FAQs

Federal regulations governing PASRR do not specify restrictions on who can conduct Level I screens.

Yes, the CMS Long-Term Care Facility Resident Assessment Instrument (RAI) User’s Manual requires the NF to provide notification to the State-designated mental health (MH) or intellectual disability (ID) authority promptly when a resident with mental illness or intellectual disability experiences a significant change in mental or physical status. Referral to the MH/ID authority should be made as soon as the criteria indicative of a significant change are evident. For more information, see FAQ “What is considered a significant change in condition?”

According to 42 CFR 483.106(a)(2), Basic Rule, the only true exemption from PASRR is the Exempted Hospital Discharge (EHD). The EHD may be applied for an individual who (a) is admitted to any nursing facility (NF) directly from a hospital after receiving acute inpatient care at the hospital, (b) requires NF services for the condition for which he or she received care in the hospital, and (c) has been certified by an attending physician before admission to the NF to likely to require fewer than 30 days NF services.

Part 42, Subpart C of the Code of Federal Regulations (CFR) contains the guiding regulations for PASRR compliance. Currently, 42 CFR 483.106(b) includes a reference to the DSM-III-R in the definition of serious mental illness; the DSM-III-R was the most current edition of the DSM available when the PASRR regulations were promulgated in 1992.

"According to 42 CFR §483.106(b)(4) of the Code of Federal Regulations (CFR), when an individual is transferred from one nursing facility (NF) to another NF, with or without an intervening hospital stay, the individual is not considered a “new admission” and does not need preadmission screening. 42 CFR 483.106(b)(4)(ii) clarifies that the transferring NF must ensure that all copies of the resident’s PASRR paperwork (including any Level II information) must be transferred with the individual.

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.

In order to be eligible for federal financial participation (FFP), Specialized Services must be included in the State Plan. They are considered “specialized add-on services” that can be provided under the nursing facility benefit authorized the Section 1905(a) of the Social Security Act.

"States may claim the enhanced 75% match rate for PASRR-related activities by completing the Form CMS-64. Specifically, a state should use line 10 to claim its “Preadmission Screenings Costs,” i.e. PASRR activities that happen before admission into a nursing facility. A state should use Line 11 for “Resident Review Activities Costs,” i.e. resident evaluations triggered by a significant change in condition that affects an individual's disability-specific needs.

The dementia exclusion for mental illness allows for the Level II evaluator to stop the evaluation if they determine that the diagnosis of dementia is primary and the mental illness (MI) diagnosis is secondary. It is important to note that the diagnosis or verification of a diagnosis of MI and dementia are Level II functions required to be conducted by mental health professionals and cannot be done by Level I reviewers. The identification of dementia must be done by the Level II evaluator as part of the diagnosis or verification of the diagnosis of MI.