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March 8, 2018

How quickly must resident reviews be completed?

Originally, Resident Reviews—Level II post-admission evaluations—had to be conducted annually; hence, the original name of the program was Preadmission Screening and Annual Resident Review, or PASARR, which is the title that is still in the rule.

The Annual Resident Review requirement was dropped in 1997 as part of the Balanced Budget Act and a Resident Review is now only required when there is a significant change in condition of a resident who has, or is suspected of having, a mental illness, intellectual disability or related condition.

42 CFR 483.100-138 is largely mute about the timing and process of Resident Reviews. The Code of Federal Regulations (CFR) still describes an annual Resident Review, and the CFR has not been updated to reflect subsequent legislative changes. In its current form, the CFR implies – but does not explicitly require – that the Resident Review should be conducted as close as possible to the anniversary of the individual's Preadmission Screen or Resident Review. It would be reasonable to conclude that Resident Reviews should be performed as soon as possible once a significant change in condition is detected.

From a person-centered perspective, the nursing facility should refer an individual to the state mental health or intellectual disability authority as quickly as possible. While there are no average annual timelines for the completion of Resident Reviews, as there are for preadmission screening determinations, the relevant authority should arrange for the review as soon as practically possible to ensure that a thorough evaluation can be conducted and appropriate adjustments made to the individual's plan of care.

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