PASARR Level II Screening
Jeannine LeCompte, Compliance Research Specialist
If a would-be resident of a nursing facility is found to be suffering from a serious mental illness or an intellectual disability (SMI/ID) in a Preadmission Screening and Resident Review (PASARR) Level I screening process, they will have to undergo a further round of checks, known as “Level II” screening.
Level II screening is designed to confirm or reject the results of the Level I screening process, and, if confirmed, provide a determination whether the individual should be placed in a nursing facility or in the community.
Level II screening should also identify the set of services the individual needs to maintain and improve their general functioning; in other words, what specialized services or specialized rehabilitative services are required to provide the best possible care.
A Level II diagnosis should include the following elements:
- A full medical history of the individual;
- A full physical examination, performed by a physician;
- A functional assessment, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs);
- A history of medication and drug use; and
- An IQ assessment performed by a PhD psychologist, or an assessment of psychiatric history performed by a qualified assessor (e.g., a psychiatrist, a psychiatric social worker, or a nurse with substantial psychiatric experience).
Level II evaluators cannot be employees of a nursing facility in order to prevent a conflict of interest.
Once the Level II evaluation is complete, the State Mental Health Agency (SMHA) and/or the State Intellectual Disability Authority (SIDA) must produce a Level II determination.
This determination is a legal document with important ramifications for the individual’s care, and will:
- Summarize the individualized evaluation information
- Specify which PASARR “target condition” was present, if any (i.e., SMI/ID, or a related condition)
- Determine whether specialized services are needed
- Make specific and clear recommendations for rehabilitative services (if the person was approved for a nursing facility stay)
The determination summary and the notice indicating a right to appeal are explained to the individual and (where appropriate) to his or her legal guardian. Copies of the determination document are forwarded to the individual’s primary care physician, the nursing facility to which they applied, and (if applicable) to the referring Level I entity.
