DADS/DSHS CHOW Process

DADS/DSHS CHOW Process A Change of Ownership (CHOW) occurs when a NF is purchased by another facility or corporation. When a NF change of ownership takes place, the facility must record the CHOW with the DADS PASRR unit and enter a PL1 for every resident in the facility within 90 days. A. Nursing facilities (NF) going through a CHOW must follow the steps below to maintain compliance with federal and state PASRR regulations. NFs must notify the DADS PASRR unit via the PASRR inbox (pasrr@dads.state.tx.us) and indicate the facility is going through a CHOW. The NF must: maintain a list of all newly admitted residents after the CHOW was initiated; enter a PASRR Level I Screening Form (PL1) for every resident in the NF once TMHP LTC portal access is reinstated; and enter the PL1 for every resident in the facility within 90 days. NFs may use the PEs from the old contract number to complete the new PL1 to help determine the number of Positive PL1s to submit. Beginning in February 2015, NFs will be able to run a query from the LTC portal that will identify all the individuals in the NF who are PASRR positive B. The DADS PASRR unit must: 1. Email the LA/LMHA to let them know the NF will be starting the process of entering their PL1s for the new contract. LA/LMHA will need to contact their assigned PASRR staff when extensions are needed to complete their CHOW related Pes. 2. Assist the NF as needed to inform the NF that they can use the PE (completed prior to the CHOW) for information to help them fill out the new PL1 to determine ID/DD/MI. For example: If the facility had 10 individuals, under the old contract number, who are positive for PASRR based on the last PE, we should expect to see 10 positive PL1s. Beginning in February, NFs will be able to print reports showing all the individuals in the facility who are positive for PASRR. These reports will help them during the CHOW process to complete the new PL1s. Please explain that the CHOW PEs may take longer to complete than non-chow PEs. Important, let the NF know they do not need to wait/stagger and can to enter all PL1s. 3. If requested by the LA/LMHA, PASRR staff will: run report from LTC portal by contract number of PL1s generated due to CHOW using begin date of PL1 entry; and

PASRR staff will calculate date of PE completion at approximately 4 per week. Mark the due date for all PEs at the bottom of the spreadsheet. Contact LA by email and provide their spreadsheet with all the alerts and the deadline. Copy DSHS on CHOW related emails sent to the LA to make sure the LMHA staff are aware. The deadline for completion of all PEs must not extend past 80 days from the date of the PL1. 4. PASRR staff will check the status of the CHOW PL1s weekly on the LTC portal. PASRR staff will note any PE completed and mark it off the list until all PEs have been completed. PASRR staff should notify LAs if they are at risk of exceeding their deadline to complete the PEs. C. The LA/LMHA must: Contact their assigned PASRR staff to notify them of any alerts due to a CHOW when extensions are needed to complete the CHOW related PEs. LA/LMHA must complete a new PE when they receive an alert from the new NF contract number due to a positive PL1. LA/LMHAs will keep a copy or all correspondence and approved extensions.

Habilitative services Habilitative services, including devices, are provided for a person to attain, maintain, or prevent deterioration of a skill or function never learned or acquired due to a disabling condition. 1 With respect to habilitative services and devices cover health care services and devices that help a person keep, learn, or improve skills and functioning for daily living (habilitative services). Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings. 2 Rehabilitative services Rehabilitative services, including devices, are provided to help a person regain, maintain, or prevent deterioration of a skill or function that has been acquired but then lost or impaired due to illness, injury, or disabling condition. 3 Rehabilitative services are health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and outpatient settings. 4 Rehabilitative services versus Habilitative services The professionals and the settings are often the same. The functional deficits and the improvements in functional outcomes that result from treatment can often be similar. The primary reason for a distinction is the different reason for needing the service and the length of time services may be required. 5 Rehabilitation therapy is designed to improve functioning somewhat finite, ending when further improvement is no longer likely. Once therapy has achieved the maximum level of functioning, the common practice is not to then provide intervention to maintain function. Habilitation is not typically episodic many people require services throughout their lifetime. 6 PASRR Specialized Services Habilitative Therapies When a therapist is requesting habilitative therapies (physical, occupational, or speech therapy) for a PASRR positive individual, request can be made based on a professional assessment for up to 6 months at a time. 1 Definition from the CMS Glossary of Health Coverage and Medical Terms 2 45 CFR 156.115 Provisions of Essential Health Benefits 3 Federal Register, February 27, 2015, Vol. 80, No. 39, pg. 10811. 4 Definition from the CMS Glossary of Health Coverage and Medical Terms 5 Habilitation Benefits Coalition, Coverage of Habilitation Services and devices in the Essential Benefits Package under the Affordable Care Act. October 25, 2011 6 Health Reform Commission Essential Health Benefits Work Group, August 6, 2012

Nursing Facilities - PASRR Interdisciplinary Team Meetings Information posted June 24, 2015 On June 25, 2015, Texas Medicaid & Healthcare Partnership will implement a modification to the Long Term Care (LTC) Online Portal to support documentation of Interdisciplinary Team (IDT) meetings and the confirmation process for all Preadmission Screening and Resident Review (PASRR) positive individuals. Effective July 7, 2015, Nursing Facilities (NFs) must document the IDT meetings and Specialized Services Reviews through the LTC Online Portal using the IDT tab on the PASRR Level 1 Screening (PL1). Upon successful completion of a PASRR Level 1 Screening and a PASRR Evaluation (PE) indicating positive PASRR eligibility, the Nursing Facility will take the following actions in order to document the IDT meeting: 1. Click the Create IDT button displayed on the PL1. 2. The Nursing Facility must complete all required fields (as indicated by a red dot next to the field) on all sections of the IDT, with the exception of the IDT Confirmation section, which will be completed by the Local Authority/Local Mental Health Authority (LA/LMHA). Nursing Facility required fields are disabled for the LA/LMHA (refer to the screen examples below). 3. Once completed, the Nursing Facility will submit the form by clicking the Submit Form button. 4. Upon successful submission of the NF portion of the IDT, the NF portion will be displayed, but disabled. 5. The following confirmation message will be displayed upon successful submission of the NF portion of the IDT: "The IDT has been successfully submitted by the NF and is now pending confirmation by the LA/LMHA." Upon successful completion of the NF portion of the IDT, the LA/LMHA must complete the IDT Confirmation section of the IDT; thereby confirming the specialized services agreed to during the IDT meeting. An IDT History trail will be displayed at the bottom of the IDT tab and will display a History of all the successfully submitted IDTs. The History will display Date of IDT Meeting (MM-DD-YYYY) as links in chronological order from most recent date of IDT meeting to latest date of IDT meeting. Each IDT will display as a collapsible link and contain the History of that IDT meeting. Nursing Facilities will have the ability to update a successfully submitted IDT until it is confirmed by the LA/LMHA, by clicking on the Update IDT button.

Additional information and details regarding the IDT will be included in the updated NF/Hospice User Guide which will be published on July 3, 2015, on this website. For questions about these changes to the LTC Online Portal, contact the LTC Help Desk at 1-800-626-4117, Option 1.

Nursing Facility PASRR Responsibility Checklist: o Ensure that all individuals in the facility have a PL1 on file and in the portal. o Communicate with the LIDDA/LIDDA to make sure that all active positive PL1s have a completed PE and that all PEs are in the individual s file. o Data enter Expedited Admission, Exempted Hospital Discharge and Negative PL1s to LTC Online Portal o Monitor the LTC Online Portal daily for alerts o Review the recommended Specialized Services on the PE when an alert is received o Certify the ability to meet the individuals needs on the PL1 no later than 7 calendar days after the PE is entered into the LTC portal. o Invite LA/LMHA to IDT Plan meeting and hold the IDT no later than 14 calendar days after the admission date. o Enter the results of the IDT into the portal within 3 business days after the meeting. o Document Specialized Services to be delivered by the NF and LA/LMHA in the residents comprehensive care plan o Initiate nursing facility specialized services within 30 days after the date that the services are agreed to in the IDT meeting o Provide a copy of the resident s comprehensive care plan to the LA/LMHA o Assist the LIDDA/LMHA with monthly service coordination visits and monthly medical reviews o Actively participate in quarterly service planning team and transition planning meetings o Collaborate with the LA to assist in the individual transitioning to alternate placement as applicable o Allow representatives of the state and Disability Rights Texas to inform and counsel residents of PASRR rights and options o Solicit assistance from DADS/DSHS/TMHP as needed o Know the PASRR rules pertaining to NFs: http://texreg.sos.state.tx.us/public/readtac$ext.viewtac?tac_view=5&ti=4 0&pt=1&ch=19&sch=BB&rl=Y

Pre-Admission Screening and Resident Review for Nursing Facilities Phase 1 Referring Entity (RE) PL1 Positive Process Begins Referring Entity completes the PL1 40 TAC 17.301 Is the PL1 positive or negative? Negative Pre- Admission Positive Exempted hospital discharge and expedited Diversions Family, acting as the RE, contacts the LA prior to the individual ever entering the NF IDT- Interdisciplinary Team LA-Local Authority MDS-Minimum Data Set NF-Nursing Facility PE PASRR Evaluation PL1- PASRR Level 1 SPT- Service Planning Team SC-Service Coordination TAC -Texas Administrative Code Nursing Facility (NF) PL1 Nursing Facility enters the PL1 into the portal for: Negative Pre- Admissions and admits the individual into the NF 19.2704 Nursing Facility enters the Positive PL1 into the portal for: Expedited Admissions and Exempted Hospital Discharges 19.2704 NF Certifies able/ unable to serve in portal NF Convenes IDT meeting with resident, LAR, RN, and LA/LMHA 19.2704 NF documents IDT in the portal within 3 business days of meeting date 19.2704(i)(5) NF Initiates specialized services by submitting request to DADS within 30 days after date of IDT 19.2704(i)(7)(A) NF delivers specialized services Local Authority/ LMHA PASRR Evaluation (PE) Positive Pre- Admission Authority enters the PL1 into the portal for: Positive Pre- Admissions 40 TAC 17.302 Completes PE within 7 days after receiving a copy of the PL1 from the RE or notification from the portal 40 TAC 17.302 If PE is Positive, confirms participation in IDT and specialized services agreed to within 5 business days of meeting 40 TAC 17.302(c)(3) Assign a Service Coordinator, 17.501(a) Convene a Service Planning Team Meeting (SPT) 17.501(b)(1)(B) and develop an individual service plan (ISP) 40 TAC 17(b)(1)(c) While the resident is in the NF, the SC will conduct monthly visits and facilitate the initiation of LIDDA specialized services and coordination of the resident s specialized services with the SPT 40 TAC 17.501(2)(B) SPT develops, revises, implements, and monitors a transition plan as necessary 40 TAC 17.503 SC conducts monthly monitoring and quarterly service planning visits w/i first year after the individual moves into a Medicaid community program 40 TAC 17.501(b)(1)(A) Service Coordination Process (Phase 2) 7-1-2015

COMMISSIONER Jon Weizenbaum July 7, 2015 To: Subject: Nursing Facilities (NFs) Provider Letter 15-16 Preadmission Screening and Resident Review (PASRR) Facility Requirements (Replaces PL 14-21) A new rule about PASRRs in nursing facilities took effect July 7, 2015. DADS will begin surveying for these new requirements on September 1, 2015. Per this new rule, nursing facilities are responsible for coordinating assessments and providing certain specialized services, as detailed below. Assessment Coordination Nursing facilities must do the following: Coordinate with referring entities to ensure that any individual seeking admission to a Medicaid-certified NF receives a PASRR Level I screening for an intellectual disability (ID), developmental disability (DD) or mental illness (MI) before or upon admission (please visit http://www.dads.state.tx.us/providers/pasrr/nursingfacilityfaq.html for questions regarding the different admission types). If the PASRR Level I screening indicates the individual may have an ID, DD or MI, coordinate with the local intellectual and developmental disabilities authority (LIDDA) and/or local mental health authority (LMHA) to ensure the individual receives a PASRR Level II evaluation. If the Level II evaluation confirms ID, DD or MI, coordinate with the LIDDA and/or LMHA to ensure the individual is properly assessed for any specialized services recommended in the Level II evaluation. If the PASRR Level II evaluation recommends specialized services, coordinate with the LIDDA to hold an Interdisciplinary Team meeting within 14 days. Per the new rule, the NF is responsible for assessing the individual s or resident s needs for physical, occupational and speech therapy and for durable medical equipment. Provision of Specialized Services For individuals with a PASRR Level II evaluation that confirms ID, DD or MI and has a LIDDA recommendation for specialized services, NFs must coordinate with the LIDDA to ensure the NF comprehensive care plan documents both the recommended specialized services and the role the NF will play in the delivery of the services. The NF must also ensure it fulfills its responsibilities as spelled out in the comprehensive care plan. If the Level II evaluation recommends durable medical equipment, physical therapy, occupational therapy and/or speech therapy, the NF is 701 W. 51st St. P.O. Box 149030 Austin, Texas 78714-9030 (512) 438-3011 www.dads.state.tx.us An Equal Opportunity Employer and Provider

Provider Letter No. 15-16 July 7, 2015 Page 2 responsible for providing these specialized services if Medicaid or other funding is available. If the Level II evaluation recommends specialized services, the NF must: certify in the LTC Online Portal (within seven calendar days after the LIDDA or LMHA has entered a PE or resident review into the LTC Online Portal for an individual or resident who has MI, ID, or DD) it can provide, arrange for or support the specialized services; document in the comprehensive care plan the roles and responsibilities of the NF in carrying out the specialized services; train NF staff on their roles and responsibilities in ensuring the specialized services are provided; and document in the individual s clinical record that the specialized services are being provided per the requirements set out in the NF comprehensive care plan. If the LIDDA or another outside entity is responsible for the specialized service, the NF must coordinate with that entity to ensure (1) the NF s comprehensive care plan includes any supports the NF must provide for successful provision of the specialized service, and (2) that NF staff receive training on their roles and responsibilities in providing those supports. For instance, if the LIDDA has arranged for an individual to participate in a specialized services program at a specified date and time, the comprehensive care plan must reflect the specific date and time of the external specialized services. The NF must not schedule facility-provided services that conflict with the LIDDA-arranged services. New Rule The new rule is located in the Texas Administrative Code (TAC), Title 40, Part 1, Chapter 19, Subchapter BB, Nursing Facility Responsibilities for Preadmission Screening and Resident Review. It complies with Centers for Medicare & Medicaid Services requirements in the Code of Federal Regulations (CFR), Title 42, Chapter IV, Subchapter G, Part 483 [F285], Subpart C, Preadmission Screening and Annual Review of Mentally Ill and Mentally Retarded Individuals. Texas Health and Safety Code, Title 4, Subtitle B, Chapter 242, Convalescent and Nursing Homes and Related Institutions, authorizes the Texas Department of Aging and Disability Services (DADS) to license and regulate nursing facilities. Survey Process To ensure compliance with 42 CFR 483.20(e) [F285], DADS surveyors will look for the following as part of the standard survey process and during any complaint investigation that may relate to the provision of PASRR-related services: 1. All NF residents must have received a PASRR Level I screening. 2. If an NF serves a resident with a positive PASRR Level I screening (i.e., the resident is suspected of having an ID, DD or MI), the facility must have obtained a PASRR Level II evaluation from the LIDDA or LMHA or have documented attempts to follow up with the LIDDA or LMHA to obtain the PASRR Level II evaluation. Note: If a individual seeking

Provider Letter No. 15-16 July 7, 2015 Page 3 admission to an NF has a PASRR Level I screening that finds a suspected ID, DD or MI and the individual does not qualify for expedited admission or exempted hospital discharge, as described in 40 TAC Chapter 19.2703 Definitions, the NF cannot admit the individual until the LIDDA or LMHA has completed a PASRR Level II evaluation. 3. If an NF admits a resident with a PASRR Level II evaluation that recommends one or more specialized services, the NF must certify in the LTC Online Portal (within seven calendar days after the LIDDA or LMHA has entered a PE or resident review into the LTC Online Portal for an individual or resident who has MI, ID, or DD) it can provide, arrange for or support the specialized services recommended in the Level II evaluation. 4. If a resident s PASRR Level II evaluation recommends one or more specialized services that have been deemed necessary through proper clinical assessment, the resident s comprehensive care plan must note all NF responsibilities related to the provision of each specialized service. 5. An NF must deliver services per each resident s care plan. For more information about PASRR, please visit the DADS PASRR website at www.dads.state.tx.us/providers/pasrr/index.cfm. If you have specific questions about regulatory policy, please contact a Regulatory Services Policy, Rules and Curriculum Development policy specialist at (512) 438-3161. Sincerely, [signature on file] Mary T. Henderson Assistant Commissioner Regulatory Services MTH:cg