DDES Memo Series 2004-17
February 9, 2005
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
To:
Area Administrators/ Human Services Area Coordinators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Facilities Serving People with Developmental Disabilities
Hospitals
Licensing Chiefs/Section Chiefs
Nursing Homes
Tribal Chairpersons/Human Services Facilitators
From:
Sinikka Santala
Administrator
The Division of Disability and Elder Services is making several changes
to the DSL-822 form and renumbering the form as DDE-822.
For example, the following changes were made:
- A clarification was added to indicate that the Preadmission Screen
and Resident Review (PASARR) short-term exemptions cannot be used
consecutively/piggybacked.
- Another option was added to indicate, "Person has a brain
injury that occurred after 22nd birthday and does not have an
additional developmental disability or an accompanying mental
illness requiring a PASARR Level II Screen."
- An option was added to indicate that the county believes that the
person does not have mental illness or developmental disability as
defined in s. 51.01, Stats., and therefore, county approval is not
necessary.
A copy of the revised form is attached. It replaces the "DSL-822
(Revised 6/97)" form. Begin using the current version of the DDE-822
now. The form may be downloaded from the Department through http://www.dhs.wisconsin.gov/forms1/f2/f20822.pdf,
an Adobe Acrobat fillable format or http://www.dhs.wisconsin.gov/forms1/f2/f20822.doc,
a Microsoft Word 97 fillable format.
Wisconsin counties continue to have responsibility and authority to
review referrals to a nursing home or an ICF/MR for people with
developmental disabilities, and referrals to a nursing home or a
Medicaid-certified Institution for Mental Disease (IMD) for people with
mental illness. Persons with a developmentally disability or mental
illness cannot be admitted to such facilities unless the responsible
county agency has reviewed the admission referral and has documented its
appropriateness through the completion of the DDE-822,
irrespective of the nature or expected duration of the admission.
Please note that Act 33 of 2003 made several changes to Chs. 49 and
55, Stats., involving the placement of persons who have a developmental
disability into a nursing home or a facility serving people with
developmental disabilities. These changes are outlined in the DDES Memo
2004-16.
Many individuals have noted that the county approval via the DDE-822
form seems to duplicate the requirements for the Preadmission Screening
and Annual Resident Review (PASARR) process, setting of a nursing
facility care level by a Bureau of Quality Assurance surveyor, physician
certification of the need for nursing facility placement, and, if
necessary, a protective placement order. Despite the appearance,
these processes do not duplicate one another. Each of these
processes are required by State or federal law/regulation and serve
different purposes. Because of the different purposes for each of these
approval processes, the requirements for the qualifications of personnel
conducting evaluations, type of evaluations performed, and the criteria
for determining if a person should be admitted to a nursing facility
differ.
PASARR only applies to Medicaid certified nursing homes. Any person,
regardless of age or payment source, seeking admission to or residing in
a Medicaid certified nursing home or a nursing facility-IMD must receive
at least a Level I Screen from a nursing home or hospital to determine
if the person has a developmental disability or mental illness. We are
continuing to link the DDE-822
form with the PASARR process because of the important relationships
among the counties, the nursing homes and the PASARR contractor in
addressing the support needs of individuals. The DDE-822
form must be completed for persons with a developmental disability
and/or mental illness who are seeking admission to any of the types of
facilities identified on the form, without regard to the person's age or
payment source.
PASARR does not permit any permanent exemptions. There are four
allowable short-term admission exemptions that are noted on the DDE-822
form: Hospital Discharge-30 day maximum; Pending Alternate placement-30
day maximum; Emergency Placement-7 day maximum and; Respite Care-30 days
per year maximum. Those four exemptions correspond with the exemptions
on the Level I Screen (see page 3, Section B of the Level I Screen). The
Level I Screen states that if a person meets one of the four short-term
admission exemptions "the individual may enter the nursing facility
with county approval through the DDE-822
form, for the specified period of time without a referral for a
PASARR Level II Screen." Note: Short-term exemptions may not be
used consecutively to extend the time in a facility without a PASARR
Level II Screen, when a PASARR Level II Screen is warranted. These
exemptions are described in the paragraphs below.
Hospital Discharge Exemption - 30 days maximum.
Under this exemption an individual may enter the nursing home from a
hospital for the purpose of convalescing from a medical problem for 30
days or less if the person meets a required nursing care level (a
skilled nursing facility level of care (SNF) for persons with
developmental disabilities). If it appears that more than a 30 day
post-hospital stay in a nursing home is needed, the nursing home will
need to contact the PASARR contractor to complete a Level II Screen as
soon as the nursing home believes that the person will need to stay
beyond 30 days. The county should complete another DDE-822
form if the county recommends a longer stay than is allowed in one of
the short-term admission exemptions. This is explained below under
"Level II Screen required." The county has the discretion to
check both the "hospital discharge exemption" box and the
"person needs a Level II Screen …" box when initially
completing the form to avoid filling out two DDE-822
forms.
The Pending Alternate Placement - 30 days maximum.
This exemption is an attempt to respond to those situations in which
the person's community placement has dissolved and nursing care is
needed, but hospitalization was found to be unnecessary. As above, the
person must meet a required nursing home level of care to be admitted.
The intent of this short-term exemption is for the person to return to a
non-institutional setting. It is not acceptable to use this exemption to
admit a person to a nursing home when the intent is for long term care.
Any person needing long-term nursing home care needs to be referred by a
hospital or nursing home to the PASARR contractor via a Level I Screen
so that a Level II Screen can be completed. To remain in compliance with
federal PASARR rules, the Department will monitor the use of this
exemption and may remove it as a short-term exemption option if it is
not used appropriately.
Emergency Placement - 7 day maximum.
This exemption is to be used in situations where protective services
(i.e., the person's health, safety, and welfare are immediately at risk
if action is not taken) are needed and a nursing facility stay of no
more than 7 days is needed for further assessment and emergency planning
purposes. For example, a person is admitted to an emergency room with a
broken leg. The physician indicates that the person does not need to be
hospitalized, but the person must remain off his/her feet to permit the
leg to heal properly. However, due to the person's developmental
disability or serious mental illness, the person is not likely to stay
off his/her feet and the person's prior living arrangement either cannot
provide the appropriate supervision, accommodate a wheelchair or ensure
safe evacuation of the person in the event of an emergency. This person
may be admitted to a nursing facility to ensure his/her health, safety
and welfare. If the nursing facility believes that the person has a
developmental disability or serious mental illness, then the facility
must make a referral for a PASARR Level II Screen within seven (7) days
unless the person is discharged within this time period.
Respite Care - Up to 7 days at a time for up to 30 days per year
maximum.
This short-term exemption is to be used for the benefit of providing
relief to in-home caregivers to whom the person will be returning after
a brief stay. As in the above exemptions, the individual needs to meet a
required nursing care level for admission. Respite care in a nursing
home is not presently funded by Medicaid under the nursing facility
benefit, however Medicaid Home and Community-Based Waiver funds (i.e.,
CIP 1A, CIP 1B, CIP II, and COP-W) are permitted to be used to pay for
respite care.
When to check the section "Level II Screen
required."
For admissions of persons with developmental disabilities and/or
mental illness to nursing homes for other than the four short-term
exemptions, a Level II Screen will need to be completed by the PASARR
contractor prior to admission. In those situations the nursing home or
hospital will contact the contracted PASARR contractor. The PASARR
contractor will in turn inform the county PASARR liaison (identified in
DDES Memo 2004-xx) to notify them that a Level I Screen has been
received so that any necessary planning at the county level can begin.
In many cases the nursing home will have already requested DDE-822
approval from the county prior to the county being contacted by the
PASARR contractor. The overlap is due to the nursing home's
responsibility to meet separate PASARR requirements and Wisconsin
nursing home administrative code requirements.
There will be situations when a second DDE-822
approval may be needed within a relatively short period of time. For
example, if the person has been admitted under one of the four
short-term exemptions and needs to stay for a longer period the county
should complete another DDE-822
form if the county agrees with the longer nursing home stay. In most
cases, the PASARR contractor would need to be involved in the Level II
Screening process for stays beyond the short-term exemption periods.
The separate category "Admission to a licensed nursing home that
is not Medicaid certified" refers to the few Medicare/private pay
only nursing homes in Wisconsin. Individuals entering those facilities
do not require PASARR Level I or Level II Screens, but do require
DDE-822
approval if they have a developmental disability or mental illness.
Persons entering an ICF/MR (FDD) are not subject to PASARR, but do
require DDE-822
approval. (A person transferring from an ICF/MR, including a
distinct-part ICF/MR, to a Medicaid-certified nursing facility is
subject to PASARR.)
Special Note Regarding Persons Who Have Had A Brain Injury:
If the brain injury occurred prior to the person's 22nd birthday,
then a PASARR Level II Screen likely is required. Complete the DDE-822
form as instructed above. If the brain injury occurred after the
person's 22nd birthday a PASARR Level II Screen is not required unless
the person has an additional developmental disability and/or mental
illness diagnosis, however a DDE-822
is required. The reason for the distinction is the fact that the
Wisconsin statutory definition of developmental disability specifically
includes brain injury regardless of age of onset. There is a
separate option on the DDE-822
form to identify a person whose brain injury occurred after his/her 22nd
birthday and does not have an additional developmental disability or an
accompanying mental illness. Such a person does not need a PASARR Level
II Screen. However, if a person has a brain injury that occurred after
his/her 22nd birthday and he/she had a pre-existing developmental
disability or now has an accompanying mental illness, then he/she needs
a PASARR Level II Screen.
Special Note Regarding Use for Out-of-State Circumstances:
Counties should complete the DDE-822
form for each county resident who will be placed in a facility in
another state. The DDE-822
form should be completed for a person who currently is a resident of
another state, not under guardianship or an involuntary commitment
order, and voluntarily is choosing to permanently reside in Wisconsin
and has stated an intent to do so. The county that will become the place
of such a person's residence should be the county to complete the DDE-822
form. If a person who is not a Wisconsin resident is under guardianship,
an involuntary commitment order, intends to return to their home that is
not in Wisconsin, or is seeking admission to a Wisconsin facility
because of the lack of available resources in their home state, then the
facility or the county staff should contact Dan Zimmerman for
consultation in addressing residency, legal and payment issues.
Routing directions are identified on the bottom of the DDE-822
form.
CENTRAL OFFICE CONTACT:
Dan Zimmerman
Bureau of Mental Health and Substance Abuse Services
1 W. Wilson Street, room 850
PO Box 7851
Madison, WI 53707-7851
(608) 266-7072
(608) 267-7793 (fax)
zimmeds@wisconsin.gov
(e-mail)
MEMO WEB SITE:
http://www.dhs.wisconsin.gov/partners/local.htm
Attachments
cc:
County PASARR Liaisons
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