A1500: Preadmission Screening and Resident Review (PASRR)

Item Rationale

Health-related Quality of Life

All individuals who are admitted to a Medicaid certified nursing facility, regardless of the individual’s payment source, must have a Level I PASRR completed to screen for possible mental illness (MI), intellectual disability (ID), developmental disability (DD), or related conditions (please contact your local State Medicaid Agency for details regarding PASRR requirements and exemptions).

Individuals who have or are suspected to have MI or ID/DD or related conditions may not be admitted to a Medicaid-certified nursing facility unless approved through Level II PASRR determination. Those residents covered by Level II PASRR process may require certain care and services provided by the nursing home, and/or specialized services provided by the State.

A resident with MI or ID/DD must have a Resident Review (RR) conducted when there is a significant change in the resident’s physical or mental condition. Therefore, when an SCSA is completed for a resident with MI or ID/DD, the nursing home is required to notify the State mental health authority, intellectual disability or developmental disability authority (depending on which operates in their State) in order to notify them of the resident’s change in status. Section 1919(e)(7)(B)(iii) of the Social Security Act requires the notification or referral for a significant change.1

Each State Medicaid Agency might have specific processes and guidelines for referral, and which types of significant changes should be referred. Therefore, facilities should become acquainted with their own State requirements.

Please see https://www.medicaid.gov/medicaid/long-term-services-supports/institutional- long-term-care/preadmission-screening-and-resident-review/index.html for CMS information on PASRR.

Planning for Care

The Level II PASRR determination and the evaluation report specify services to be provided by the nursing home and/or specialized services defined by the State.

The State is responsible for providing specialized services to individuals with MI or ID/DD. In some States specialized services are provided to residents in Medicaid- certified facilities (in other States specialized services are only provided in other facility types such as a psychiatric hospital). The nursing home is required to provide all other care and services appropriate to the resident’s condition.

The services to be provided by the nursing home and/or specialized services provided by the State that are specified in the Level II PASRR determination and the evaluation report should be addressed in the plan of care.

Identifies individuals who are subject to Resident Review upon change in condition.

Steps for Assessment

Complete if A0310A = 01, 03, 04 or 05 (Admission assessment, Annual assessment, SCSA, Significant Correction to Prior Comprehensive Assessment).

Review the Level I PASRR form to determine whether a Level II PASRR was required.

Review the PASRR report provided by the State if Level II screening was required.

Coding Instructions

Code 0, no: and skip to A1550, Conditions Related to ID/DD Status, if any of the following apply:

PASRR Level I screening did not result in a referral for Level II screening, or

Level II screening determined that the resident does not have a serious MI and/or ID/DD or related conditions, or

PASRR screening is not required because the resident was admitted from a hospital after requiring acute inpatient care, is receiving services for the condition for which they received care in the hospital, and the attending physician has certified before admission that the resident is likely to require less than 30 days of nursing home care.

Code 1, yes: if PASRR Level II screening determined that the resident has a serious mental illness and/or ID/DD or related condition, and continue to A1510, Level II Preadmission Screening and Resident Review (PASRR) Conditions.

Code 9, not a Medicaid-certified unit: if bed is not in a Medicaid-certified nursing home. Skip to A1550, Conditions Related to ID/DD Status. The PASRR process does not apply to nursing home units that are not certified by Medicaid (unless a State requires otherwise) and therefore the question is not applicable.

Note that the requirement is based on the certification of the part of the nursing home the resident will occupy. In a nursing home in which some parts are Medicaid certified and some are not, this question applies when a resident is admitted, or transferred to, a Medicaid certified part of the building.