Background:
On March 25, 2020, the Centers for Medicare and Medicaid Services notified MO HealthNet Division of their approval of a Federal Section 1135 Waiver request to suspend pre-admission screening and annual resident review (PASRR) Section 1919(e)(7) of the Act allows Level I and Level II assessments to be waived for 30 days. All new admissions can be treated like exempted hospital discharges. After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) should receive a Resident Review as soon as resources become available.
Effective April 2, 2020 and until April 25, 2020, certified Skilled Nursing Facilities and Intermediate Care Facilities may follow the process outlined below for new admissions into Medicaid-certified beds.
For an applicant that may require a Level II evaluation (have a qualifying mental illness (MI) or intellectual disability (ID) diagnosis):
- The applicant may enter the Skilled Nursing Facility (SNF) prior to completion of a Level II PASRR evaluation or Special Admission Category.
- The Hospital (or other individual completing the paperwork) will send the completed DA 124 C form to the SNF prior to discharge. The SNF should review the client’s information to ensure the Level of Care points (24) would meet prior to admission and ensure they have enough information to determine if they can meet the medical and behavioral needs of the individual.
- The SNF will submit the entire DA 124 application (DA 124 A/B, DA 124 C and any other supporting documentation) with a Special Admission Category form indicating “Waiver due to COVID-19” to COMRU@health.mo.gov. The SNF should indicate if the client plans to reside at the SNF after 30 days.
- DHSS recommends that SNFs submit the complete DA 124 application to COMRU within 14 days of admission to the SNF.
- Once received, COMRU will determine if the applicant meets Level of Care and refer applicants requiring a Level II PASRR screening to DMH.
- After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) will receive a Resident Review as soon as resources become available.
For completed applications already submitted to COMRU for processing:
- The applicant may enter the Skilled Nursing Facility (SNF) prior to completion of a Level II PASRR evaluation or Special Admission Category.
- COMRU will process all pending Level II PASRR applications as Special Admission Category #5 indicating “Waiver due to COVID -19”.
- Upon discharge, the hospital or other submitter will notify COMRU via email of the following information: the client’s name, DCN or SSN#, and the receiving SNF information (Name, Telephone number and fax number).
- The hospital/submitter will ensure a copy of the DA 124 application (DA 124 A/B form and DA 124 C form) are sent to the accepting SNF prior to discharge.
This information should be added to the DA 124 application in process and sent to DMH. For the DA 124 applications that were already referred for Level II PASRR screening, DHSS will notify DMH and Bock & Associates via email of the individuals change in location.
Questions regarding this process can be directed to COMRU@health.mo.gov. The DA 124 application (DA 124 A/B form, DA 124 C form and Special Admission Category Referral form) can be accessed at https://health.mo.gov/seniors/nursinghomes/pasrr.php.
