The purpose of a Level II evaluation is to confirm that an individual has a mental illness or intellectual disability. The Level II evaluation also assesses the applicant’s need for nursing facility services and whether the applicant requires specialized services or specialized rehabilitative services. This section contains Level II resources for state PASRR programs.

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.

Key Differences Between PASRR Level I Preliminary Screens and PASRR Level II Evaluations


All individuals who apply to reside in a Medicaid-certified nursing facility, regardless of payer, are required to receive a Level I PASRR screen to identify mental illness or intellectual disabilities. If an individual is suspected to have mental illness or an intellectual disability, a Level II evaluation is conducted to confirm this. A Level II must not merely rubber stamp the outcome of the Level I. Rather it must “look behind” the diagnosis of record to identify the “true” diagnosis. This presentation will further discuss the relationship between Level I and Level II evaluations and highlight common misconceptions as well as promising practices.

PASRR Determination: Written Notices and Evaluation Reports


PASRR regulations include requirements for written notices of determination and evaluation reports to be produced as a part of the assessment process. The notices of determination and evaluation reports must include specific information about the outcomes of the evaluation, the person’s disability, and the necessary services and supports needed. Additionally, these written documents must be disseminated to specific entities. This webinar will review the regulations regarding PASRR notifications and help PASRR stakeholders understand requirements for achieving compliance with the written determination and notice process. Additionally, the webinar will explore strategies for creating effective, person-centered notices that have the potential to lead to positive outcomes for the individuals assessed.

Telehealth and PASRR: Opportunities for Preadmission Screening and Resident Review


This webinar will provide an overview of telehealth and the PASRR program and discusses the potential applications of telehealth to address barriers in PASRR. Although telehealth offers the opportunity to improve program efficiency and effectiveness, PASRR authorities must balance state-specific barriers, available resources, operational considerations, regulatory requirements, clinical quality, and budgetary limitations.

If a nursing facility resident with MI/ID is admitted to a hospital for a short time and then wishes to return to the facility, must a Level II evaluation be completed prior to their return to the facility?


There is no federal requirement that a Level II evaluation be completed prior to the individual returning to the nursing facility (NF). A Level II evaluation is required when there is a significant change in a resident’s condition. When a resident is returning from a hospital stay, there may be a clear change in condition. In instances where the significant change is evident, the individual would be subject to a Resident Review upon their return to the nursing facility, per CFR §483.106(b)(3).

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