Under the federally-mandated Preadmission Screening and Resident Review (PASRR) program, all customers entering a Medicaid-certified nursing facility after January 1, 1989 must be screened for intellectual cognitive disability and serious mental illness (ICD/MI), to avoid inappropriate placement.
The PASRR is a two-level screening process. Hospital discharge planners and nursing facility staff complete the PASRR prior to admission to a nursing facility (NF). The Level I screening determines whether the customer has any diagnosis or other presenting evidence that suggests the presence of ICD/MI. If there is an indication of ICD/MI, the case must be referred for a Level II determination.
The Level II screening determines whether the customer is ICD/MI and whether he or she can be appropriately treated in a NF setting. If a Level II determination is indicated in Section E of the PASRR Screening Document, the customer or the customer’s representative must sign in Section F. Admission to a NF cannot occur until the Level II is completed and indicates that NF admission is appropriate.
Referrals for Level II evaluations for potential mental illness are sent to the PASRR Coordinator at the Arizona Department of Health Services, Division of Behavioral Health Services. Referrals for Level II evaluations for potential intellectual cognitive disability are sent to the Arizona Department of Economic Security, Division of Developmental Disabilities.
Nursing facilities must do all of the following for PASRR:
· Ensure that the Level I screening and, if applicable, Level II determinations have been completed and are kept in the customer’s current medical chart;
· Perform a new Level I screening and, if applicable, a Level II, when a customer enters a NF for convalescent or respite care and is later found to require more than 30 days of NF care; and
· Perform a new Level I screening and, if applicable, a Level II, when a customer’s mental health condition changes or new medical records information becomes available that indicates the possible need for a Level II referral.
PAS Assessors shall report any nursing facilities that are not in compliance with this regulation to the PASRR Coordinator in DHCM.
Term |
Definition |
Intellectual cognitive disability |
Is defined as a chronic disability that impairs general intellectual functioning or adaptive behavior and requires treatment or services. The impairment must be demonstrated before age 22. The impairment must be likely to continue indefinitely and substantially limit the customer’s ability to function in major life activities. |
Serious mental illness |
Is defined as a condition that impairs emotional or behavioral functioning to the point that it interferes with the person’s ability to remain in the community without supportive treatment. The mental impairment is severe and persistent and may limit the customer’s ability to: · Function in primary activities of daily living, interpersonal relationships, homemaking, self-care, employment or recreation; or · Seek or receive local, state or federal assistance such as housing, medical and dental care, rehabilitation services, income assistance and food stamps, or protective services. NOTE Although people with a primary diagnosis of intellectual cognitive disability frequently have similar problems or limitations, they are not included in this definition. |
Completed PASRR Level I screening and Level II determination, if applicable, in customer’s case file maintained by nursing facility.
Program |
Legal Authorities |
ALTCS |
42 USC 1396b 42 CFR 483.112 42 CFR 483.130 ARS 36-2903.03 AAC 9-28-404 |