Download Understanding the UAS and PRI/Screen

UAS and PRI/Screen for
Transition Specialists
Transition Center Nurses for MFP
Christine Trimboli RN & Laura Bingell RN
“Open Doors is a Money Follows the Person program of New York Association on Independent Living under contract with New York State Department of Health. This document
was developed under grant CFDA 93.971 from the U.S. Department of Health and Human Services, Center for Medicare &Medicaid Services. However, these contents do not
necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.”
Definitions
PRI
• Patient Review Instrument
A clinical tool used to assess a
person’s condition and the
amount of care required for
admission to an institutional
setting and before discharge.
Screen - A supplement done
to better determine mental
health, cognitive factors and
resources available.
UAS
•
Uniform Assessment System
A comprehensive assessment
system designed to determine
the amount of care required
in home and community
based settings.
It includes supplements for
Functional status and
Mental Health status.
(Adult, 4-17 years, 0-3 years)
Who Does It?
PRI and Screen
UAS
• PRI - RN (Nurse
Evaluator- NE)
• Screen – RN or SW
• Qualified through
NYSDOH contracted
training program
• RN – SW (Assessor)
• Qualified by
NYSDOH Health
Commerce
• Web based
training
Where Each is Conducted
• UAS- in community,
• PRI- in the
in facility prior to
community, while
leaving, used by MLTCs
hospitalized or on
and RRDCs for waivers
‘swing bed’ status,
to determine if
and prior to
minimum LOC is met
leaving NH
https://www.health.ny.gov/health_care/medicaid/publications/gis/15ma011.htm
Nursing
Home
Resident
• SC will need a PRI and Screen less than 90 days old
for submission to RRDC with waiver application
Waiver
participant
• UAS to be completed by NE
(usually CHHA or LDSS) within 90
days of return to the community
MLTC
• Contract with own
NE/Agency
How Outcomes are Measured
• CAPs – Clinical Assessment Protocols
• RUGs - Resource Utilization Groups Classification
• NFLOC – Nursing Facility Level of Care
What Do These Mean?
CAPS
Clinical Assessment Protocol
Key factors in an individual’s life that indicate areas
requiring additional needs and supports.
4 Areas of Focus
•
•
•
•
Functional Performance
Cognition and Mental Health
Social Life
Clinical Issues
• Resource Utilization Groups
• Major classifications that people are assigned
to based on clinical characteristics, functional
status, complexity of care needed and
cognitive status.
• The primary purpose of assigning a RUGs
category is to calculate the relative
cost for care in a facility.
NFLOC
Nursing Facility Level of Care
• Based on scoring index that is uniform for
all UAS assessments and programs now in NYS
• Uses information from the following portions of
assessment-Cognitive, Communication, Vision, Mood and
Behavior, Functional Status, Continence and Nutritional
Status
• Responses and observations in these areas are converted
into points
• The higher the number the greater need for care
5 or greater qualifies for waiver services
Focus on UAS
Purpose of UAS
• Evaluates individual’s health status/strengths and
guides the development of a plan of care
• Assists with program eligibility determinations and
identification of program options
• Improves care coordination and facilitates service
delivery
• Improves communication about assessment
information and reduces redundancy
• Ensures that individuals receive the right care, within
the right setting, and at the right time
UAS Process
• Interview and observe the person, then consult with
a family member(s), PCP and/or other caregiver(s).
Focus on whether the person is actively managing
tasks of daily living, not whether the caregiver(s)
believe the person might be capable of doing so.
• THE FOCUS IS ON ACTUAL PERFORMANCE.
UAS - Areas Evaluated
•
•
•
•
•
•
Cognition- Short Term and Procedural
Communication and Vision
Mood and Behavior
Functional Status – ADL, IADL, Mobility
Continence
Nutritional Status
UAS Components
Bathing, personal hygiene,
dressing of lower body,
locomotion, and change
in ADL status
Disease dx (schizophrenia),
abnormal thought process,
delusions, tobacco, alcohol,
substance abuse, depression,
cognitive performance
Functional
Assessment
Mental Health
Assessment
Community
Assessment
CODING Choices Related to Function
 Independent
 Modified independence
 Minimally impaired
 Moderately impaired
 Severely impaired
 No discernable consciousness, coma
What person has
actually done in the past
3 days
What person is capable
of doing in the
professional opinion of
evaluator
Areas Evaluated In Mental Health
Supplement
• Mental Health Service History
• Mental State Indicators
– Self-deprecation, expressions of guilt/shame, irritability,
hopelessness, inflated self-worth, pressured speech,
racing thoughts, obsessive/compulsive behaviors,
intrusive thoughts/flashbacks, substance use, unusual
physical movements, hygiene, harm to self and/or others
(attempts/ideations), suicide intent, expressions of
concern by family, tendency toward violence, police
intervention, stress/trauma, medications, family conflict
Mental Health Coding Choices
 Never
 More than 1 year ago
 31 days to 1 year ago
 8 to 30 days ago
 4 to 7 days ago
 In last 3 days
6/12/14 Announcement from
TBI Services Coordinating Council
“There is great concern many of New York’s most
vulnerable citizens, those with a documented traumatic
brain injury (TBI) whom are currently being served by
the New York State Department of Health TBI waiver,
will be inaccurately assessed as not meeting level of care
criterion, particularly if their primary disabilities are
cognitive/behavioral and not physical.”
The Alzheimer’s Association
“ The need for assistance with activities of daily living
(ADLs) must be defined to include verbal assistance
and the extent or severity of need must be determined by the
duration of the assistance required, not the type of assistance.”
“Level-of-care criteria must include measures of individuals’ need for
supervision to protect them from the negative effects of impaired judgment
and decision-making; impulsive inappropriate or disruptive behaviors;
and other potentially harmful behavior such as wandering.
These measures must be weighted appropriately so that
people with severe impairments will be eligible.”
Focus on H/C PRI and Screen
What is a PRI?
• HC-PRI = Hospital & Community Patient
Review Instrument
• Assessment tool developed by NYSDOH
• Determines LOC and appropriateness of
placement
• Assesses physical, medical, & cognitive
characteristics
• Determines selected services
Sections of a PRI
•
•
•
•
•
•
•
Administrative Data
Medical Events
Activities of Daily Living (ADLs)
Behaviors
Specialized Services
Diagnosis
Plan Of Care Summary
How a PRI Works
Category Defines
Scoring Reflects
• Medical conditions
and treatments
• Need for
rehabilitation
• Mental Health and
behavior
• How much assistance
or supervision is
required with ADLs
Scoring -Eating
 How individual consumes food
 Level of independence with eating
 How maintains nutrition
 Need for verbal cuing
 Need for assist opening containers
 Need for assist cutting food
Scoring- Transfer
 Is physical assistance required
 Are transfers independent
 Intermittent supervision needed
 Assist for guidance, safety, steadiness
 Total dependence
 Equipment/Hoyer Lift/ Gait Belt
Scoring- Toileting
 Ability to get to toilet, bedpan, or commode
 Ability to maintain personal hygiene
 Ability to appropriately adjust clothing
 Assessing for continence/incontinence
 Incontinence briefs or pads
 Toileting/bowel regime
Categories - Special Needs Groups
Heavy
Rehabilitation
Severe
Behavioral
Clinically
Complex
Reduced
Physical
Functioning
• Requires restorative
PT or OT
• 5 sessions/week
• Min. of 2.5 hrs/week
• Must be likely to
improve
• Does not meet HR criteria
• ADL score of 5 or more
• 1 or more of following:
stage 4 decubitus,
suctioning, comatose,
nasal gastric feeding,
parenteral feeding,
quadriplegia, or
multiple sclerosis (MS)
• Doesn’t meet criteria for prior categories
• ADL score less than 5
• One or more of following:
dehydration
internal bleeding
daily oxygen
dialysis
terminal illness
1 or more MD visits/week
wound care
stasis ulcer
chemotherapy
urinary tract infection
blood transfusions
cerebral palsy
• Exhibits behavior- infantile, • Remaining individuals
disruptive, verbally/socially
who did not meet
inappropriate or physical
prior criteria
aggression
• More custodial
• Behaviors must be
documented
• Can present challenge
• Behaviors 1/week
for appropriate
for past 4 weeks
placement
What is a Screen?
Screen validates
•
•
•
•
Level of care needed
Qualification for NH placement
Qualification for HCBS
Need for supervision and oversight based on
diagnoses of dementia/Alzheimer’s
Two Purposes of the Screen
• To determine potential for appropriate
care in a setting other than a RHCF
• To assess those recommended for RHCF
for possible mental illness, and
developmental disabilities- requiring
additional review instruments
May trigger a ‘Community Based Assessment’
Community Based Assessment
To determine resources available to an
individual that would support living in the
community.
•
•
•
•
A person’s environment
Informal supports
Economic resources
Physical/Mental needs
Questions?
https://www.health.ny.gov/forms/doh-694.pdf
Web address to see PRI/Screen forms.
Laura Bingell RN
[email protected]
(607)962-8225
Christine Trimboli RN
[email protected]
(518)538-6767