Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:755 - Preadmission Screening and Resident Review Program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.558,
				42 C.F.R.
				431.200-431.250,
				435.1009,
				483.15,
				483.100-483.138,
				483.440,
				42 U.S.C.
				1396r
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health
				and Family Services, Department for Medicaid Services, has the responsibility
				to administer the Medicaid Program.
				KRS
				205.520 authorizes the cabinet, by
				administrative regulation, to comply with any requirement that may be imposed,
				or opportunity presented, by federal law to qualify for federal Medicaid funds.
				This administrative regulation establishes the program requirements and payment
				provisions for preadmission screening and resident review (PASRR).
Section 1. Definitions.
(1) "Department" means the Department for
			 Medicaid Services or its designee.
(2) "Department approved system" means a
			 technology system in which:
(a) Providers
			 electronically submit and track level of care (LOC) requests through a
			 self-service portal;
(b) The system
			 triggers LOC tasks as reminders to providers and allows them to submit
			 reassessments electronically; and
(c) Information is exchanged electronically
			 with Kentucky's:
1. Medicaid Enterprise
			 Management Solution (MEMS); and
2.
			 Integrated eligibility and enrollment system.
(3) "Department for Behavioral Health,
			 Intellectual and Developmental Disabilities" or "DBHDID" means the state agency
			 or its designee with the responsibility for both the evaluation and
			 determination functions for individuals with serious mental illness, an
			 intellectual disability, or a related condition as defined by
			 42
			 C.F.R. 483.106(d) and
			 (e).
(4) "Exempted hospital discharge" means an
			 individual:
(a) Who is admitted to a nursing
			 facility directly from a hospital after receiving acute inpatient care at the
			 hospital;
(b) Who requires nursing
			 facility services for the condition for which the individual received care in
			 the hospital; and
(c) Whose
			 attending physician has certified, prior to admission to the nursing facility,
			 that the individual is likely to require less than thirty (30) days nursing
			 facility services.
(5)
			 "Intellectual disability" is defined by
			 42 C.F.R.
			 483.102(b)(3).
(6) "Interfacility transfer" means an
			 individual who is transferred from one (1) nursing facility to another nursing
			 facility, with or without an intervening hospital stay.
(7) "Level of care of nursing facility
			 services" means those standards as established by
			 907
			 KAR 1:022, Section 4.
(8) "New admission" means an individual who
			 is admitted to a nursing facility (NF) for the first time or who is not a
			 readmission or an exempted hospital discharge.
(9) "Nursing facility" or "NF" means a
			 facility meeting the requirements established in
			 907
			 KAR 1:022.
(10) "Preadmission screening and resident
			 review program" or "PASRR" means the process that:
(a) Screens and identifies an individual with
			 a serious mental illness, an intellectual disability, or a related condition
			 prior to admission to an NF;
(b)
			 Results in a determination, based on a physical and mental evaluation of each
			 individual with a serious mental illness, an intellectual disability, or a
			 related condition, of the appropriateness of the individual's admission to an
			 NF; and
(c) Identifies appropriate
			 services if the individual is admitted to an NF.
(11) "Provisional admission" means an
			 individual:
(a) Is admitted to an NF for
			 fourteen (14) calendar days or less before a PASRR level II is
			 required;
(b) Meets the level of
			 care of nursing facility services as established in
			 907
			 KAR 1:022; and
(c)
1.  Has
			 been diagnosed with delirium, which, pursuant to
			 42 C.F.R.
			 483.130(d)(4), precludes an
			 accurate diagnosis and assessment until the delirium clears; or
2. Is in need of respite for an in-home care
			 giver and to whom the individual with serious mental illness, an intellectual
			 disability, or a related condition is expected to return after fourteen (14)
			 days.
(12)
			 "Readmission" means an individual who is readmitted to an NF from a hospital to
			 which the individual was transferred for the purpose of receiving acute
			 inpatient care.
(13) "Related
			 condition" means a severe, chronic condition that meets the requirements
			 established in
			 42 C.F.R.
			 435.1010.
(14) "Serious mental illness" means an
			 individual's condition that meets the requirements established by
			 42 C.F.R.
			 483.102(b)(1).
(15) "Services of lesser intensity" means
			 services that are:
(a) Within the scope of
			 services provided or arranged by the nursing facility as included in the
			 facility's per diem rate;
(b) Less
			 intensive than specialized services; and
(c) Intended to help residents who have a
			 serious mental illness, intellectual disability, or related condition to:
1. Improve, maintain, or prevent regression
			 of optimal functional status; and
2. Achieve highest possible level of
			 well-being.
(16) "Significant change" means that the
			 individual's condition has had a major decline or improvement requiring a
			 comprehensive reassessment.
(17)
			 "Specialized services for an intellectual disability or a related condition"
			 means the continuous, aggressive, and consistent implementation of a program of
			 specialized and generic training, treatment, and health and related services,
			 which are comparable to services an individual receives in an intermediate care
			 facility for individuals with an intellectual disability (ICF-IID), or in a
			 community based waiver program that provides services to persons with an
			 intellectual disability in which twenty-four (24) hour supervision is available
			 that is directed toward:
(a) The acquisition
			 of the skills necessary for the person to function with as much
			 self-determination and independence as possible;
(b) The prevention or deceleration of
			 regression or loss of current optimal functional status; and
(c) The coordination and interaction, at all
			 times and in all settings, of all staff and the individual served, in the
			 implementation of the specified individual program plan (IPP) objectives for
			 the individual.
(18)
			 "Specialized services for serious mental illness" means the implementation of
			 an individualized plan of care that:
(a) Is
			 developed in conjunction with and supervised by a physician;
(b) Is provided by an interdisciplinary team
			 of qualified mental health professionals;
(c) Prescribes specific therapies and
			 activities for the treatment of a person who is experiencing an acute episode
			 of serious mental illness that necessitates continuous supervision by trained
			 mental health personnel; and
(d)
			 Requires the level of intensity provided in a psychiatric inpatient
			 hospital.