FAQs

Since its inception, all 50 states, including the District of Columbia, have requested some form of technical assistance from PTAC.  As a result of questions posed by the states, PTAC has developed a library of FAQs to use as a resource for states to find a quick snapshot of information regarding common PASRR topics.  Click on Read More below to access the FAQ, as well as additional information related to the topic.

Can PASRR requirements be waived during an emergency?

PASRR requirements cannot be waived or suspended in an emergency unless the state receives authority to do so under an 1135 waiver. Under Section 1135 of the Social Security Act, the HHS Secretary may be authorized to take certain actions during eligible major disasters or emergencies. These actions may include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to help meet the needs of eligible individuals and providers living in emergency areas. Additional information about 1135 waivers can be found on the Section 1135 Waiver Flexibilities webpage on Medicaid.gov, located at: https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/cms-1135-waivers/index.html

E-PASRR systems – Key considerations and resources for state to state consultation

A number of states with internal or vendor provided e-PASRR systems have agreed to be a resource for state to state consultation around their e-PASRR experience. A full listing of the states and a contact person may be found on the following e-PASRR Resource Guide.

What is the relationship between PASRR and Nursing Facility level of care?

Need for nursing facility (NF) services is defined by individual states, all of whom establish NF level of care (LOC) criteria. The LOC assessments are conducted for NF applicants separately from the PASRR process, but Section 1919(b)(3)(F) of the Social Security Act prohibits NFs from admitting any new resident who has serious mental illness (SMI) or an intellectual disability or related condition (ID/RC), unless it has been determined by the State Mental Health Authority (SMHA) or State Intellectual Disability Authority (SIDA) that because of the physical and mental condition of the individual, nursing facility services are needed.

How does the presence of a traumatic brain injury (TBI) affect the PASRR process?

The April 10, 2018 FAQ “Are individuals with a traumatic brain injury (TBI) subject to PASRR?” confirms that all individuals applying to a Medicaid-certified nursing facility (NF), regardless of diagnosis, must undergo a Level I screen to determine if the individual possibly has a condition meeting PASRR’s definition of mental illness, intellectual disability or a related condition.

Webinar Assistance and FAQs

This page is meant to provide assistance in navigating webinars.

Out-of-State PASRR Arrangements: Questions & Answers

Adults or children who have been identified as having a Preadmission Screening and Resident Review (PASRR) disability sometimes move from a nursing facility (NF) in one state to an NF in another state. State staff members who administer PASRR programs often have questions about how such moves should be handled. For example: When does the individual need a new evaluation? And what happens if the Specialized Services an individual was receiving in State A are not available in State B? The purpose of this brief is two-fold: (1) to establish a framework for reasoning through these questions and (2) to present a series of scenarios, formulated as questions, that address situations that commonly arise.

In a preadmission screen, what counts as recent information?

For a variety of reasons, including the availability of evaluators, it may not always be possible to perform a complete psychiatric evaluation on an individual before they are admitted to a nursing facility (NF). In these cases, it is possible to rely instead on information in the individual's medical record and/or psychosocial history.

When does a Level I screen need to be conducted?

According to CFR 42-§483.102, a PASRR Level I screen must be completed for all applicants to a Medicaid-certified nursing facility, regardless of payer. A Level I screen must be completed before a resident can be admitted into a nursing facility. If a current nursing facility resident experiences a significant change in his or her mental or physical condition, the individual is subject to a Resident Review evaluation.

When does a Level II evaluation need to be conducted?

Pre-Admission General Rule. Under 42 CFR §483.102 (a), the PASRR process applies to all Medicaid-certified nursing facility (NF) applicants, regardless of the source of payment for the NF services, and regardless of the individual's or resident's known diagnoses. Therefore, a Level II evaluation must be completed for all such applicants who meet NF level of care requirements, and who have been identified as having suspected mental illness (MI) and/or intellectual disability (ID) by the Level I preadmission screening process.

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