Loading
The Oregon Administrative Rules contain OARs filed through November 15, 2014
 
QUESTIONS ABOUT THE CONTENT OR MEANING OF THIS AGENCY'S RULES?
CLICK HERE TO ACCESS RULES COORDINATOR CONTACT INFORMATION

 

OREGON HEALTH AUTHORITY,
ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES

 

DIVISION 48

INTERMEDIATE AND SKILLED NURSING FACILITIES

PASARR — Pre-Admission Screening and Annual Resident Review

309-048-0050

Statement of Purpose and Statutory Authority

(1) Purpose. These rules prescribe Division standards and procedures regarding the screening, evaluation and provision of specialized services to persons with mental illness who apply for or reside in Medicaid certified nursing facilities. They implement Public Law 100-203 of the Omnibus Budget Reconciliation Act of 1987 that added Section 1919 to the Social Security Act.

(2) Statutory authority and procedure. These rules are authorized by ORS 413.042 and to carry out the provisions of ORS 410.535, 414.065 & 426.490 to 426.500 and Public Law 100-203.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0060

Definitions

As used in these rules:

(1) “Annual resident review” means the review of referrals from the annual resident screening process by designees of the Addictions and Mental Health Division. The purpose of the review is to determine the need for a Level II psychiatric evaluation.

(2) “Annual resident screening” means the annual screening by nursing facility staff of all residents for acute symptoms or indicators of mental illness.

(3) “Categorical determination” means a decision made by a contractor of the Aging and People with Disabilities Division (APD) based on a functional assessment. This determination identifies a person who, despite the presence of mental illness, can be admitted to a nursing facility. The categories are:

(a) Individuals requiring nursing facility care for 30 days or less for convalescent care following an acute care hospitalization for illness or surgery;

(b) Persons with terminal illness with a prognosis of six months or less; and

(c) Persons with severe medical condition that precludes participation in or benefit from specialized services.

(4) “Client Process Monitoring System (CPMS)” means the automated client data system maintained by the Division.

(5) “Community Mental Health Program (CMHP)” means the organization of all services for persons experiencing problems related to mental illness, drug and alcohol abuse, and mental retardation or other developmental disabilities, operated by, or contractually affiliated with, a local mental health authority operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Division.

(6) “Determination” means the decision/recommendation made by a designee of the Division regarding an individual’s eligibility for Level II evaluation, i.e., presence of a serious mental illness and need for “specialized services” as required by Public Law 100-203. Determinations regarding an individual’s need for nursing facility services are the responsibility of the APD.

(7) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(8) “Indicators of mental illness — applicants.” Applicants to nursing facilities with a diagnosis of a major mental disorder and a history of treatment related to his diagnosis in the past two years are considered to have indicators of mental illness. Alzheimer’s and/or a diagnoses of dementia are excluded from this definition of major mental disorder.

(9) “Indicators of mental illness — residents.” Residents of nursing facilities with psychiatric or behavioral symptoms that indicate a need for “specialized services” are considered to have indicators of mental illness regardless of diagnosis or history of treatment.

(10) “Level I” means the federally required screening for indicators of mental illness process implemented by APD under OAR 411-070-0043. All applicants to nursing facilities are screened for indicators of mental illness and a determination made whether the applicant requires nursing facility care based on a functional assessment.

(11) “Level II” means the evaluation process conducted by designees of the Division to determine whether an individual with mental illness requires specialized services. The determination is based on a current functional assessment, history and physical, psychosocial evaluation, a mental health assessment and a medication review.

(12) “Level II summary” means the form approved by OMHS which identifies data to be collected by Division designees in the Level II evaluation.

(13) “Licensed medical professional” means a medically trained person who is licensed to practice in the State of Oregon and has one of the following degrees: MD (Medical Doctor); DO (Doctor of Osteopathy); NP (Nurse Practitioner); PA (Physician’s Assistant); or RN (Registered Nurse).

(14) “Nursing facility (NF)” means a facility that contains Medicaid certified inpatient beds and provides medical services but excludes hospital/surgical procedures. The facility must be licensed and certified by APD.

(15) “Office of Mental Health Services (OMHS)” means that portion of the Division responsible for mental health services.

(16) “Pre-admission screening (PAS)” is the state required process used by APD to screen all Medicaid eligible persons seeking admission to nursing facilities. This screening covers functional, medical, economic and psychosocial variables and is the basis for making a determination regarding the individual’s categorical status and his/her need for nursing facility services.

(17) “Pre-Admission Screening and Annual Resident Review (PASARR)” is the assessment process conducted by agencies within the Oregon Health Authority that implements the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203), Subsection 1919(e)(7), which prohibits a Medicaid certified nursing facility from admitting any individual until a screening is completed to determine mental illness or mental retardation (or related conditions), and whether the individual requires nursing facility services or specialized services for mental illness.

(18) “Private admission assessment” is the process that APD uses to screen for indicators of mental illness and categorical status in non-Medicaid applicants to nursing facilities.

(19) “Qualified mental health professional (QMHP)” means a mental health practitioner with qualifications defined in OAR 309-032-1505.

(20) “Senior and Disabled Services Division (SDSD)” means the Oregon Health Authority agency responsible for the provision of nursing facility services as specified in OAR chapter 411.

(21) “Specialized psychiatric rehabilitative services” means services of a lesser intensity than required under specialized services for mental illness. The nursing facility may provide these services directly or make arrangements for their provision with private sector practitioners or community mental health programs.

(22) “Specialized services for mental illness” means the implementation of an individualized plan of care developed, provided and supervised by a physician and qualified mental health professionals in an inpatient psychiatric hospital. This plan of care shall prescribe specific therapies and activities for the treatment of persons who are experiencing an acute episode of severe mental illness. A nursing facility resident requiring specialized services shall be considered to be eligible for the level of services provided in an inpatient psychiatric hospital. Residents requiring this level of care will require relocation to an inpatient facility until the “acute” nature of their symptoms are stabilized.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0070

Procedures for Level I, Pre-Admission Screening (PAS)

(1) Nursing facility placement. A person identified with mental illness indicators who requests placement in a nursing facility must meet APD-PAS criteria demonstrating a need for nursing facility care. The person may be placed in a nursing facility without a Level II evaluation if the person:

(a) Meets criteria of categorical determinations OAR 309-048-0060; or

(b) Has a primary diagnosis of dementia; and

(c) Does not require specialized services OAR 309-048-0060(22).

(2) Level II referrals. Persons shall be referred to the Division for a Level II evaluation prior to placement in a nursing facility if:

(a) A Level I pre-admission screen or a private admission assessment has identified the individual as having indicators of mental illness; and

(b) The individual is not eligible for a categorical determination.

(3) Level II waiver. The Division may waive the Level II evaluation requirement if:

(a) The individual does not need specialized services or has received maximum benefit from specialized services; and

(b) The individual has been determined to be in need of nursing facility services by an APD designee or contractor; and

(c) A facility has been identified that can meet the individual’s mental health needs.

(4) Level II eligibility. Individuals may be required by he Division to have a Level II evaluation to determine the need for specialized services prior to placement in a nursing facility if any of the above conditions (subsections (3)(a), (b) and (c) of this rule) are not met.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0080

Procedures for Annual Resident Reviews (ARR)

A resident screened and referred by a nursing facility as having indicators of mental illness shall be reviewed by a Division designee using a format approved by the Division.

(1) Timelines. The review shall be completed by a QMHP within 7 working days of receipt of the referral from the nursing facility.

(2) Screening and consultation. The review shall consist of up to two hours of screening and consultation to determine if the indicators of mental illness require a comprehensive evaluation (Level II).

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0090

Level II Evaluations

(1) Content. A Level II evaluation shall:

(a) Be completed by a QMHP within 30 calendar days of the annual resident review referral or within seven working days of the pre-admission screening referral;

(b) Include a mental health assessment, a psychosocial evaluation, relevant testing and a review of the medication regime and physical examination by a licensed medical professional;

(c) Establish a diagnosis and determine the need for specialized services.

(2) Specialized psychiatric rehabilitation. If the need for specialized services is not established, the evaluation shall include treatment recommendations for specialized psychiatric rehabilitation services whenever indicated.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0100

Documentation

(1) Level II waivers. The Division shall send a copy of any waiver from the pre-admission requirement for a Level II, to the APD Level I screener who has determined that the individual needs nursing facility care pursuant to OAR 309-048-0060.

(2) Nursing facility. CMHP evaluators shall send copies of the annual resident review and Level II evaluation to the nursing facility within 7 and 30 days respectively.

(3) Division. CMHP evaluators shall send copies of the annual resident review, Level II evaluation and the Level II summary sheet to the OMHS within 30 days of receipt of the nursing facility referral.

(4) Client Process Monitoring System. CMHP designees shall enter information on all persons receiving a Level II evaluation into CPMS.

(5) Standards. Level II evaluations shall follow documentation standards set forth in OAR 309-032-1535.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0110

Specialized Services for Individuals Residing in Nursing Facilities

(1) Location. Specialized services for persons with mental illness are provided only in inpatient psychiatric settings that provide 24 hour coverage by trained mental health professionals who can deliver mental health services designed by an interdisciplinary team which includes a psychiatrist.

(2) Readmission to nursing facilities. A person identified by a Level II evaluation as in need of specialized services shall not enter or remain in a nursing facility. When a client has received maximum benefit from specialized services, the client can be reconsidered for admission subject to Level I requirements or return to a nursing facility placement subject to APD OAR 411-088-0000 to 411-088-0080, Licensing Requirements for Nursing Facilities, Transfer Rules.

(3) Procurement of specialized services. When a client is identified to be in need of specialized services, the Level II evaluator shall:

(a) Assist the nursing facility or Level I screener in locating an appropriate treatment resource;

(b) Insure that the client in need of specialized services is informed of his/her treatment options including the right to refuse treatment;

(c) Inform all parties involved, of procedures related to precommitment investigation, if the client refuses specialized services and presents a danger to self or others;

(d) Notify the Division within 72 hours if a client is determined to be in need of specialized services and these services are not being provided.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0120

Relocation of Persons with Mental Illness From Nursing Facilities to Other Residential Settings

(1) Coordination of Plans. CMHP, NF and APD staff shall coordinate relocation plans for residents of nursing facilities with mental illness found to be ineligible for nursing facility care.

(2) Right of return. All relocations of residents must comply with nursing facility transfer rules, division 88, OAR 411.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

309-048-0130

Appeals

In accordance with ORS 413.042, adults with mental illness, and court approved legal guardians for individuals with mental illness, shall have the right to appeal decisions made by the Division based on screenings, admission waiver request, discharge and relocation plans.

(1) Appeals. Appeals shall be submitted to the Children, Adult and Families Division (CAF) Hearings Office and arrive there within 30 calendar days after receipt of the contested determination/decision.

(2) Negotiations. The CAF Division Hearings Office shall, when it deems appropriate, refer appealed decisions back to the Division for efforts to negotiate an agreement. If the Division is unable to negotiate an agreement within 10 working days, the Division will remand the appeal back to the CAF Hearings Office for final disposition.

(3) Hearings. The CAF Hearings Office shall convene a hearing in accordance with OAR 461-025-0300 through 461-025-0375, and reach a final determination on the appeal within ninety (90) days of the final day of the hearing.

(4) Determinations. All decisions of the CAF Hearing Office shall be final.

Stat. Auth.: ORS 413.042 & 426.500
Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500
Hist.: MHD 2-1995, f. & cert. ef. 4-6-95

The official copy of an Oregon Administrative Rule is contained in the Administrative Order filed at the Archives Division, 800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the published version are satisfied in favor of the Administrative Order. The Oregon Administrative Rules and the Oregon Bulletin are copyrighted by the Oregon Secretary of State. Terms and Conditions of Use

Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

© 2013 State of Oregon All Rights Reserved​