Preadmission Screening and Resident Review (PASRR)

Overview
Requirement
Setting PASRR Process
Out-of-State Arrangements
Frequently Asked Questions
Important Contact Information
Department Communications
Other Resources

Overview

Section 1919(e)(7) of the Social Security Act and Chapter 42 of the Code of Federal Regulations, Sections 483.100 through 483.138 specify the requirements for mental illness and mental retardation preadmission screening of all individuals before they enter a Medicaid certified nursing facility (NF), regardless of payment source.

Federal regulations require that PASRR Level I screenings take place prior to admission in order for a state to receive federal financial participation for Medicaid reimbursement of nursing home care. Individuals determined to require Specialized Services through the PASRR Level II process are prohibited from being admitted to a NF, or remaining in a NF.

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Requirement

The Level I PASRR Screening Tool must be completed for all applicants to a nursing facility (NF), before admission, regardless of whether or not Medicaid is payer for the applicant. Medicaid-certified NF may include facilities that are certified by both Medicaid and Medicare, or the Medicaid-certified distinct part of a larger institution.

The Level I PASRR Screening Tool (LTC-26) can be found on the Department of Health and Senior Services (DHSS) website http://web.doh.state.nj.us/apps2/forms/.

PASRR is not required for admissions to the following facilities:

• Assisted Living Facilities
• Fully private pay NF
• Transitional Care Units in hospitals
• New Jersey Veteran Homes

To find out if a nursing facility is Medicaid-certified, please use the department's searchable facility database.

Who can complete a Level I PASRR?

The minimum credentials for a professional completing the Level I PASRR Screening Tool is a Registered Nurse (RN) or Certified Social Worker* (CSW). *State, county and municipal employees are exempt from social work licensing or certification requirements pursuant to NJSA 45:15BB-5(f).

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Setting PASRR Process

Acute Care and Rehabilitation Hospitals – It is necessary for the hospital discharge planner to initiate the completion of the Level I PASRR Screening Tool for all discharges to a Medicaid certified NF.

• If the Level I is negative, then the individual can be admitted to the NF. A copy of the Level I must accompany the individual to the NF and must be placed on the active medical chart.
  
  
• If the Level I is positive for serious mental illness then a copy of the Level I must be faxed to the Division of Mental Health Services (DMHS) for a Level II Evaluation and Determination. –OR-
  
  
• If the Level I is positive for mental retardation or a related condition then a copy of the Level I must be faxed to the Division of Developmental Disabilities (DDD) for a Level II Evaluation and Determination. –OR-
  
  
• If the Level I is positive for serious mental illness AND mental retardation or a related condition, then a copies of the Level I must be faxed to both DMHS and DDD for a Level II Evaluation and Determination.

After completion of a positive Level I Screen, the discharge planner must issue written notice (LTC-29) to the individual and his or her legal representative that the individual needs a Level II evaluation for SMI or MR and is being referred to the State Mental Health or Mental Retardation Authority. A copy of the letter can be downloaded here: http://web.doh.state.nj.us/apps2/forms/.

Additionally, positive screens for individuals on Medicaid, or will be Medicaid eligible within 180 days, must be referred to the Office of Community Choice Options for a Level of Care assessment. A Level of Care assessment is not required for private pay or private insurance individuals.

Exempted Hospital Discharge - Individuals discharged from an acute hospitalization directly to a NF for continued treatment of a condition expected to require less than 30 days of admission may exempt from PASRR requirements with physician certification. If after 30 days the individual remains in the NF for more than 30 days, the NF must complete the Level II Evaluation and Determination process by day 40.

NF Admissions from the Community – NF staff must coordinate the completion of the Level I PASRR Screening Tool for all admissions to a Medicaid certified NF.

• If the Level I is negative, then the individual can be admitted to the NF. A copy of the Level I must accompany the individual to the NF and must be placed on the active medical chart.
  
  
• If the Level I is positive for serious mental illness then a copy of the Level I must be faxed to the Division of Mental Health Services (DMHS) for a Level II Evaluation and Determination. –OR-
  
  
• If the Level I is positive for mental retardation or a related condition then a copy of the Level I must be faxed to the Division of Developmental Disabilities (DDD) for a Level II Evaluation and Determination. –OR-
  
  
• If the Level I is positive for serious mental illness AND mental retardation or a related condition, then a copies of the Level I must be faxed to both DMHS and DDD for a Level II Evaluation and Determination.

Individuals being admitted to a Medicaid certified NF for a county or state approved respite stay can be exempt from the Level II Evaluation and Determination by the DMHS or DDD utilizing Categorical Determinations. DMHS and/or DDD can apply them prior to the Level II Evaluation and Determination process.

After completion of a positive Level I Screen, NF staff must issue written notice (LTC-29) to the individual and his or her legal representative that the individual needs a Level II evaluation for SMI or MR and is being referred to the State Mental Health or Mental Retardation Authority. A copy of the letter can be downloaded here: http://web.doh.state.nj.us/apps2/forms/.

Positive screens on for individuals on Medicaid, or will be Medicaid eligible within 180 days, must be referred to the Office of Community Choice Options for a Level of Care assessment. A Level of Care assessment is not required for private pay or private insurance individuals. A Level of Care assessment is not required if the individual is being exempted from the Level II process using Categorical Determinations.

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Out-of-State Arrangements

An individual being referred for NF admission from a state other than New Jersey must have a completed Level I, and if positive, a completed Level II Evaluation and Determination, prior to admission. It is the responsibility of the admitting NF in New Jersey to ensure receipt of those PASRR documents from the referring state.

If the individual is on Medicaid, either in New Jersey or another state, or will be Medicaid eligible in 180 days, the referring facility must contact the Office of Community Choice Options Field Office at the number below and request an Out-of-State packet. The Office of Community Choice Options manager will walk the referrer through the process.

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Frequently Asked Questions

• PASRR Questions and Answers [pdf 111k]

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Important Contact Information

PASRR Level I Process

Division of Aging and Community Services
(609) 633-8604

Office of Community Choice Options

PASRR Level II Process

Department Communications

• Letter to Providers, Sept. 21, 2010 [pdf 107m]
  
  
• Letter to Hospital and Nursing Facilities, Oct. 18, 2010 [pdf 112k]
  
  
• Notice of Changes to PASRR Process, DHS/DMAHS Newsletter, Vol. 20, No. 25, Oct. 2010 [pdf 31k]

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Other Resources

• PASRR Powerpoint Presentation Fall 2011 [ppt 221k]
  
  
• Centers for Medicare and Medicaid Services (CMS)

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