PASRR is guided by federal regulations that require: (1) 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; and (2) all NF residents experiencing a significant change in mental or physical status to be reviewed to determine if the change is connected to mental illness, intellectual disability or related condition. The PASRR process is intended to assure that NF placement is, or continues to be, appropriate, and that any individual with a mental illness, intellectual disability, or related condition receives services that may be needed to address his or her unique needs. State Medicaid, Mental Health (MH), and Intellectual Disability (ID) Authorities are responsible for PASRR.
The Minimum Data Set (MDS) 3.0 is a core set of screening, clinical, and functional status elements that support a comprehensive assessment for all NF residents. The MDS 3.0 is one of three components to the Resident Assessment Instrument, which all NFs must use, and which helps NF staff develop an individualized care plan based on the resident’s strengths and needs. The MDS must be performed within 14 days of a resident’s admission to a NF and then is periodically updated according to a specified schedule. The data collected on the MDS assessment is sent to CMS and is an important component of Survey and Certification enforcement.
PASRR and MDS 3.0 are linked in two ways that advance quality improvement at the program level and quality of care for NF residents:
- PASRR specific MDS data, and other MDS items that ask about PASRR‐related diagnoses, have contributed to PTAC National Reports in 2014, 2015, and 2016. These reports measure the effectiveness of PASRR in identifying individuals with a mental illness, intellectual disability, or related condition.
- MDS PASRR questions guide State Survey Agency staff in checking for NF PASRR compliance, including incorporating any recommended Specialized Services identified in the Level II report in the NF plan of care; confirming that PASRR screenings and any required evaluations were done prior to admission; and confirming that NFs notify state authorities when an individual admitted under the Exempted Hospital Discharge stays beyond 30 days.
- A MDS review, based on a Significant Change in Status, requires the NF to notify the appropriate MH or ID authority of the need for a Resident Review, if question A1500 of the MDS shows that the person was identified by PASRR as having a mental illness, intellectual disability, or related condition.
*It is important that states understand that CMS guidance to NFs on actions to take when there is a significant change in status addresses individuals who have previously been identified by PASRR and individuals who may not have been identified as having a PASRR condition at the time of admission. (See FAQ “What is considered a significant change in status?”)