State Preadmission Screening and Resident Review (PASRR) Program

1. PASRR Level I hide All Applicants prior to admission to a Medicaid – Certified NF Regardless of Payer Identification Screen hide hide MI MR State Preadmission Screening and Resident Review (PASRR) Program General PASRR Process • The purpose of PASRR is to • ensure that Nursing Facility • applicants and residents • with Mental Illness and/or • Mental Retardation are: • Identified • Admitted or retained in a Nursing Facility (NF) only if they need NF services • Provided with Specialized Services (SS), if needed No evidence of MI/MR Evidence of MI/MR PASRR Level II Evaluation The PASRR regulations are complex. The complexity mostly has to do with provisions to reduce unnecessary evaluations in certain circumstances, e.g., categorical determinations. For most individuals, PASRR is straightforward hide Review of NF Residents when needs change • Determinations • Need for SS • Need for NF hide Medicaid – Certified NF If NF is not needed, PASRR ends. State makes other placement. Placement Options hide hide Jan Earle, Centers for Medicare and Medicaid Services jearle@cms.hhs.gov

2. Level I Identification Screen For suspected MI/MR MI MR MI/MR MI MR MI/MR MI MR MI/MR Suspected MI Suspected MR Suspected MI/R MI MR MI/MR Suspected MI Suspected MR Suspected MI/MR State Preadmission Screening and Resident Review (PASRR) Program Level I: State PASRR program screens for possible mental illness (MI) or mental retardation (MR) in nursing facility (NF) applicants and NF residents. This pre-PASRR activity is referred to as Level I. Nursing Facility Applicants: Level I Identification Screen Nursing Facility Residents: Level I Identification Screen Residents without identified MI/MR Residents with Identified MI/MR All Applicants, regardless of payer, before admission to a Medicaid-certified NF (or distinct part) MDS Indicates suspected MI/MR MDS Indicates significant change in condition1 NF notifies SMH/MRA NF notifies SMA or Designee SMA or designee: Does MDS data support Need for RR? 1 Exemption from Level II for certain Hospital Discharges Track exempted NF admissions with suspected MI/MR. Stays > 30 days get Level II evaluation Yes No Yes Level II PASRR Evaluation Preadmission Screening (PAS) hide Resident Review (RR) hide MI MR MI/MR MI MR MI/MR 1Any change in MDS is reported. Therefore, State Medicaid Agency (SMA) or designee determines relevance to MI/MR and whether Level II evaluation is needed. Jan Earle, Centers for Medicare and Medicaid Services jearle@cms.hhs.gov

3. Process same as for Mental Illness, except that State Mental Retardation Authority is responsible for both evaluations and determinations PASRR Level II — Mental Retardation MI and MR Any applicant or resident with indication of both MI and MR receives both evaluations Group Determination by Category1: SS not Needed ( NF Needed) No Yes NF Determination By State MI Authority Based on individual's total needs and capability of specific NF to meet those needs hide State Preadmission Screening and Resident Review (PASRR) Program Level II: Produces 2 Determinations — Need for NF and Need for SS. MI and MR are evaluated separately. Evaluations are individualized except for certain group determinations by category. NF applicants identified in Level I with suspected MI/MR NF residents with suspected new or changed MI/MR hide PASRR Level II — Mental Illness Level II: Resident Review (RR) Level II: Preadmission Screening (PAS) hide Group Determination by Category1: NF needed Individualized Evaluation by entity independent of State Mental Illness Authority No Categorical Determination Yes Categorical NF Determination hide hide hide Categorical evaluation report Categorical NF report / Individualized SS eval report hide hide SS Determination by State MI Authority hide hide Individualized evaluation report hide 1If Categories are established by the state and included in the state plan. SS categories limited to emergency, respite, delirium, and MR/dementia. Jan Earle, Centers for Medicare and Medicaid Services jearle@cms.hhs.gov