Federal Program Goals
Medicaid regulations require states to maintain a PASRR program to screen nursing facility (NF) applicants and residents for serious mental illness (SMI), intellectual disabilities (ID), developmental disabilities (DD), or related conditions (RC). This will ensure NF applicants and residents with these conditions are:
- Placed appropriately (in the least restrictive environment), and
- Provided with the services they need for their conditions.
PASRR is part of the Federal Omnibus Budget Reconciliation Act. The rules regarding the PASRR process are found in the Code of Federal Regulations Part 483, Subpart C. Volume 57, No. 230
(42 CFR 483.100 to 42 CFR 483.204).
Program Overview
PASRR includes Level I, Level II and Resident Review.
Level I is an initial screening conducted prior to NF admission. The Oregon Department of Human Services (ODHS) Office of Aging and People with Disabiities (APD) is responsible for Level I screening.
Level II and Resident Review assessments are required for:
- All NF applicants and residents identified with indicators of SMI, ID, DD or RC. Identification can be during the Level I screening or at any time during residency (unless the individual qualifies for an Exempted Hospital Discharge).
- Any resident with confirmed SMI, ID, DD or RC with significant changes in their cognitive or physical conditions.
The ODHS Office of Developmental Disabilities is responsible for Level II assessments for those with ID, DD or RC.
The Oregon Health Authority (OHA) Behavioral Health Division is responsible for Level II assessments for those with SMI or behavioral health needs.
Level I is an initial screening conducted prior to NF admission. The screening is to identify individuals with indicators of SMI, ID, DD or RC.
The Level I screen is conducted by hospital discharge planners, hospice/home health agencies, medical office social workers, APD, Area Agencies on Aging specialists and case managers and Private Admission Assessment contractors.
Individuals identified with SMI, ID, DD or RC may receive further evaluation if the individual needs long-term care.
If the Level I screener finds SMI, ID, DD or RC indicators during the screening, the screener then requests a Level II screening.
The Level II and Resident Review for SMI are both comprehensive evaluations. Both are performed by a qualified mental health professional (QMHP) assigned by the local county's Community Mental Health Program.
The QMHP will determine if the individual meets diagnostic criteria for SMI. Once SMI is confirmed, the QMHP will:
- Evaluate the individual’s SMI symptoms, history and care needs.
- Recommend the most appropriate care setting.
- Determine if specialized services are needed (e.g., psychiatric hospitalization).
If the QMHP determines that the NF is the most appropriate setting, the determination may include recommendations for “services of a lesser intensity than Specialized Services” to meet the resident's needs. Recommendations may include but not be limited to:
- Behavioral strategy recommendations,
- Referral to health care provider for medical interventions,
- Referral to health care provider with pharmacologic suggestions,
- Referral to mental health provider or substance use disorder treatment provider for evaluation and treatment,
- Staff education and training, and
- Referral to social programs such as senior centers and faith communities.