OBRA/PASRR

For those with Intellectual or Developmental Disabilities

Our staff cannot conduct the pre-admission screen when an individual has an intellectual or developmental disability. Staff from the Department of Developmental Services must conduct the screening.

Contact the Intake Desk at the Department of Developmental Services PASRR Project at 617-624-7796 (note: do not use previously listed 800 number; it is an unattended voice-mail.)

Note: DDS staff have up to three business days to come into the hospital to conduct this screen. The patient generally cannot be discharged to the nursing facility until the screen is completed. If patient is in ED or Observation stay call DDS and see if they will OK as an emergency transfer (on weekends/holidays if it is in the best interest of the patient transfer to the SNF and have them call DDS on next business day).

DDS staff can also consult to hospital staff on best practices in caring for those with intellectual or developmental disabilities while here.

When in doubt, or with any questions, call the DDS PASRR project 617-624-7796.

Note on terms:  this screening falls under the same OBRA rules as for those with mental illness. Both technically are called OBRA/PASRR (ORBRA Pre-Admission Screening/Resident Review) either for Mental Illness or Developmental Disabilities. Watch for confusion- some of our staff may call the mental illness screen an OBRA and the developmental disabilities screen a PASRR.

 

Indications:

• Intellectual Disability
  • Significantly sub-average intellectual functioning that manifests before age 18
  • Note: the term Mental Retardation is no longer used, but may appear in medical records and documentation.

 

• Developmental Disability - individuals who have a severe, chronic disability that meets the following conditions:
• Onset before age 22,
• Likely to continue indefinitely
• Results in substantial functional limitations in THREE or more of the following:
  • self-care
  • understanding and use of language
  • learning
  • mobility
  • self-direction
  • capacity for independent living
• Related conditions found to be closely related to intellectual disability may include Cerebral palsy, epilepsy or any condition other than mental illness, that results in
  • impairment of general intellectual functioning or adaptive behavior similar to that of those with intellectual disabilities AND
  • Requires treatment or services similar to those required for these persons
  • May include autism, spinal cord injury, head injury, multiple sclerosis, muscular dystrophy, blindness, deafness, cystic fibrosis, orthopedic impairment, spina bifida.

 

Exemption:
The only exemption for this population is convalescent care of less than 30 days (discharging physician makes decision re: anticipated LOS. Must be documented in medical record and signed by an MD. Other disciplines' signaturesdo not qualify for this exemption.)

 

Screening Process:

• Department of Developmental Services will come to MGH to do onsite assessment prior to discharge, call 617-624-7796 (note: do not use previously listed 800 number; it is an unattended voice-mailbox)
  • The Regional Nursing Facility Specialist will visit the individual, speak with involved medical and social service staff, conduct a record review and will contact family members/guardians.
• DDS has 3 business days to do onsite assessment with verbal decision usually available day of visit and written determination to follow within 7 to 9 days.
• We must have DDS verbal decision prior to transfer to SNF.

 

Screening Outcomes:

Three possibilities-

1. Aproved for nursing facility admission, NO assessment for "specialized services"* needed
   • Only those who are very medically compromised and would not benefit from services
2. Approved for nursing facility admission, assessment for specialized services needed
3. NOT approved for nursing facility admission
   • If not approved DMR should offer an alternative plan

*Specialized Services- services specific to the disability (ID/DD) offered in addition to standard nursing facility services that are provided by ID/DD professionals. 2000 settlement agreement in Rolland v.Cellucci* requires that these services be in place within 90 days of admission to nursing facility. Day Habilitation completes the plans and provides the services.

(* Settlement agreement has been concluded- DDS found in compliance; most clients now served in community setting. See next section re: DDS Policy 2012-2.)

-Adapted from DMR PASARR Frequently Asked Questions (Rev 4/29/04) and MGH Case Management Guideline & Criteria Manual 12/09.

 

DDS Policy 2012-2:

DDS will, except in special circumstances, identify appropriate services and arrange for community placement for the individual as soon as practicable. Once supports and an appropriate residential placement have been determined, continued stay in the nursing facility shall not be authorized through PASRR

 

When in doubt, or with any questions, call the DDS PASRR project 617-624-7796.

 

rev 9/14