Preadmission Screening and Resident Review (PASRR) stands as a critical federal mandate designed to prevent the inappropriate placement of individuals in nursing homes for long term care. As a fundamental long term care tool, PASRR ensures that individuals, particularly those with serious mental illness (SMI) or intellectual disability (ID), receive the most suitable care setting for their needs. This process is vital for anyone involved in long term care, from healthcare providers to families seeking the best options for their loved ones.
PASRR’s core objectives are threefold for Medicaid-certified nursing facilities:
- Comprehensive Evaluation: To meticulously evaluate all applicants for any indications of serious mental illness (SMI) and/or intellectual disability (ID). This initial screening acts as the first gate in ensuring appropriate placement.
- Optimal Setting Recommendation: To offer every applicant access to the most appropriate care environment. This could range from community-based services and supports to nursing facilities, or even acute care settings, depending on the individual’s unique requirements.
- Service Provision Guarantee: To ensure that all applicants receive the necessary services within their determined setting. This commitment to service provision is central to PASRR’s effectiveness.
The significance of PASRR extends beyond individual care, playing a crucial role in states’ efforts to rebalance long term care systems. By shifting the focus away from institutionalization and towards community-based support, PASRR aligns with the principles of the Olmstead vs L.C. Supreme Court decision (1999). This decision, grounded in the Americans with Disabilities Act, affirms that individuals with disabilities cannot be forced into institutions to access public benefits if those benefits can be effectively delivered in community settings. PASRR is therefore a key tool in upholding these rights and promoting community integration.
Furthermore, PASRR significantly enhances person-centered care planning. By mandating the consideration of psychological, psychiatric, and functional needs alongside personal goals and preferences, PASRR ensures a holistic approach to long-term care planning. This comprehensive evaluation process is a cornerstone of effective long term care tools used to evaluate criteria for admission.
The PASRR process itself is structured in two levels. Initially, all applicants to Medicaid-certified nursing facilities undergo a Level I screen. This preliminary assessment is designed to identify individuals who might have SMI or ID. Those who screen positive at Level I then proceed to a more detailed Level II PASRR evaluation. Level II evaluations are in-depth assessments that determine the individual’s needs, the most appropriate care setting, and generate recommendations for services that will inform their individualized plan of care.
The regulations that govern PASRR are primarily detailed within the Code of Federal Regulations (CFR), specifically sections 42 CFR 483.100-138. These regulations provide the framework for states and facilities to implement PASRR effectively.
For further information and updates, the Centers for Medicare & Medicaid Services (CMS) is a primary resource. In February 2020, CMS issued a Notice of Proposed Rule Making and a Fact Sheet concerning PASRR, highlighting ongoing developments and refinements in this critical area of long term care. The public comment period for these proposed rules was extended to May 20, 2020, reflecting the importance of stakeholder input in shaping PASRR policies.
In conclusion, PASRR is an indispensable set of long term care tools used to evaluate criteria for admission to nursing facilities. It is crucial for ensuring appropriate placement, promoting community-based care, and upholding the rights of individuals with SMI and ID. By understanding and utilizing PASRR effectively, healthcare professionals and policymakers can contribute to a more equitable and person-centered long term care system.
