PASARR Level I Screening
Jeannine LeCompte, Compliance Research Specialist
Long-term care facilities are legally obliged to adhere to the regulations governing new admissions, and, in particular, the Preadmission Screening and Resident Review process (PASARR), which is designed to ensure that any would-be resident who suffers from a serious mental illness, and/or intellectual disability (SMI/ID), receives the best possible care.
The first stage of this legally mandated process is a preadmission screening, or “Level I” PASARR, which must be completed before a resident enters a nursing facility. This must be done no matter what the source of funding is: Medicare, Medicaid, private insurance, or direct payment.
According to Title 42 of the Code of Federal Regulations Chapter IV, Subchapter G, Part 483, Subpart C, a new admission is an individual who is admitted to a nursing facility for the first time or does not qualify as a readmission. A resident who is a readmission is given an annual resident review rather than preadmission screening.
For individuals with an SMI, the evaluation must be carried out by the state mental health authority and be based on an independent physical and mental evaluation performed by a person or entity other than the state mental health authority. For individuals with intellectual disability, the evaluation must be made by the state intellectual disability or developmental disabilities authority.
In designating an independent person or entity to perform such evaluations, the state must not use a nursing facility or an entity that has a direct or indirect affiliation or relationship with a nursing facility.
A preadmission screening determination must be made in writing within an average of seven to nine working days of referral of the individual with SMI or ID by whatever agent performs the Level I identification. There are differing rules and regulations for the process in each state, and facilities need to adhere to their specific state’s rules.
Title 42, § 483.128, details the PASARR evaluation criteria. It states that the Level I process must identify all individuals who are suspected of having an SMI or ID. The process must provide for the issuance of written notice to the individual or resident and his or her legal representative that the individual or resident is suspected of having an SMI or ID, and is being referred to the state mental health or intellectual disability authority for full screening.
All evaluations must be adapted to the cultural background, language, ethnic origin, and means of communication used by the individual being evaluated, and must involve the individual being evaluated; their legal representative; and, if available, the individual’s family. Family members may participate in the process if the individual or his or her legal representative agree that they may.
Evaluators may use relevant data, obtained prior to initiation of preadmission screening, if it is considered valid, accurate, and reflects the current functional status of the individual.
In the case of individualized evaluations, to supplement and verify the currency and accuracy of existing data, the PASARR program may need to gather additional information necessary to assess proper placement and treatment.
The findings must include a full evaluation report which contains the full details of the professionals making the finding, and a full history of the individual, along with an identification of their needs. This report must be sent to the individual or his or her legal representative, and to the appropriate state authority.
If the report shows that the individual has an SMI or ID, the next step is to carry out a Level II evaluation.
