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What is PASRR?
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.
An Alabama Preadmission Level I Screening Form is required for everyone who:
- 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
Out of State Referrals
- 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.
Significant Changes
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.
A Level I Screening Form Update/Significant Change is required for any of the following: (not an exhaustive list)
- 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
What is a 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.
What is an Inter-facility Transfer?
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.
PASRR Regulatory Tracking Requirements/Monthly Level II Report
- 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.
Categorical Convalescent Care Rules (MI/ID/RC)
- 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.
Important Reminder: The state of Alabama requires all out of state nursing facilities to complete an
Alabama Level I Screening Form prior to admission.
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JOB OPENING (OBRA Office)
Submit Level I Screenings
- Don't forget to login if you need to submit a Level I screening.
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