Pre-Admission Screening & Resident Review
Pre-Admission Screening and Resident Review (PASRR) is a federally mandated program under the federal Omnibus Reconciliation Act (Public Law 100-203) and 42 CFR 483.100-38. The program requires that individuals, regardless of payment source, applying for admission to or residing in a Medicaid Certified Nursing Facility be screened for mental illness, intellectual disability or related conditions which affect intellectual functioning. Federal law prohibits payment for Nursing Facility services until the PASRR screening has been completed. The mandate applies to all individuals prior to admission to a Medicaid–certified long-term care nursing facility, regardless of payer.
Goals
To evaluate all individuals prior to admission to a Medicaid Certified Nursing Facility (NF) for evidence of Mental Illness (MI), Intellectual Disability (ID) and Related Condition (RC).
To ensure that individuals with Mental Illness (MI), Intellectual Disability (ID), or Related Condition (RC) are evaluated for placement in the least restrictive environment.
To identify their disability specific needs and make recommendations for Specialized Services (SS) when needed.
Level I – Screening
A preliminary screening to identify individuals who may have Mental Illness (MI), Intellectual Disability (ID), and/or Related Condition (RC).
The nursing facility is responsible for ensuring a Level I screen is completed for everyone prior to admission.
The hospital discharge planner is responsible for submitting a Level I screen to the nursing facility and a positive (trigger) Level I screen to PASRR. A level I screens that do not trigger are not submitted to PASRR, however, must be provided to the nursing facility.
NOTE: Effective February 1, 2017, the revised New Mexico PASRR Level I Identification screen must be used. NM PASRR will not accept the New Mexico PASRR Level I identification screen dated 1/06.
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Level II – In-depth Evaluation
An in-depth evaluation to determine if an individual who “triggers” at Level I, in fact has Mental Illness (MI), Intellectual Disability (ID) and/or Related Condition (RC) for the purposes of PASRR.
Level II assessment are required when the individual is being admitted to a nursing facility for long term placement, which may occur prior to admission or after a convalescent waiver is due to expire.
Waivers
A waiver to the Level II Evaluation may be issued on behalf of an individual, if they meet criteria on the PASRR Level I Identification Screen for Mental Illness (MI), Intellectual Disability (ID) and/or Related Condition (RC).
Convalescent Care Waiver
A Convalescent Care Waiver (CCW) may be issued when an individual will be admitted to a nursing facility directly from a hospital stay for skilled nursing care for a period not to exceed 30 days. Physician’s orders are required. Language required in the order; “Admit (name of individual) to (name of skilled nursing facility) for convalescent care for (specific medical condition being treated for at the hospital) for a period not to exceed 30 days.” The physician must sign the order (electronic signature is acceptable).
This waiver is time limited to a period of 30 days. If the individual will remain in the nursing facility, a Level II evaluation will be required, after a 30 day stay.
Dementia Waiver
May be issued when an individual will be admitted to a nursing facility for short term or long term stay. The individual has a primary diagnosis of Dementia followed by a diagnosis of Mental Illness (MI), Intellectual Disability (ID), or Related Condition (RC) which impacts intellectual capabilities. Physician certification or medical records documentation of dementia via brain scan or mental status exam is required. Language required in the certification; “(name of individual) has a primary diagnosis of Dementia with a secondary diagnosis of (specific Mental Illness (MI), Intellectual Disability (ID) or specific Related Condition (RC).” The physician must sign the certification (electronic signature is acceptable).
There is no time limit for stay in a nursing facility. In the event a Dementia waiver is issued; a Level II assessment will not be needed.
Severity of Illness Waiver
May be issued when an individual will be admitted to a nursing facility, when he/she has an end of life diagnosis which could include hospice services. Verification of end of life diagnosis or hospice admission documentation is required.
There is no time limit for stay in the nursing facility. In the event a Severity of Illness waiver is issued; a Level II assessment will not be needed.
The nursing facility should contact PASRR if there is a change in the individual’s status.
Respite Stay Waiver
May be issued when an individual will be admitted to a nursing facility for a period not to exceed 14 days. A physician’s order is required. Language required on the order; “(name of individual) will be admitted to (name of nursing facility) for respite stay for a period not to exceed 14 days.” The physician must sign the order (electronic signature is acceptable).
This type of waiver is time limited to 14 days. In the event the individual will remain longer than 14 days, a Level II assessment will be required.
Frequently Asked Questions
Should all Level I screens be sent to PASRR?
No. Only Level I screens where the individual triggers for Mental Illness (MI), Intellectual Disability (ID) and/or Related Condition (RC) should be submitted to NM PASRR.
What is the definition of trigger in reference to a Level I Identification Screen?
Trigger means when each item in Section C – Mental Illness (MI) criteria has been checked as yes, and/or each item in Section D – Intellectual Disability (ID) criteria have been checked as yes, and/or the item in Section E – Related Condition (RC) criteria has been checked as yes. This indicates; the individual completing the Level I Identification Screen has evidence to support a diagnosis of Mental Illness (MI), Intellectual Disability (ID) and/or Related Condition (RC) on behalf of the individual being referred to PASRR.
Should a nursing facility admit an individual who has a Level I screen or Level II assessment from a different state?
Yes, PASRR is federally mandated. A nursing facility can accept Level I and Level II assessments from different states, when the Level I and Level II assessment have been completed correctly. The nursing facility should contact NM PASRR to advise of the admission in the event other PASRR steps are needed.
Can a Level I identification screen be sent via email?
No. NM PASRR does not have a secure feed with hospitals and/or nursing facilities.
When an individual is admitting to a nursing facility from home does the nursing facility need to complete a Level I?
The Level I must be completed by either the nursing facility or the referring doctor for every individual who will be admitted to a nursing facility. However, those individuals will admit from home to a nursing facility, who trigger for Mental Illness (MI), Intellectual Disability (ID) and/or Related Condition (RC), a Level II assessment must be completed prior to admission.
How can admission to a nursing facility be expedited?
If an individual will be admitted to a nursing facility for skilled nursing, a doctor’s order is required. Language required in the order; “Admit (name of individual) to (name of skilled nursing facility) for convalescent care for (specific medical condition being treated for at the hospital) for a period not to exceed 30 days.” The physician must sign the order (electronic signature is acceptable).
Is substance abuse a qualifying diagnosis?
Yes, substance abuse is a mental illness diagnosis therefore C-1 is a yes on the Level I Identification screen. For substance abuse to trigger for a Level II assessment, C-2 and C-3 must also be answered yes.
How long will a Level I identification screen or a Level II Evaluation take to be completed?
Per PASRR federal law, NM PASRR has:
- nine (9) business days from date of receipt of a completed Level I Identification screen to make a determination and communicate with the nursing facility if the individual should be admitted;
- 10 calendar days from the expiration date on a convalescent waiver to complete a Level II Evaluation; and
- nine (9) business days to complete a Level II Evaluation when the individual will be admitted for long term nursing care from the date of receipt of the completed Level I Identification screen.
New Mexico PASRR attempts to complete all Level I Identification Screens within two business days, unless the team is unavailable due to being out of town completing assessments.
Recent Activity
Publications
Latest
- PASRR Level 1 Training Slideshow Presentation (Presentation)
- PASRR Level 1 Identification Screen Form (Form)