Source: http://lawfilesext.leg.wa.gov/law/wsr/2015/12/15-12-096.htm
Timestamp: 2020-06-03 10:36:06
Document Index: 67085509

Matched Legal Cases: ['§ 483', '§ 483', '§483', '§435', '§483', '§483', '§ 431']

WSR 15-12-096
[Filed June 2, 2015, 11:52 a.m.]
Preproposal statement of inquiry was filed as WSR 15-07-003.
Title of Rule and Other Identifying Information: The department is amending chapter 388-97 WAC, Nursing homes, as follows: Amending WAC 388-97-2000 Preadmission screening and resident review (PASRR) determination and appeal rights; repealing WAC 388-97-1920 Preadmission screening—Level I, 388-97-1940 Advanced categorical determinations, not subject to preadmission screening—Level II, 388-97-1960 Preadmission screening—Level II and 388-97-1980 Resident review; and new sections WAC 388-97-1910 Definitions related with PASRR, 388-97-1915 PASRR requirements prior to admission of new residents, and 388-97-1975 PASRR requirements after admission of a resident.
Hearing Location(s): Office Building 2, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html), on July 7, 2015, at 10:00 a.m.
Date of Intended Adoption: Not earlier than July 8, 2015.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., July 7, 2015.
Assistance for Persons with Disabilities: Contact Jeff Kildahl, DSHS rules consultant, by June 23, 2015, phone (360) 664-6092 or TTY (360) 664-6178, e-mail KildaJA@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing these new, amended, and repealed rules to assure compliance with federal standards regarding the PASRR process in accordance with 42 C.F.R. § 483.100-138.
Reasons Supporting Proposal: This amendment will provide greater clarity regarding the PASRR process for nursing facilities.
Statutory Authority for Adoption: Chapters 18.51 and 74.42 RCW.
Statute Being Implemented: Chapters 18.51 and 74.42 RCW.
Rule is necessary because of federal law, 42 C.F.R. § 483.100-138.
Name of Proponent: Department of social and health services, aging and long-term support administration, governmental.
Name of Agency Personnel Responsible for Drafting: Amy Abbott, P.O. Box 45600, Olympia, WA 98513, (360) 725-2581; Implementation: Carl Walters, P.O. Box 45600, Olympia, WA 98513, (360) 725-2400; and Enforcement: Tim Hoekstra, P.O. Box 45600, Olympia, WA 98513, (360) 725-3238.
No small business economic impact statement has been prepared under chapter 19.85 RCW. Under RCW 19.85.025(3), a small business economic impact statement is not required for rules adopting or incorporating, by reference without material change, Washington state statutes or federal statutes or regulations.
A cost-benefit analysis is not required under RCW 34.05.328. Under RCW 34.05.328 (5)(b)(iii), a cost-benefit analysis is not required for rules adopting or incorporating, by reference without material change, Washington state statutes or federal statutes or regulations.
WAC 388-97-1910 Definitions related with PASRR
"Exempted hospital discharge" means the process by which an individual who meets the criteria in WAC 388-97-1920 (2)(a) through (c) may be admitted to a nursing facility without a PASRR level II evaluation, even though he or she may have a serious mental illness or an intellectual disability or related condition.
"Intellectual disability or related condition" means a condition as defined in 42 CFR §483.102 (b)(3) and 42 CFR §435.1010 or successor laws.
"Serious mental illness" means a condition as defined in 42 CFR §483.102 (b)(1) or successor laws.
"Specialized services" are services provided or arranged for by the department as described in 42 CFR §483.120 or successor laws, which are additional to services the nursing facility is required to provide. The PASRR level II evaluation identifies the specialized services needed by the resident.
WAC 388-97-1915 PASRR requirements prior to admission of new residents
WAC 388-97-1975 PASRR requirements after admission of a resident
Following a resident's admission, the nursing facility must:
(1) Review the all level I screening forms for accuracy. If at any time the facility finds that the previous level I screening was incomplete, erroneous or is no longer accurate, the facility must immediately complete a new screening using the department's standardized level I form, following the directions provided by the department's PASRR program. If the corrected level I screening identifies a possible serious mental illness or intellectual disability or related condition, the facility must notify DDA and/or the mental health PASRR evaluator so a level II evaluation can be conducted.
(2) Record the evidence of the level I screening and level II determinations (and any subsequent changes) in the resident assessment in accordance with the schedule required under WAC 388-97-1000.
(3) Maintain the level I form and the level II evaluation report in the resident's active clinical record.
(4) Immediately complete a level I screening using the department's standardized form if the facility discovers that a resident does not have a level I screening in his or her clinical record, following directions provided by the department's PASRR program. If the level I screening identifies a possible serious mental illness or intellectual disability or related condition, notify the DDA and/or mental health PASRR evaluator so a level II evaluation can be conducted.
(5) Notify the DDA and/or mental health PASRR evaluator when a resident who was admitted on an exempted hospital discharge appears likely to need nursing facility services for more than thirty days, so a level II evaluation can be performed. This notification must occur as soon as the nursing facility anticipates that the resident may require more than 30 days of nursing facility services, and no later than the twenty-fifth day after admission unless good cause is documented for later notification.
(6) Notify the DDA and/or mental health PASRR evaluator when a resident who was admitted with an advance categorical determination appears likely to need nursing facility services for longer than the period specified by DDA and/or the mental health PASRR evaluator, so that a full assessment of the individual's need for specialized services can be performed. This notification must occur as soon as the nursing facility anticipates that the resident will require more than the number of days of nursing facility services authorized for the specific advance categorical determination and no later than five days before expiration of the period (three days for protective services) unless good cause is documented for later notification.
(7) Immediately notify the DDA and/or mental health PASRR evaluator for a possible resident review when there has been a significant change in the physical or mental condition, as defined in WAC 388-97-1910, of any resident who has been determined to have a serious mental illness or intellectual disability or related condition. Complete a new level I screening for the significant change.
(8) Provide or arrange for the provision of any services recommended by a PASRR level II evaluator that are within the scope of nursing facility services. If the facility believes that the recommended service either cannot or should not be provided, the facility must document the reason(s) for not providing the service and communicate the reason(s) to the level II evaluator.
(9) Immediately complete a new level I screening using the department's standardized form if the facility finds that a resident, not previously determined to have a serious mental illness, develops symptoms of a serious mental illness, and refer the resident to the mental health PASRR evaluator for further evaluation.
(10) Provide services and interventions that complement, reinforce and are consistent with any specialized services recommended by the level II evaluator. The resident's plan of care must specify how the facility will integrate relevant activities to achieve this consistency and the enhancement of the PASRR goals.
(11) Discharge, in accordance with WAC 388-97-0120, any resident with a serious mental illness or intellectual disability or related condition who does not meet nursing facility level of care, unless the resident has continuously resided in the facility for at least thirty months and requires specialized services. The nursing facility must cooperate with DDA and/or mental health PASRR evaluator as it prepares the resident for a safe and orderly discharge.
AMENDATORY SECTION (Amending WSR 08-20-062, filed 9/24/08, effective 11/1/08)
WAC 388-97-2000 Preadmission screening and resident review (PASRR) determination and appeal rights.
(1) The resident has the right to choose to remain in the nursing facility and receive specialized services if:
(a) He or she has continuously resided in a nursing facility since October 1, 1987; and
(b) The department determined, in 1990, that the resident required specialized services for a serious mental illness or developmental disability but did not require nursing facility services.
(2) ((In the event that residents chose to remain in the nursing facility as outlined in subsection (1) above, the department, or designee, will clarify the effect on eligibility for medicaid services under the state plan if the resident chooses to leave the facility, including its effect on readmission to the facility.
(3) An individual applying for admission to a nursing facility or a)) A nursing facility resident who has been adversely impacted by a PASRR determination may appeal the department's determination that the individual is:
(a) Not in need of nursing facility care as defined under WAC 388-106-0350 through 388-106-0360;
(b) Not in need of specialized services as defined under WAC ((388-97-1960)) 388-97-1910; or
(c) Need for specialized services as defined under WAC ((388-97-1960)) 388-97-1910.
(((4))) (3) The nursing facility must assist ((the individual applying for admission or)) a resident, as needed, in requesting a hearing to appeal the department's PASRR determination.
(((5) If the department's PASRR determination requires that a resident be transferred or discharged, the department will:
(a) Provide the required notice of transfer or discharge to the resident, the resident's surrogate decision maker, and if appropriate, a family member or the resident's representative thirty days or more before the date of transfer or discharge;
(b) Attach a hearing request form to the transfer or discharge notice;
(c) Inform the resident, in writing in a language and manner the resident can understand, that:
(i) An appeal request may be made any time up to ninety days from the date the resident receives the notice of transfer or discharge;
(ii) Transfer or discharge will be suspended when an appeal request is received by the office of administrative hearings on or before the date of transfer or discharge set forth in the written transfer or discharge notice; and
(iii) The resident will be ineligible for medicaid nursing facility payment:
(A) Thirty days after the receipt of written notice of transfer or discharge; or
(B) If the resident appeals under subsection (1)(a) of this section, thirty days after the final order is entered upholding the department's decision to transfer or discharge a resident.
(6) The department's home and community services may pay for the resident's nursing facility services after the time specified in subsection (5)(c)(iii) of this section, if the department determines that a location appropriate to the resident's medical and other needs is not available.
(7) The department will:
(a) Send a copy of the transfer/discharge notice to the resident's attending physician, the nursing facility and, where appropriate, a family member or the resident's representative;
(b) Suspend transfer or discharge:
(i) If the office of administrative hearings receives an appeal on or before the date set for transfer or discharge or before the resident is actually transferred or discharged; and
(ii) Until the office of appeals makes a determination; and
(c) Provide assistance to the resident for relocation necessitated by the department's PASRR determination.
(8) Resident appeals of PASRR determinations will be in accordance with 42 C.F.R. § 431 Subpart E, chapter 388-02 WAC, and the procedures defined in this section. In the event of a conflict between a provision in this chapter and a provision in chapter 388-02 WAC, the provision in this chapter will prevail.))
WAC 388-97-1920
Preadmission screening—Level I.
WAC 388-97-1940
Advanced categorical determinations, not subject to preadmission screening—Level II.
WAC 388-97-1960
Preadmission screening—Level II.
WAC 388-97-1980
Resident review.