PASRR is a provision at section 1919 (e) (7) of the Social Security Act. It requires that all Medicaid certified facilities neither admit nor retain individuals with mental illness, intellectual disability or related conditions unless a thorough PASRR evaluation indicates that such placement is both appropriate and the individual’s total care needs can be met. The state of Alabama uses the Level I Screening Form as an identification tool to classify individuals that may have MI/ID/RC diagnoses. The Social Security Act requires that the Level I Screening Form be completed prior to admission for all applicants seeking admission into a Medicaid certified facility, regardless of their payment source. The statute also requires nursing facilities to submit an updated Level I Screening Form to the OBRA Office for PASRR significant changes.

• Is applying for admission into an Alabama Medicaid certified nursing home
• Is discharged from an Alabama Medicaid certified nursing home into the community for more than 30 days
• Is transferring from an out of state nursing home to an Alabama Medicaid certified nursing home

• All out of state referrals must complete an Alabama Level I Screening Form and have it submitted to the OBRA Office for review prior to admission.

Nursing facilities must continuously monitor all residents for PASRR significant changes. These changes are mandated to ensure continued eligibility and appropriateness for nursing home level of care; this includes monitoring both re-admissions and residents that remain in the nursing home.

• Increased psychiatric, mood-related or behavioral symptoms of individuals with a MI/ID/RC diagnosis OR
• Individuals without a previous Level II history who obtain a new mental illness diagnosis
• Has never been evaluated through the PASRR process, but exhibits signs, symptoms and/or behaviors suggesting the presence of a mental disorder
• A Level I Screening Form must be updated for a significant change within 14 days of the status change
• Significant Changes can be Medical Declines, where the condition impacts the resident’s MI/ID/RC diagnosis
• A Significant Change is required for MI/ID/RC residents who were approved under a 120 Day Time limited Categorical, Convalescent Care Determination and are now expected to stay beyond the approved timeframe
• Individuals with MI/ID/RC who have been re-admitted to a nursing home following a hospital stay and have been identified as having a PASRR significant change must complete an updated Level I Screening Form within 14 days of the re-admission

A re-admission is a nursing home resident who returns to the same nursing home after a hospital stay. In these cases, unless the readmission is identified as having a PASRR significant change, an updated Level I Screening Form is not required.

An inter-facility transfer is a nursing home resident who transfers directly from one Alabama Medicaid Certified Nursing Facility to another Alabama Medicaid Certified Nursing Facility with or without an intervening hospital stay. There cannot be a break in institutional care. (E.g. nursing home or hospital)

Inter-facility Transfers do not require an updated Level I Screening Form submission. The discharging nursing home is responsible for ensuring that a copy of the PASRR documentation accompanies the resident to the receiving NF.

Remember: For inter-facility transfers, always ensure that the PASRR documentation exists and that it is complete and accurate.

• You must identify all admissions, discharges, and deceased residents who have a diagnosis of MI/ID/RC as determined by the OBRA Office on the Monthly Level II Report.
• The Level II Report is due by the 10th of every month.
• If there are no changes, an email or fax notification must be sent to the OBRA Office by the 10th of the month. The notification must include the following: facility name, contact person, fax and telephone number, and the terms, "Level II Report, NO CHANGES."
• When MI/ID/RC Categorical Convalescent Care residents are discharged from the nursing home prior to 120 days, these discharges must be included on the Monthly Level II Report.

• In order to meet the criteria for a Categorical Convalescent Care Admission, you must have the following: a minimum of OT/PT/ST 5x a week by a licensed therapist, be a direct admission from a hospital (cannot be in home/community setting) and must not be a danger to the safety or welfare of self or others.
• When nursing facilities receive the Categorical Convalescent Care Determination, they must contact the OBRA Office immediately upon admission to ensure that the Level II Evaluation is completed.
• Categorical Convalescent Care admissions are timed stays. They are valid for up to 120 days.
• If a Categorical Convalescent Care resident is expected to reside in your facility past the 120 day timed stay and needs additional PT/OT/ST, you must submit an updated Level I Form to the OBRA Office for a Significant Change prior to the expiration date. If not, your determination is invalid.
• If the PT/OT/ST frequency is reduced from 5x a week, the determination is invalid; in this case, you must either discharge the resident from your facility or submit an updated Level I Screening Form to the OBRA Office for a Significant Change from short-term to long-term status. If an update is completed for a change to long-term status, nursing facilities must ensure that the resident meets Alabama's level of care criteria.
• If the PT/OT/ST is discontinued prior to the 120 day period, the categorical convalescent care determination is no longer valid.
• When a Categorical Convalescent Care resident discharges from a Nursing Facility before the 120 day period expires, you must indicate this discharge on the Monthly Level II Report.