​Pennsylvania PASRR Process

PASRR requires that

1. all applicants to a Medicaid-certified nursing facility be evaluated for serious mental illness (SMI), intellectual disability (ID) and/or other related condition (ORC);
2. be offered the most appropriate setting for their needs (in the community, a nursing facility (NF), or acute care settings); and
3. receive the services they need in those settings.
   

PASRR is an important tool for states to use in rebalancing services away from institutions and towards supporting people in their homes, and to comply with the Supreme Court decision, Olmstead vs L.C. (1999), under the Americans with Disabilities Act, individuals with disabilities cannot be required to be institutionalized to receive public benefits that could be furnished in community-based settings. PASRR can also advance person-centered care planning by assuring that psychological, psychiatric, and functional needs are considered along with personal goals and preferences in planning long term care.

In brief, the PASRR process requires that all applicants to Medicaid-certified Nursing Facilities be given a preliminary assessment to determine whether they might have SMI, ID, or ORC before admission. This is called a "PASRR Level I screen." Those individuals who test positive for the PASRR Level I are then evaluated in-depth, this is called "PASRR Level II". The results of this evaluation result in a determination of need, determination of appropriate setting, and a set of recommendations for services for the individual's plan of care.

For Pennsylvania, the provisions for this were addressed in Pennsylvania Bulletin, Volume 18, Number 52 on December 24, 1988. There are numerous parts to this regulation including the residents' rights package; you might hear it referred to as MA 401 process. The Federal Regulations for PASRR are located in the 42 Code of Federal Regulations (CFR) § 483.100 through § 483.138.

The PASRR Level I form is completed by the nursing facility, the hospital, or the Area Agency on Aging (AAA) office no later than the day of admission. Family members may assist in this process. The PASRR Level I form is to be used as a worksheet. You are to make any additions or corrective changes directly on the PASRR Level I form itself. Date and initial/ sign to indicate that a change has been made to the form. For example, if the person had a Psych hospitalization 3 years ago and you want to make a note of that on the form, as this may be helpful to someone to know in the future, you can do that.

Nursing Facilities are responsible to make sure the form is filled out correctly at the time of admission.

If the individual has a MI, ID, or ORC diagnosis and meets the criteria for a further evaluation as identified on the PASRR Level I form, the PASRR Level II evaluation must be completed and a final determination is made by the Program Office before the individual can be admitted to the Nursing Facility. The Program Office will communicate their determination with a Program Office Letter of Determination.

Per regulation, Nursing Facilities cannot admit individuals with a Mental Illness (MI), an Intellectual Disability (ID), or other Related Conditions (ORC) that meet criteria on the PASRR Level I without going through the PASRR Level II evaluation. Failure to timely complete (prior to admission) the PASRR process will result in forfeiture of Medicaid Reimbursement to the Nursing Facility during the period of non-compliance in accordance with Federal PASRR Regulations 42 CFR §483.122.

NOTE: Program Office Letters cannot be used again (from a prior stay) for a new admission unless you get approval from the Program Office.