2017 PASRR RFB Appendix A-PASRR-Related Definitions.doc

Preadmission Screening and Resident Review (PASRR) Level II Screens

Preadmission Screening and Resident Review (PASRR) Level II Screens

Appendix A PASRR-Related Definitions

1.

Abbreviated Level II Screen. An Abbreviated Level II Screen determines if a person has a severe medical condition, listed below, that indicates that he/she is unable to participate in or benefit from specialized services at that time. It is not necessary to complete all portions of the Level II evaluation form if there is adequate documentation supporting the medical diagnosis with a description of the severity of the illness. The nursing facility or hospital is to submit the appropriate medical documentation with the Level I Screen to the team. The team then reviews the materials and either determines that the medical condition does result in severe impairment or conducts a Full Level II Screen. A determination that a severe impairment exists will exempt the person from specialized services. The medical conditions are:

A.

Terminal illness, meaning the individual has a medical prognosis that his/her life expectancy is six (6) months or less if the illness runs its course;

B.

Severe physical illnesses that result in a level of impairment so severe that the individual could not be expected to actively participate or benefit from specialized services or specialized psychiatric rehabilitative services, including, but not limited to coma, ventilator dependence, functioning at a brain stem level, chronic obstructive pulmonary disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, and congestive heart failure; and

C.

Severe dementia (including Alzheimer’s disease or a related disorder) that results in a level of impairment so severe that the individual could not be expected to actively participate or benefit from specialized services or specialized psychiatric rehabilitative services.

2.

Appropriateness of placement is defined as the placement of an individual who has a serious mental illness or a developmental disability in a nursing facility when the following criteria are met:

A. The individual’s total needs are such that they cannot be met in the community with supports and can be met only on an inpatient basis (i.e., a hospital, an institution for mental diseases (IMD), an intermediate care facility for the mentally retarded (ICF/IID), or a nursing facility); and

B.

Among all types of inpatient placements, a nursing facility can best meet the individual’s needs.

3.

Full Level II Screen. A Full Level II Screen is a screen that completes all sections of the State-developed or State-approved Level II Screen form, identifies the client’s strengths and needs, provides treatment recommendations, and indicates the determination of the client’s need for nursing facility placement and the client’s need for specialized services.

4.

Intellectual Disability: An individual is considered to have intellectual disability (IID) if he or she has a level of retardation (mild, moderate, severe or profound) described in the American Association on Intellectual Disability’s Manual on Classification in Intellectual Disability (1983) or a related condition as defined in 42 CFR 483.1010:

“Persons with related conditions” means individuals who have a severe, chronic disability that meets all of the following conditions:

(a) It is attributable to—

(1) Cerebral palsy or epilepsy; or

(2) Any other condition, other than mental illness, found to be closely related to Intellectual Disability because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons, and requires treatment or services similar to those required for these persons.

(b) It is manifested before the person reaches age 22.

(c) It is likely to continue indefinitely.

(d) It results in substantial functional limitations in three (3) or more of the following areas of major life activity:

(1) Self-care.

(2) Understanding and use of language.

(3) Learning.

(4) Mobility.

(5) Self-direction.

(6) Capacity for independent living.

5.

Partial Level II Screen. A Partial Level II Screen is a screen that was not completed because it was determined/decided/concluded that the person does not have a serious mental illness or a developmental disability. This determination/decision/conclusion may be made as soon as there is sufficient reliable data to warrant the determination.

6.

Qualified mental health professional (QMHP): A QMHP is a person who has one (1) year of professional experience working with persons who have a serious mental illness and is one of the following:

A.

A psychologist licensed under ch. 455, Stats.;

B.

A physician;

C.

A registered nurse;

D.

A human services professional who has a Master’s degree in a human services field other than a field under A. – C., above, such as social work, rehabilitation counseling, occupational therapy, or psychology; OR

E.

A human services professional who has a Bachelor’s degree in a human services field other than a field under A. – C., above, such as social work, rehabilitation counseling, occupational therapy, or psychology, and has at least three (3) years of professional experience working with persons with a serious mental illness.

7.

Qualified intellectual disability professional (QIDP): A QIDP is a person who meets the requirements of 42 CFR 483.430 (a) (1) and (2) of the ICF/IID regulations, has specialized training in mental retardation or at least one (1) year of experience working directly with persons with mental retardation or other developmental disabilities and is one of the following:

A.

A doctor of medicine or osteopathy;

B.

A registered nurse;

C.

An individual who holds at least a bachelor’s degree in occupational therapy, physical therapy, psychology, social work, speech pathology/therapy, recreation, dietetics/nutritional science, or a human services field (including, but not limited to, sociology, special education, and rehabilitation psychology).

8.

Serious Mental Illness: A person is considered to have a serious mental illness if he/she:

A. Has a major mental disorder meeting the diagnostic requirements in the Diagnostic and Statistical Manual, 3rd Edition - Revised (DSM III-R) of schizophrenia; mood, paranoid, panic or other severe anxiety disorder; somataform disorder; personality disorder; other psychotic disorder; or another mental disorder that may lead to a chronic disability. Dementia, as described in DSM III-R, is not considered a major mental disorder, even though it is a mental disorder that leads to a chronic disability; and B.

Has been limited continuously or intermittently during the past three (3) to six (6) months in at least one of the following areas of major life activity:

1) Interpersonal functioning, including but not limited to: social isolation, altercations with others, difficulty interacting appropriately and communicating effectively with others;

2) Concentration, persistence, and pace resulting in problems, such as, difficulty completing common tasks found in a workplace, school, or home setting, difficulty in completing tasks on time, or frequent errors; and

3) Adaptation to change; and C.

Has needed as a result of the mental disorder either psychiatric treatment that is more intensive than outpatient care (e.g., partial or inpatient hospitalization) at least two (2) times during the past two (2) years, supportive services to maintain functioning in the community or in a residential treatment facility, or intervention by housing or law enforcement officials.

9.

Specialized services for persons with a developmental disability: This term means services that meet the requirements of 42 CFR 483.440 (a) (1) and (2), the definition of active treatment in the Federal regulations for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID):

(1) Each client must receive a continuous active treatment program, which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services and related services described in this subpart [ed. note: the subpart includes the entirety of the ICF/IID regulations], that is directed toward:

(i) The acquisition of the behaviors necessary for the client to function with as much self-determination and independence as possible; and

(ii) The prevention or deceleration of regression or loss of current optimal functional status.

(2) Active treatment does not include services to maintain generally independent clients who are able to function with little supervision or in the absence of a continuous active treatment program.

10.

Specialized services for persons with serious mental illness: This term means the services specified by the State which results in the continuous and assertive implementation of an individual plan of care that:

A. Is developed and supervised by an interdisciplinary team, which includes a physician, qualified mental health professionals and, as appropriate, other professionals;

B.

Prescribes specific therapies and activities for the treatment of persons experiencing severe and persistent symptoms of a serious mental illness, which necessitates supervision by trained mental health personnel; and

C. Is directed toward diagnosing and reducing the resident’s psychiatric/behavioral symptoms that necessitated institutionalization, improving his or her level of independent functioning, and achieving a functional level that permits reduction in the intensity of mental health services to below the level of specialized services at the earliest possible time.

11.

Specialized psychiatric rehabilitation services (SPRS): This term means the services determined by the comprehensive assessment and the (SPRS) care plan necessary to prevent avoidable physical and mental deterioration and to assist clients in obtaining or maintaining their highest practicable level of functional and psycho-social well-being. SPRS shall include:

A.

The client’s regular participation, in accordance with their SPRS care plan, in professionally developed and supervised activities, experiences and therapies; and

B.

Activities, experiences and therapies that reduce the resident’s psychiatric and behavioral symptoms, improve the level of independent functioning, and achieve a functional level that permits reduction in the need for intensive mental health services.

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RFB No. S-0627 DCTS-17 Appendix A – PASRR-Related Definitions