f)(8)(A) of the Social Security Act. The legislative intent of these amendments, and CMS's subsequent regulations, was to ensure the appropriate placement for individuals with SMI and/or MR/DD/RC by.