PASRR – Pre-Admission Screening and Resident Review

IPRO, as the NYS PASRR contractor for the New York State Department of Health is responsible for performing the Level II comprehensive evaluation of mentally ill RHCF/nursing home applicants and for current RHCF/NH residents who are referred by the entity that performed the Level I SCREEN (Pre-Admission). This is an all payer review.

This Web page will provide useful information, that will help facilities apply for a PASRR Level II Adult Mental Health Evaluation.

OVERVIEW

The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) mandated that all individuals with serious mental illness (SMI) or mental retardation (MR) applying for nursing home placement be:

  1. Identified;
  2. Placed appropriately; and
  3. Receive the SMI or MR services they require in a setting appropriate to the person’s needs.

In addition, residents of nursing homes with SMI or MR need to be reevaluated when they experience a significant change in physical or mental status.

Preadmission Screen Resident Review (PASRR) regulations are detailed in 42 Code of Federal Regulations (CFR), Part 483, Subpart C. Persons identified as having MR are referred to their local Developmental Disabilities Service Office (DDSO) for a PASRR evaluation. Persons identified as having possible SMI are referred to IPRO, the NYS PASRR contractor, for a PASRR evaluation.

The Americans with Disabilities Act (ADA) of 1990 and the Olmstead decision of 1999 prohibits states from unnecessarily institutionalizing persons with disabilities and failing to serve them in the most integrated setting appropriate to the person’s needs. PASRR activities and Olmstead activities are closely linked.

PROCESS DESCRIPTION: THE REFERRAL ENTITY

All individuals applying to NYS Residential Health Care Facilities (RHCF) must have a Hospital/Community Patient Review Instrument (H/C PRI) and a SCREEN form completed. The SCREEN form provides a placement recommendation. All individuals recommended for RHCF placement must be reviewed using the federally required Level I review process to determine if the individual has possible serious mental illness (SMI) or possible mental retardation (MR). Individuals identified by the SCREENER as having possible SMI, who do not meet the criteria for a categorical determination, are referred to IPRO for a Level II evaluation.

REFERRAL TYPES:

PASRR Preadmission Screen (PAS) - PASRR Level II requests are initiated primarily in the hospital setting, OMH psychiatric center and community-based settings when the SCREEN document indicates serious mental illness and when the referring entity is recommending the individual for RHCF placement.

PASRR “Resident Review”
PASRR Level II referrals generated by the RHCF (and occasionally by hospitals) are indicated as PASRR Resident Reviews (RR) and consist of 2 types: resident review preadmission and resident review significant change.

The Resident Review Preadmission may be generated when the RHCF identifies that an admission received from the hospital, community based setting or psychiatric center did not reflect serious mental illness (SMI), traumatic brain injury or when the categorical determination no longer applies. The RHCF is then responsible to complete a SCREEN to reflect Level I SMI and a referral to IPRO for a Level II is then generated.

The Resident Review Significant Change is indicated when there is a significant change in the physical or mental condition of a RHCF resident (improvement or decline) with SMI which may have an impact on their overall needs, including but not limited to the need for specialized services. The RHCF must complete a comprehensive assessment promptly, i.e., within 14 days, and request a Level II Resident Review. This is also true when a resident is newly diagnosed with mental illness. The RHCF is expected to contact IPRO within 14 days of identifying a significant change, regardless if it has bearing on the resident’s need for specialized services.

It should be noted that when a RHCF resident with newly diagnosed severe mental illness or a significant change is admitted to a hospital for acute care, the PASRR (Resident Review) would then be conducted at the hospital prior to return to the RHCF to ensure that the most appropriate care and services are provided to this individual.

SCHEDULING THE LEVEL II ASSESSMENT

INTAKE PROCESS

The Referral Entity completes the Adult Mental Health Evaluation Intake Form which is used to assist IPRO with scheduling the Level II assessment and assuring that the appropriate documentation is photocopied and available for the IPRO evaluator at the time of the evaluation. The intake form should be provided to IPRO’s PASRR coordinator via facsimile at 516-326-6179. The Referral Entity can contact IPRO via toll free 1-800-633-9441 or 516-326-2110.

DOCUMENTS TO BE MADE AVAILABLE TO THE ASSESSOR

There are 8 primary sources of information that are required to complete the assessment. You must be provided all 8 sources. A 9th item, which includes RHCF progress notes and psychiatric/applicable consults, are provided when an RHCF requests a preadmission screen or significant change Level II evaluation (Resident Review). All information must be reflective of the individual’s current condition, if information is not current, the assessor will make a request for the current documentation in order to proceed.

  • A comprehensive history and physical examination, including a complete medical history, review of all body systems, specific evaluation of the individual’s neurological system in the areas of motor functioning, sensory functioning, gait, deep tendon reflexes, cranial nerves and abnormal reflexes.
  • A functional assessment of the individual’s ability to engage in ADL’s and IADL’s. The assessment must address self-monitoring of health status, self-administering and scheduling of medical treatment, including medication compliance, self-monitoring of nutritional status, handling of money, dressing appropriately, and grooming.
  • Psychosocial evaluation, including current living arrangements, medical and support systems.
  • A comprehensive psychiatric evaluation, including a complete psychiatric history, evaluation of intellectual functioning, memory functioning and orientation, description of current attitudes and overt behaviors, affect, suicidal or homicidal ideation, paranoia, and degree of reality testing (presence and content of delusions) and hallucinations.
  • PRI or H/C PRI
  • SCREEN
  • Physician request for RHCF placement or current RHCF monthly order sheet.
  • Social Service and Discharge Planning documentation relevant to PASRR request.
  • RHCF progress notes and psychiatric/applicable consults related to significant change.

 


CONTACTS:

Diane Thorp MHA, BSN, RN, RAC-CT
Assistant Director
(516) 209-5444
dthorp@ipro.org

Emily Frank RN, MS, BSN, BS
PRA
(516) 209-5593
efrank@ipro.org

Eddie Ramgoolam RN
PRA
(516) 209-9335
Eramgoolam@ipro.org

Shaheen Khan
Senior Program Support Coordinator
(516) 209-5306
skhan@ipro.org

Rashene Cook
Senior Program Support Coordinator
(516) 209-5306
rcook@ipro.org