Nevada PASRR Level II Program and Promising Practices Dave Caloiaro, MSW, LISW Chief, Administrative Programs, Planning and Quality Nevada Division of Public and Behavioral Health (DPBH)

General DPBH Overview: Mental Health (MH) Services Statutorily, DPBH is the State Mental Health Authority (SMHA) in Nevada. In FY 2012, DPBH provided mental health services to 16,758 Nevadans. DPBH offers a full range of mental health services through four statewide agencies, including, but not limited to, inpatient hospitalization, outpatient therapy, medication clinic, case management, psychosocial rehabilitation, residential programs and program for assertive community treatment (PACT). 2

General DPBH Overview: Alcohol and Substance Abuse Services Substance Abuse Prevention and Treatment Agency (SAPTA) is the is the AOD authority in Nevada SAPTA provides alcohol and other drugs prevention and treatment services through community providers). IN FY 2012 SAPTA contracted service providers provided treatment services to 10,522 Nevadans.

PASRR Level II Program Nevada contracts the PASRR Level I and Level II program processes to Hewlett Packard Enterprise Services (HPES). They do the client evaluation and make the nursing facility placement Specialized Services recommendations.

Nevada PASRR Level II Evaluation A comprehensive face-to-face evaluation is conducted by an LCSW Evaluation utilizes a 13-page evaluation form that includes level of support needed for ADLs and medical needs, identifies whether the needs can be met in an alternative community setting and includes recommendations for specialized services.

Nevada PASRR Level II Evaluation (cont) Documentation includes H&P, psychiatric/psychological evaluation, psychosocial assessment, progress notes, and, in addition to talking with the patient, the evaluator may also interview the caregiver, family legal guardian or facility staff. All evaluations are reviewed by a HPES psychiatrist or psychologist, who determines level of service provided by a NF and is NF placement is needed, the specialized services is needed for the management of the client.

PASRR Level II Resident and Specialized Services Coordination The Nevada Division of Public and Behavioral Health assigns a regional PASRR Coordinator to NF residents screened as PASRR II-B, to ensure the client receives the provision of Specialized Services they require. There are Mental Health PASRR Coordinators in three locations of the state – north, south and rural.

PASRR II-B Resident and Specialized Services Coordination (cont) The DPBH Regional PASRR Coordinator: Performs quarterly onsite reviews of the PASRR II-B client at the nursing facility (out-of-state performs medical record reviews), to assure PASRR clients are receiving the provision of Specialized services they require. Whenever possible, serves as a member on the client’s multi-discipline Treatment/Care Plan team. Assists acute care hospital discharge planners with finding alternatives to nursing facility placement, if requested.

Nevada PASRR II-B Specialized Services For Persons with Mental Illness Psychotropic Medications Psychiatrist Follow-up Services Psychotherapy Psychiatric or Psychological Evaluation Transitioning Services, to assist in moving to a less restrictive environment Monitoring and Advocacy

DPBH Bi-Annual PASRR Level II Program Compliance Reviews DPBH conducts a comprehensive PASRR Program Compliance Review on a bi-annual basis, in three parts: 1) Desk review of the PASRR QIO-like contractor/vendor, shared jointly by Medicaid and DPBH, of randomly selected PASRR Level II case determinations (and accompanying medical records), 2) Onsite review of PASRR II-B residents who require Specialized Services, in a number of Nevada and out-of-state nursing facilities; and 3) Performance review of each of DPBH’s three regional PASRR coordinators.

DPBH’ Continuing Commitments with the Nevada PASRR Program Continuing the close working relationship and partnership with Nevada Medicaid. Maintaining the Nevada Statewide Nevada PASRR Committee, which meets quarterly, and includes members from Medicaid, the PASRR Vendor, DPBH’s three statewide MH PASRR coordinators, and the Division of Aging and Disability Services’ three regional Intellectual Disability PASRR Coordinators. When funding resources permit it, continuing to provide education and training to nursing facility staff with respect to Nevada PASRR requirements, including documentation requirements.

Chief, Administrative Programs, Planning and Quality Contact Information: Dave Caloiaro, MSW, LISW Chief, Administrative Programs, Planning and Quality Nevada Division of Public and Behavioral Health (DPBH) (775) 684-5970 Email: dcaloiaro@health.nv.gov Add Clip Art