Pre-Admission Screening and Resident Review (PASRR)
Preadmission Screening and Resident Review (PASRR) is guided by federal regulations that require all individuals being considered for admission to a Medicaid-certified nursing facility (NF) be screened prior to admission, to determine if the person has, or is suspected of having, a mental illness, intellectual disability, or related condition.
PASRR helps to ensure that individuals are not inappropriately placed in nursing homes for long term care. PASRR requires that 1) all applicants to a Medicaid-certified nursing facility be evaluated for mental illness (MI) and/or intellectual disability (ID); 2) be offered the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings); and 3) receive the services they need in those settings including specialized services.
- Q1: What is a PASRR Level I Screening?
- Q2: When and where is a Level I Screening conducted?
- Q3: How soon does the PASRR Level I Screening need to be completed?
- Q4: Who can complete a Level I Screening?
- Q5: What is a PASRR Level II Evaluation?
- Q6: What is the determination of a Level II Screening?
- Q7: Who can complete a Level II evaluation?
- Q8: If an individual tests positive in the Level I Screening for both MI and ID, are separate Level II evaluations needed?
- Q9: How long does it take for a PASRR Level II Evaluation to be completed?
- Q10: Who is exempted from a PASRR Level II Evaluation?
- Q11: What are Specialized Services?
- Q12: Is another Level I Screening and/or another Level II Evaluation required when an individual is transferred to another Nursing Facility?
- Q13: When are Resident Reviews required?
Q1: What is a PASRR Level I Screening?The PASRR Level I Screening is a preliminary assessment completed for all individuals prior to admission to a Medicaid-certified Nursing Facility in order to determine whether an individual might have a mental illness or intellectual disability.
Q2: When and where is a Level I Screening conducted?A Level I Screening must be completed before an individual can be admitted into a Medicaid- certified nursing facility and can be completed in a hospital, emergency room, doctor’s office or in any community setting.
Q3: How soon does the PASRR Level I Screening need to be completed?There is no set timeline for how quickly Level I's must be completed. Not all individuals enter NFs from hospitals, and the discharge planning process can vary dramatically depending on the circumstances of the individual and the practices of the discharging hospital. Moreover, Level I Screenings, but must be completed prior to an individual’s admission to the NF.
Q4: Who can complete a Level I Screening?The Level I Screening may be completed by all entities involved in the PASRR process, such as hospital discharge planners, case managers, nursing facility staff, social workers or other qualified health professionals.
Q5: What is a PASRR Level II Evaluation?The PASRR Level II is a comprehensive evaluation required as a result of a positive Level I Screening. A Level II is necessary to confirm the indicated diagnosis noted in the Level I Screening and to determine whether placement or continued stay in a Nursing Facility is appropriate.
Q6: What is the determination of a Level II Screening?The determination is the outcome of the Level II evaluation which ensures that Nursing Facility placement is, or continues to be, appropriate, and that services provided to individuals with a MI, ID, or related condition meet the individual’s needs, including the need for specialized services.
Q7: Who can complete a Level II evaluation?Level II evaluations for individuals with ID are performed by the Department of Economic Security (DES) and evaluations for individuals with MI are coordinated by AHCCCS and performed by a designated entity.
Q8: If an individual tests positive in the Level I Screening for both MI and ID, are separate Level II evaluations needed?All individuals requiring admission to a Medicaid-certified Nursing Facility must be screened for both mental illness and intellectual disability. An individual who tests positive for both MI and ID must undergo two separate Level II Evaluations – one for mental illness coordinated by AHCCCS and one for intellectual disability performed by DES.
Q9: How long does it take for a PASRR Level II Evaluation to be completed?Level II determinations must be completed within 7-9 working days.
Q10: Who is exempted from a PASRR Level II Evaluation?A request for a PASRR Level ll Evaluation is not required under the following circumstances:
- When it is determined that an individual has a primary diagnosis of dementia and a secondary diagnosis of mental illness or intellectual disability. Conversely, a PASRR Level II must be requested if an individual has a primary diagnosis of an MI and/or ID and a secondary diagnosis of dementia.
- For individuals requiring admission to a nursing facility for a convalescent period, or respite care (not to exceed 30 consecutive days), do not require a PASRR Level II Evaluation. If it is later determined that the admission will last longer than 30 consecutive days, a new PASRR Level I Screening must be completed as soon as possible or within 40 calendar days of the admission date to the nursing facility.
- When an individual meets one or more of the following as a result of a terminal or severe illness:
- An individual has been diagnosed with a terminal illness and has a life expectancy of < 6 months (records supporting the terminal state must be present), and there is not a current risk to self or others and behaviors/symptoms are stable.
- An individual has been diagnosed with a severe illness including, brain-stem dysfunction, progressed ALS, progressed Huntington’s disease, when in a Coma state, is ventilator dependent, etc., of such severity that the individual would be unable to participate in a program of specialized care associated with his/her MI and/or ID or related condition.
Q11: What are Specialized Services?When the recommended services resulting from the PASRR Level II evaluation are beyond those normally provided and included in the NF daily rate, they are considered Specialized Services. These services have three key characteristics:
- They address individualized needs related to a person’s MI and/or ID or a related condition, as identified in the Level II evaluation.
- They are provided to the individual during their residency in the NF.
- They exceed the services a NF typically provides under its daily rate. Recall that PASRR applies to any individual applying for admission to a Medicaid-certified nursing facility, regardless of insurance type. Any applicant to a Medicaid-certified NF may need Specialized Services, regardless of insurance type.
Q12: Is another Level I Screening and/or another Level II Evaluation required when an individual is transferred to another Nursing Facility?When an individual is transferred from one NF to another NF, with or without an intervening hospital stay, the individual is not considered a “new admission” and therefore, another Level I Screening or Level II Evaluation is not necessary.
Q13: When are Resident Reviews required?Nursing facilities are required to notify the state mental health authority (AHCCCS) or state intellectual disability authority (DES), as applicable, of the need for a Resident Review promptly after a significant change in the mental or physical condition of a resident who has, or is suspected of having, a mental illness, intellectual disability or related condition. All PASRR screening information shall accompany the readmitted or transferred individual.