1. PASRR overview Nursing Facility Admissions and PASRR

2. PASRR Pre-admission Screening and Resident Review Pre-Admission Screening and Resident Review (PASRR) is a federally mandated program that is applied to all individuals seeking admission to a Medicaid certified Nursing Facility (NF) regardless of funding source. PASRR must be administered to identify: Individuals with Mental Illness (MI), Intellectual Disability (ID), or Developmental Disability (DD). Appropriateness of placement in the nursing facility. Eligibility for specialized services. Alternatives to NF placement (least restrictive enviroment). The PASRR process was redesigned and re-implemented in May 2013. The 3 main objectives were: 1.Eliminate the role of NFs in the PASRR evaluation process. 2.Require specialized services to be identified prior to admission to the NF. 3.Require automated notification when PASRR evaluations are needed.

3. Who Needs a PASRR? Beginning in May 24, 2013 all individuals seeking admission into a Medicaid certified nursing facility must have a PL1 Screening Form entered into the TMHP LTC Online portal prior to admission. If the individual is PL1 positive (suspected of having MI, ID or DD), the individual will require the PASSR Evaluation (PE) to be completed by the Local Intellectual Disability and Developmental Disbability Authority/Local Mental Health Authority (LIDDA/LMHA) and is submitted within 7-14 days depending on the type of admission. Helen Farabee Centers is the both the LIDDA and LMHA for this area. If the individual is PL1 negative (not suspected of having MI, ID or DD), the NF enters the PL1 into the portal and the PASRR process ends for that individual.

4. Who completes the PL1? The PL1 Screening Form is the responsibility of the Referring Entity. Referring Entity (RE): The entity that refers an individual to a nursing facility, which includes a hospital, attending physician, LAR or other personal representative selected by the individual, family member of the individual, or a representative from an emergency placement source, such as law enforcement. For approximately 95% of all PASRR admissions the RE is the hospital. REs can be: hospice agencies, acute inpatient facilities, psychiatric hospitals, assisted living facilities or any other organization that is the first to recommend or refer an individual for Nursing Facility placement.

5. 3 Types of NF Admissions Expedited Admission: When an individual is seeking admission to a nursing facility, is suspected to have MI, ID or DD and meets the criteria for convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite or coma. Expedited admissions are approximately 90% of PASRR admissions. Exempted Hospital Discharge: When a physician has certified an individual who is suspected of having MI, ID or DD is likely to require less than 30 days of nursing facility care for the same condition the individual was hospitalized for. Exempted Hospital Discharges are approximately 7% of PASRR admissions. Example: broken hip suffered from fall going to NF for rehabilitation services. Pre-Admission: When an individual is suspected of having MI, ID or DD but is not an Expedited Admission or an Exempted Hospital Discharge. Preadmissions are approximately 3% of PASRR admissions. Example: family visits from out of town and finds loved one in unsafe/unsanitary conditions.

6. Who completes the PE? The PE is the responsibility of the LIDDA or LMHA: Local Authority: Responsible for the planning, policy development, coordination, resource development and allocation, and for supervising and ensuring the provision of mental health services to individuals with mental illness or intellectual disability services to individuals with an intellectual or developmental disability in one or more local services.

7. LIDDA/LMHA Service Responsibilities When individuals in a Nursing Facility are determined to have a mental illness or intellectual/developmental disability and are in need of specialized services, then the LIDDA/LMHA can provide them if the resident chooses. Examples of Specialized Services: Service Coordination/ Case Management. Every 6 months explaining options/alternatives to NF. Rehabilitative Skills Training. Counseling. Psychiatric Services (evaluation and medication management). Vocational Training.