Federally mandated guidelines have been developed to insure that individuals with mental illness are appropriately admitted to nursing facilities and that they receive services that maximize their quality of life and level of functioning. The OBRA Pre-Admission Screening Program is a compliance effort based on assessments of individuals meeting the criteria prior to nursing facility placement.
The Omnibus Budget Reconciliation Act of 1987 (OBRA) is a federally mandated assessment program for those persons regardless of age or payer source who have a major mental illness and who are seeking nursing facility level of care in this state. The purpose of these evaluations is to determine the appropriateness of the placement In a nursing facility setting, to divert persons whose illness prevents them from functioning satisfactorily in such a setting and to make initial recommendations for treatment within a nursing facility.
Once a referral has been made, an assessment will be performed to evaluate the nature and acuity of the mental illness condition at no cost to the individual or facility. Upon completion by an OBRA assessor or a psychiatric hospital, a letter of notification will be faxed and mailed to the Individual's local ASAP. This letter should be included in paperwork sent to the admissions department of the admitting nursing facility. The individual may be admitted to the facility only after all pre-admission forms have been completed.
As previously mentioned, OBRA is a federal mandate. The goal of the OBRA assessment program is to permit the admission to nursing facilities of persons with a mental illness, identifying initial recommendations for continued treatment of the stated psychiatric condition. A second goal is to exclude those persons whose mental illness is in an acute phase, rendering the individual unsafe to be placed in a nursing facility.
Individuals requiring "specialized services," or inpatient psychiatric care, would be excluded from admission until the exacerbation is brought under control. Notification of denial of admission will be faxed daily to the appropriate ASAP.
The only exception to this process are persons whose nursing facility is not receiving federal or state funding and whose cost is assumed privately. To date four facilities within the Commonwealth meet these criteria.
Pre-Admission Screenings are performed at no cost to the individual or the facility. Federal and state funds underwrite this program.
Upon completion the assessments are mailed to the HES office where they are processed, catalogued, electronically stored and returned to the nursing facility that has accepted the individual. Each assessment that is received is thoroughly reviewed by a board-certified psychiatrist. A cover letter citing procedures for disputing the determination accompanies the original (or copy if requested from the archives) of each form sent to a facility.
It should be noted that 21,600 unique individuals have been screened by HES and its subcontractors, resulting in nearly 50,000 assessments since 1989. If your nursing facility has not received an assessment, please contact the OBRA offices.
Can the Findings of the Assessment be Disputed?
Under the Department of Mental Health regulations 104CM16.01(1), every individual or his/her representative has the right to appeal a decision made by HES or its subcontractors. The regulations guarantee the right to a fair hearing before an impartial hearing officer designated by the Division of Medical Assistance. To request an application for an impartial hearing, contact the following Division within thirty (30) days of the date of the assessment:
LEVEL I & LEVEL II PRE-ADMISSION SCREENING TRAININGS
Health & Education Services, Inc.
Karen Vautour LICSW - OBRA Project Director
Eliza Nieves - Administrative Assistant
Jennifer Cosme - Administrative Assistant