Frequently Asked Questions
||Who is Bock Associates?
Bock Associates is an independent company who has a contractual agreement with the Missouri Department of Mental Health (DMH) to complete the Level II (PASRR) Evaluations throughout the state of Missouri. Bock Associates has a local office in Jefferson City and also subcontracts with a network of nurses throughout the state who complete on-site Level II Evaluations.
||How do I reach Bock or one of Bock’s nurse contractors?
Our local office is open from 8 am to 4 pm, Monday through Friday (except State holidays). We can be reached by telephone at (573) 634-7309, by fax at (573) 634-7317 or email at email@example.com
. Although we are unable to give out our nurse contractors' private telephone numbers, we would be happy to relay your message to them. If you are calling after hours, or if we are temporarily unavailable, you may leave a message on our voice mail system and we will get back to you.
||I’m not sure whether or not an individual needs a Level II evaluation. How can I make sure?
First, contact Department of Health and Senior Services-Comprehensive Medical Review Unit (COMRU) at (573) 526-8592. COMRU is responsible for reviewing the DA 124 forms and determining whether or not further evaluation is necessary. In certain cases (primary dementia, psychiatric condition related to medical condition, or if a special admission category is approved.) a Level II may not be needed, or can be completed after NF admission. If you are unsure, it is best to call and discuss the case to avoid unexpected delays, and or loss of reimbursement. Bock Associates is NOT able to tell you whether or not further evaluation is necessary.
||The individual came to the hospital from a nursing home, and will be returning to a nursing home. Does he need a new Level II Evaluation?
In many cases, this individual will not require a new Level II as this is considered a "transfer". However, the individual experiences a Change in Status, or if the individual has been out of the nursing facility for an extended time a new Level II may be needed. Also, some individuals assumed to have had a previous Level II in fact have none on record. If you are in doubt, please contact COMRU to discuss your case or review the information related to change of status on the DHSS website at http://health.mo.gov/seniors/nursinghomes/pdf/ChangesinStatus.pdf
. Bock Associates can only tell you if the individual has a PASRR evaluation on file with our office.
||The individual has a psychiatric diagnosis, but needs to go to the nursing home for medical (not psychiatric) reasons. Does he still need a Level II Evaluation?
If the individual is suspected of having a "serious mental illness" or intellectual disability/related condition as per the DA124-C form, the individual will still need a Level II Evaluation regardless of the reason for nursing home placement.
||The individual is going to the nursing home on a “private pay” basis (or Medicare, VA contract, etc) and is not applying for Medicaid. Does she still need a Level II Evaluation?
By federal regulations, the PASRR process is required of all individuals seeking admission to a Title IXX "Medicaid bed" (meaning that the accepting nursing home participates in the Medicaid program), regardless of how the particular individual will be paying for their stay. This means that private pay individuals must also comply with the process if the nursing home they choose accepts Medicaid for that bed.
||I know that an individual does need a Level II Evaluation. How is this arranged?
First you must complete and send in the DA124 forms to the Department of Health and Senior Services-COMRU. If a Level I Evaluation is deemed necessary, the DA124 forms are forwarded to the Department of Mental Health (DMH). DMH will contact Bock Associates, forward the information to Bock, and authorize a Level II Evaluation. Bock will contact you to verify location, determine a contact person, and assign the evaluation to a local nurse contractor. Bock's nurse contractor will call the contact person to set up an appointment for the Level II Evaluation.
||How long will the process take?
You can expect an average of seven to nine working days from the time the Department of Health and Senior Services-COMRU sends the CORRECTLY completed DA124 forms to DMH. Some assessments are completed faster than others due to various factors including location, current workload, available records/information, weather, etc. The annual average is about five working days after Bock Associates receives the referral information for the assessment to be completed. However, Bock cannot guarantee completion in less than seven working days.
||I just sent in the DA124 forms. Can I call Bock to arrange an appointment?
Bock can begin a Level II Evaluation only after authorization is received from DMH. At that time you will be contacted by our office for verification. After we verify that the client is there and seeking nursing home admission, the evaluation will be assigned to a local nurse contractor. The nurse will contact you to arrange an appointment within five working days. Calling the office will not expedite the process.
||Is there any way to expedite the process?
The PASRR process will go more smoothly for you if:
- The DA124 are completed correctly, comprehensively, and signed by both the individual/guardian and physician (and do not need to be returned to you for revisions, signatures, dates, etc);
- The client's current location as well as the facility contact person's name and telephone number are CLEARLY listed on the forms (so we don't have to spend time searching for the individual and/or contact person);
- You have carefully completed the DA 124-C form questions regarding whether the client is suspected of having serious mental illness and/or intellectual disability/developmental disability, or related condition, and have determined whether or not the individual meets any "special admission" categories listed (NOTE: special admission categories must be verified by COMRU. Click here for more information about special admissions http://health.mo.gov/seniors/nursinghomes/pdf/sacreferral.pdf ). Failure to follow form directions including definitions discussed on the back page will unnecessarily delay the process.
- You have gathered the individual's psychiatric history including information on previous symptoms and hospitalizations (the nurse will need this information to complete the evaluation); and
- You START EARLY. The evaluation can be cancelled if the individual decides to return home or to a less restrictive setting.
||I think that an individual meets a “special admission category” on the DA 124-C form. Can she be sent to the nursing facility without a Level II Evaluation?
All special admissions must be pre- approved by COMRU according the guidelines listed here http://health.mo.gov/seniors/nursinghomes/pdf/sacreferral.pdf
. Depending on the case, some individuals may need a full Level II AFTER admission to the nursing home. Others may require a modified Level II (telephone evaluation). The special admission DOES NOT "EXEMPT" individuals from the PASRR process, rather defers the evaluation until after nursing home admission.
||The Bock nurse came out to evaluate the individual. Now can we discharge?
The Bock nurse contractor is NOT AUTHORIZED to approve nursing home placement. After the nurse completes the evaluation and forwards it to Bock's Jefferson City office, the evaluation is reviewed by a physician. The Level II recommendations are then forwarded to DMH, who in turn communicates this information to the Department of Health and Senior Services-COMRU. COMRU will inform you of the Level II Determination and authorize NF placement. Again, Bock is not able to authorize NF placement. However, after the nurse has been to your facility, you may call our office to determine a more definite time-frame for completion.
||What does the Level II Evaluation determine? Did the individual “pass” the Level II?
The authorization for nursing home admission is a multi-step process involving the Department of Health and Senior Services-COMRU, DMH, and as a DMH agent, Bock Associates. The Level II Evaluation process is not designed to be "pass/fail". Rather the evaluation process specifies recommendations for specialized and rehabilitative psychiatric or developmental disability services for individuals as well as recommendations on the most appropriate and least restrictive placement setting as required by federal and state PASRR regulations.
||An individual was admitted to our nursing facility from a different NF. Do they need a new Level II?
A DA-124 application does not need to be sent to COMRU when the client is a direct admission from a nursing facility to another nursing facility. The DA-124 application and the PASRR Level II screening (if applicable) must be obtained from the prior nursing facility for the client's current record. Failure to obtain a previous PASRR report may result in citation by DHSS surveyors.
||I am unable to obtain the DA124s and/or Level II Evaluation from the previous NF. What should I do?
If the facility is unable to obtain copies of the DA-124 application, COMRU may be able to provide copies. However the nursing facility would need to follow the Missouri Sunshine Law. The facility would submit in writing to COMRU the information requested, along with the client's name and Medicaid number. A charge will be assessed for release of information under the Sunshine Law.
If the facility is unable to obtain copies of the PASRR Level II Evaluation, Bock Associates may be able to provide copies. The facility would submit in writing to firstname.lastname@example.org
the information requested, along with the client's name and Medicaid number. A charge will be assessed for PASRR evaluation copies, completed prior to the last 60 days, at the rate of $20.00 handling charge per request and $0.10 per page At the time of the original PASRR evaluation, Bock Associates will continue, at no additional charge, to mail evaluation copies to the current Nursing Facility (if the individual resides in a NF at the time of the evaluation) or discharging hospital and proposed Nursing Facility (if the individual is hospitalized, and the proposed NF is indicated at the time of the evaluation). Unless otherwise indicated, PASRR evaluation copies requested will be emailed to you, password protected.