Preadmission Screening and Resident Review

Preadmission Screening and Resident Review (PASRR) is a federally mandated screening process dating back to 1987. PASRR was created as a part of the Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act and PASRR requirements were also added to the Social Security Act as sections 1919 (b) (3) (F) and 1919 (e) (7). The process is administered by the Centers for Medicare and Medicaid Services (CMS). Maximus partners with the State of Indiana to help carry out this program.

Preadmission Screening and Resident Review (PASRR) was established as part of the de-institutionalization process to ensure people with disabilities (i.e., Serious Mental Illness, Intellectual and/or Developmental Disabilities):

• are not inappropriately institutionalized in a NF 
• receive services in the least restrictive setting, and that 
• needed services/supports are identified for the NF to provide 

PASRR is an important tool for states to use in rebalancing services away from institutions and towards supporting people in their homes, and to comply with the Supreme Court decision, Olmstead vs L.C. (1999), under the Americans with Disabilities Act, individuals with disabilities cannot be required to be institutionalized to receive public benefits that could be furnished in community-based settings. 

The goal of PASRR is to optimize an individual’s placement success, treatment success, and ultimately, an individual’s quality of life.

The Preadmission Screening and Resident Review (PASRR) process requires that all applicants to Medicaid-certified nursing facilities be given a preadmission, preliminary, assessment to determine whether they might have Serious Mental Illness (SMI) or an Intellectual Disability (ID) or Developmental Disability (DD). This is called a "Level I Screen." Individuals with indicators of SMI/ID/DD receive a clinical review to determine if an in-depth evaluation called "Level II" is needed prior to nursing facility (NF) admission. The results of this evaluation also determine the appropriateness of a nursing home setting and if specialized services are needed relative to the PASRR condition.

Regulations governing PASRR are found in the Code of Federal Regulations, at 42 CFR 483.100-138.

Level II evaluations involve completion of an individualized assessment, interviews, and record reviews. 

To conduct a Level II assessment, a Maximus assessor must meet and interview the person, review their medical record, and interview support staff. 

Sometimes, this means we must interview providers. Our clinicians interview the individual for about 45 minutes to an hour and ask questions related to the person’s medical needs, mental health and service history, developmental history, symptom presentation and cognitive status, interests and preferences, functional needs, community support needs and any needed services in a NF if they are admitted. 

Through this process, assessors determine if the person has a Serious Mental Illness (SMI)  and/or Intellectual or Developmental Disability (ID/DD) and if so, whether the person requires the level of service provided by a nursing facility, and if the individual requires specialized services for their qualifying condition.

A Summary of Findings report includes a synopsis of information gathered following completion of a comprehensive Preadmission Screening and Resident Review (PASRR)  Level II evaluation as well as the final assessment determination. After Maximus receives the assessor’s completed Level II assessment, our Clinical Coordinators review all submitted information, including the medical record and supporting interviews. The CC then documents if the person appears psychiatrically stable, if NF care is appropriate (meaning the person meets medical necessity for NF admission), and what types of services a person would need to be successful in a NF.

This Summary of Findings report is sent to the individual, their legal guardian, the submitting facility, and their primary care doctor, if one is identified.

Questions about the Summary of Findings report can be submitted to the Indiana LCAR Services – Maximus Help Desk by phone at 833.597.2777 or email at PASRR@fssa.IN.gov.

The Summary of Findings report letter will also include the individual’s appeal rights. The individual or their legal guardian may appeal the Preadmission Screening and Resident Review (PASRR)  decision by following the instructions included in their Summary of Findings letter.

This means that although you have medical needs that qualify for nursing facility Level of Care (NF LOC), you also have disability-specific needs that may be better served in a different setting. You may access HCBS Waiver Services with a NF LOC approval but Preadmission Screening and Resident Review (PASRR)  denial, but you may not admit to a nursing facility. If you disagree with this outcome, you may appeal it. Appeal rights provided with your PASRR denial explain how to appeal the decision.