On March 11, the Centers for Medicare and Medicaid Services (CMS) held a webinar on its notice of proposed rulemaking (NPRM) to change the regulations surrounding the Preadmission Screening and Resident Review (PASSR) process – including updating the definition of intellectual / developmental disabilities (I/DD). With comments due on the NPRM by April 20th, ANCOR is sharing our notes from the webinar as well as the slides.
Key proposed changes to the PASSR process include:
Updating the definition of I/DD from one used in 1988 to the latest one written in 2010.
Requiring “level 1” identification screening for all new applicants.
Creates exceptions for re-admissions or inter-facility transfers.
Replacing categorical exemptions with provisional admissions for “level 2”. Clarifies that provisional admission is only for stays under 30 days. Longer stays will require residential review.
Removing references to the annual review process, which is no longer required in statute, and instead clarifying when resident review is required.
Aligning the definition of “significant change” with what is used in nursing facilities’ (NF) survey and certification process, and requiring review if staff discover previously unidentified mental illness or I/D.
Updating criteria for “specialized services” to include person-centeredness.
Clarifying that federal financial participation (FFP) is available for NF services if they are included in state plan and do not duplicate NF services.
Clarifying that NF “level of services” is not the same thing as NF “level of care.”
Allowing level 2 interviews to be done via telehealth.
Interview can be terminated early in case of advanced dementia, terminal illness / severe illness.
Adding / clarifying reporting requirements:
PASSR to be completed within timeframe of 9 calendar days, requires annual report on timeliness.
Tracking how many people yearly with mental illness or I/DD are discharged or diverted, including into Home and Community Based Services (HCBS).
Proposal would tie this tracking to potential withholding of FFPs if individuals are retained too long in NFs when: 1) they qualify for HCBS; 2) want to go into HCBS and; 3) there is a placement available for them.
ANCOR will keep members informed of future developments on this topic.
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