Specifications include, but are not limited to: 3.2 Resident Review/Evaluation Update 3.2.1 The Contractor shall conduct a resident review/evaluation update for individuals referred by the Department in accordance with the applicable federal PASARR guidelines and requirements specified in 42 CFR 483.100to 483.138. 3.2.2 The Contractor shall complete a resident review/evaluation update for one of the following scenarios: a. For individuals with a change to their condition from a prior Level II evaluation specified in the CFR above. b. For individuals identified as requiring short term nursing facility services with a required redetermination on the current Level II determination. c. Requested by the Department. 3.2.3 The resident review shall include an evaluation of the individual, a review of the previous PASARR Level II evaluation, and a clinical assessment of current information to verify if the previous PASARR determination remains valid and/or to update additional information necessary for the individual’s care. 3.2.4 The Contractor shall send the evaluation update report, in a format specified by the Department, which provides the confirmed qualifying condition and the determination of service needs based on the qualifying condition in accordance with the applicable federal PASARR guidelines and requirements specified in 42 CFR 483.128. 3.2.5 The Contractor shall complete all requirements above within an annual average of 7 working days. 3.3 Partial Screening/Evaluation 3.3.1 The Contractor shall utilize the term partial screening/evaluation when the Level II evaluation has been terminated. 3.3.2 The Contractor shall terminate the Level II evaluation during the initial review of all documentation obtained only if the evaluator finds enough evidence to support the individual a. Does not have MI, ID/DD, or related condition as defined by CFR 483.128(m); or does have a primary diagnosis of dementia (including Alzheimer's Disease or a related disorder); or b. A non-primary diagnosis of dementia without a primary diagnosis that is a serious mental illness, and does not have a diagnosis of ID/DD or a related condition; or c. The individual or appointing authority no longer desires to continue, the individual has been discharged, or expired prior to the completion of the comprehensive evaluation. 3.3.3 The Contractor shall have detailed documentation and sufficient evidence to support the cause of termination within the individual’s file.
