CMS Preadmission Screening and Resident Review Proposal – Slides and Notes from Informational Webinar

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 20^th, 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.