TOPIC: LAWS & RULES

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

This presentation will identify key changes to Preadmission Screening and Resident Review (PASRR) requirements being proposed in the recently-released Notice of Proposed Rulemaking. PASRR is a statutory requirement that states screen all applicants to and residents of Medicaid-certified nursing homes for mental illness and intellectual disability and, when possible, divert or transition these individuals to community placements. The presentation will provide a basic overview of PASRR”s statutory requirements and highlight proposed regulatory changes that support community integration.

This paper builds on the Coverage Learning Collaborative guidance from the Centers for Medicare & Medicaid Services (CMS) on how states can support Medicaid operations and enrollees in times of emergency but focuses on options for addressing Preadmission Screening and Resident Review (PASRR) requirements. The purpose of this paper is to clarify the range of options that states have for addressing PASRR responsibilities, including those that do not require waiving PASRR requirements as part of an 1135 waiver. PASRR scenarios have been included to address common questions raised by nursing facilities (NFs) in past emergencies. This paper supersedes prior Center for Clinical Standards and Quality All-Hazards guidance.

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.

This webinar will highlight the ongoing relationship of State Authorities and Nursing Facilities (NF) throughout the PASRR process. The webinar will address 1) the relationship between PASRR and Nursing Facility level of care; 2) the relationship between the PASRR regulations and the recently updated regulations that govern the conditions of participation for long-term care facilities; and 3) the relationship between PASRR and MDS 3.0. Various FAQs from the PTAC website will be used as reference material.

The PASRR Final Rule (57 FR 56450) was published in 1992, at which time the term "mental retardation" was still widely used. In the time since the PASRR Final Rule was published, the term "intellectual disability" has come to replace "mental retardation" in most state laws.