IOWA NURSING FACILITY PROVIDER TRAINING

Transcription

1 IOWA NURSING FACILITY PROVIDER TRAINING Changes in Iowa PASRR

2 Learning Objectives 2 By the end of the training, you will understand: Nursing Facility (NF) tracking system PathTracker Admissions, discharges, transfers Status Change submissions Short-term decisions process Exemptions Categoricals Level II Evaluations Specialized Services Reviews 100% of LII evaluations with SS recommendations Submission of requested documents Inclusion of recommended services in NF care plans Level I Quality Assurance Reviews Follow up on 2% of completed LI screens Submission of requested documents

3 Four Changes in Iowa PASRR 3 Specialized Services review process started 8/1/14 Full implementation 10/1/14 Nursing Facility (NF) tracking system 10/1/14 Level II short-term decisions 10/1/14 Quality Assurance reviews for completed Level I screens 11/2014

4 Tracking System PathTracker 4 Enhancements and Advantages of PathTracker Same site: Submit Status Change Level I screen Same login/password Fills in demographics for residents Better access to PASRR records Print forms for resident charts Faster information turnaround Submit records for Level I QA Reviews ~62 residents/month, statewide Report any significant changes Maintains state and federal tracking compliance Admissions, Discharges, Transfers Moving toward linking with payment 2% of Level I screens Submit records for 100% of SS reviews ~55 residents/month, statewide

5 Level I Quality Assurance Reviews 5 Follow up double check on accuracy of submitted Level I screen Ascend contacts LI submitter for disposition information Ascend contacts NF for current status and history NFs use PathTracker to upload documentation Ascend evaluates for compliance (Level I) Offers education to LI submitters For process improvement Reports findings to DHS

6 Level II Specialized Services Review 6 Ascend requests care plan 30 days after completion of Level II NF has 15 calendar days to reply Can submit immediately after completion Only for people with SS recommendations Initially will have to fax Ascend building an upload feature To be released soon! Seeking verification of: PASRR Summary of Findings in the medical record All PASRR recommended services incorporated in care plan Documented efforts to implement PASRR specialized services Including barriers or refusal to participate Documented delivery of PASRR specialized services NF receives compliance status letter following completion of SS review Ascend reports non-compliance to DHS MHDS follows up on non-compliance issues Offers technical assistance as needed/requested 2014 Ascend Management Innovations LLC. All rights reserved.

7 Level II Specialized Services Identification 7 On the PASRR Summary of Findings:

8 From Iowa DHS, Division of MHDS and IME 8 Use of PathTracker Plans underway for linkages to payment & eligibility systems When implemented, use of PathTracker may become necessary PathTracker may eliminate use of CAR form Iowa s Department of Inspection and Appeals (DIA) requires completion of care plans within 21 days of admission DHS, Magellan, and others are developing a care plan template for use by Iowa providers Will include tools for identifying most potential rehabilitative and specialized services Plan to pilot by November, 2014 Optional DHS providing as a tool to assist you Will be available on PASRR.com when complete

9 What is a Short-term Decision? 9 Time limited approval on Level II Likelihood of transition to community Based on clinical presentation and history Duration days Short-Term decisions assist individuals to return home before they lose their assets, community and social support systems.

10 Short-Term Decisions 10 Level II Assessments Exempted hospital discharge/categorical decisions Abbreviated Level II activity 30 days, 60 days Level II short-term approvals 90 days 180 days All short-term decisions require additional assessment if the individual will stay longer than approval period.

11 Extending a Time-Limited Approval 11 For individuals who cannot discharge by end of timelimited approval Document all efforts to achieve timely discharge Submit new Level I screen to trigger review Will conduct a new Level II evaluation to assess for continued NF appropriateness Any outcome possible Including denials and short-term approvals Based on clinical presentation NF should begin discharge planning at admission for any individual with a short-term approval.

12 Expected Statewide Volumes 12 Average 3100 Level I screens/month Level I Quality Review: 2% = approx. 62/month Average 130 Level II evaluations/month SS Review: 100% = approx. 55/month ST Approval: projecting approximately 77/month

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14 14 PathTracker