FAQs

A number of states with internal or vendor provided e-PASRR systems have agreed to be a resource for state to state consultation around their e-PASRR experience. A full listing of the states and a contact person may be found on the following e-PASRR Resource Guide.

The Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, version 1.5, provides guidance to nursing facilities (NF) on when a significant change requires referral for a PASRR Resident Review evaluation if a mental illness, intellectual disability, or related condition is present or is suspected to be present.

PASRR requirements cannot be waived or suspended in an emergency unless the state receives authority to do so under an 1135 waiver. Under Section 1135 of the Social Security Act, the HHS Secretary may be authorized to take certain actions during eligible major disasters or emergencies. These actions may include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to help meet the needs of eligible individuals and providers living in emergency areas. Additional information about 1135 waivers can be found on the Section 1135 Waiver Flexibilities webpage on Medicaid.gov, located at: https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/cms-1135-waivers/index.html

Need for nursing facility (NF) services is defined by individual states, all of whom establish NF level of care (LOC) criteria. The LOC assessments are conducted for NF applicants separately from the PASRR process, but Section 1919(b)(3)(F) of the Social Security Act prohibits NFs from admitting any new resident who has serious mental illness (SMI) or an intellectual disability or related condition (ID/RC), unless it has been determined by the State Mental Health Authority (SMHA) or State Intellectual Disability Authority (SIDA) that because of the physical and mental condition of the individual, nursing facility services are needed.

Level II evaluations for individuals with intellectual disabilities and/or related conditions: According to 42 CFR 483.106(e)(1) and 42 CFR §483.106(e)(2) of the Code of Federal Regulations (CFR), evaluations for individuals with intellectual disabilities (ID) and/or related conditions (RC) are the responsibility of the state intellectual disability authority (SIDA). Thus, the state intellectual disability authority may complete ID/RC Level II evaluations. 42 CFR 483.106 (e)(1) allows the SIDA to delegate, by subcontract, the evaluation to another entity, but the SIDA must retain ultimate responsibility for the performance of this duty. Additionally, 42 CFR 483.106(e)(1)(iii) explicitly prohibits the SIDA from delegating evaluations to a NF or an entity that has a direct or indirect affiliation or relationship with a NF. NFs and their staff may not perform Level II evaluations on behalf of the SIDA.

The April 10, 2018 FAQ “Are individuals with a traumatic brain injury (TBI) subject to PASRR?” confirms that all individuals applying to a Medicaid-certified nursing facility (NF), regardless of diagnosis, must undergo a Level I screen to determine if the individual possibly has a condition meeting PASRR’s definition of mental illness, intellectual disability or a related condition.

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Adults or children who have been identified as having a Preadmission Screening and Resident Review (PASRR) disability sometimes move from a nursing facility (NF) in one state to an NF in another state. State staff members who administer PASRR programs often have questions about how such moves should be handled. For example: When does the individual need a new evaluation? And what happens if the Specialized Services an individual was receiving in State A are not available in State B? The purpose of this brief is two-fold: (1) to establish a framework for reasoning through these questions and (2) to present a series of scenarios, formulated as questions, that address situations that commonly arise.

For a variety of reasons, including the availability of evaluators, it may not always be possible to perform a complete psychiatric evaluation on an individual before they are admitted to a nursing facility (NF). In these cases, it is possible to rely instead on information in the individual's medical record and/or psychosocial history.