Preadmission Screening and Resident Review (PASRR) protects individuals with serious mental illness or mental retardation from inappropriate placement in nursing facilities.  Federal law requires that a Medicaid-certified nursing facility (NF) may not admit an applicant with serious mental illness (MI), mental retardation (MR), or a related condition, unless the individual is properly screened, thoroughly evaluated, found to be appropriate for NF placement, and will receive all specialized services necessary to meet the individual's unique MI/MR needs. NF residents with MI or MR must have a Resident Review when there is a significant change in the resident's physical or mental condition. The Centers for Medicare & Medicaid Services (CMS) requires each state and territory to specify the PASRR program in their Medicaid state plan.

All applicants to Medicaid-certified NFs (regardless of payer source) receive a Level I PASRR screen to identify possible MI/MR. These screens generally consist of forms completed by hospital discharge planners, community health nurses, or others as defined by the state. Individuals who do or may have MI/MR are referred for a Level II PASRR evaluation.

The Level II PASRR evaluation and determinations are to confirm whether the applicant has MI/MR for PASRR purposes, to assess the applicant's need for NF services, and to determine whether the applicant requires specialized MI/MR services. The State Mental Health Authority must use an independent evaluation (that meets minimum Federal criteria) in making the NF and specialized services determinations for MI. The State Mental Retardation Authority has responsibility for both the evaluation and the determination functions for MR. The State Mental Health or Mental Retardation Authority may delegate these responsibilities to another state agency (e.g., State Department on Aging) or a contractor. Determinations made by the State Mental Health or Mental Retardation Authority as to whether NF level of services and specialized services are needed must be based on an individualized Level II evaluation, except for certain categories of persons obviously likely to require nursing facility services, or for whom specialized services are not normally needed. States may elect in their Medicaid State plan to utilize these "categorical determinations" as defined in Federal regulations. Categorical determinations may be based on existing sources of data rather than an individualized Level II evaluation.

PASRR determinations must consider community services first, and recommend institutional placement only when appropriate. However, non-institutional long-term care services and supports for MI/MR may be unavailable or subject to long waiting lists. Consequently, PASRR determinations must document the most appropriate setting in which the individual could be served, but may conclude that in some cases NF is the most appropriate available service for the individual. If an individual with MI/MR is admitted into the NF, the NF plan of care must take into account all of the PASRR evaluation findings and service recommendations. The state must provide or arrange for any specialized services determined to be necessary.

CMS matches state expenditures for PASRR activities at 75% — meaning that states pay only 25 cents on the dollar.

PASRR can be coordinated with other efforts to divert and transition individuals from institutional placements, such as the state's Olmstead activities, and Money Follows the Person or other grants. PASRR interrupts what can be an otherwise almost automatic discharge process from hospital to nursing facility, providing the opportunity to identify alternative community supports. CMS has expanded PASRR technical assistance to states, and in cooperation with other partners such as the Substance Abuse and Mental Health Services Administration (SAMHSA), is working to maximize the effectiveness of PASRR to assure that individuals with MI and MR are served in the most appropriate manner.

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Page Last Modified: 11/17/2009 11:14:03 AM
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