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Preadmission Screening and Resident Review Process (PASRR)

The PASRR provisions of the Nursing Home Reform Act, amendments to the Medicaid Act, and the implementation of federal regulations, establish a comprehensive plan for ensuring that individuals with a serious mental illness (SMI) or intellectual disability or related conditions (ID) who do not meet nursing facility level of care are not admitted to and do not reside in a Medicaid-certified nursing facility (NF).

The PASRR requires that NF applicants and residents with a diagnosis or suspicion of SMI, ID, or both, as those terms are defined in the regulations, are identified prior to their admission into an NF.  The PASRR determines whether an individual needs the level of services that an NF provides, and whether individuals who need NF services also need specialized services. The PASRR is required for all applicants to an NF, regardless of the payer source.

Section 409.985, Florida Statutes and Rule 59G-1.040, Florida Administrative Code, contain the Florida law implementing the federal laws that govern PASRR.

A Level I PASRR screen identifies whether an individual applying for admission into an NF has or is suspected of having an SMI, ID, or both.

The Level II PASRR confirms or rules out an SMI, ID or both. It is an in-depth evaluation of the individual and a determination of the need for NF services. If an NF is the most integrated setting appropriate to meet the individual’s long-term care needs, the Level II PASRR must also evaluate what specialized services, if any, would be recommended for the individual during their NF stay.

In addition to the Agency for Health Care Administration (AHCA), the following agencies are responsible for the PASRR process in Florida:

The Agency for Persons with Disabilities (APD)
The APD is responsible for completion of the Level II PASRR evaluations and determinations for ID.

The Florida Department of Children and Families (DCF)
The DCF Mental Health program office is responsible for completing the Level II PASRR determinations for SMI.

The Florida Department of Elder Affairs (DOEA)
The DOEA Comprehensive Assessment and Review for Long-term Care Services (CARES) program, or the entity to which CARES delegates this responsibility, performs the Level I PASRR screening for all adults. The CARES program is also responsible for sending a request for a Level II PASRR evaluation for adults applying for NF services or those residing in an NF, when appropriate.

The Florida Department of Health (DOH)
The DOH is AHCA’s delegate for completion of the Level I PASRR screen for children under the age of 21 years. The Children’s Multidisciplinary Assessment Team (CMAT) within DOH performs the Level I PASRR screen for children. The CMAT is also responsible for requesting a Level II PASRR evaluation for any child applying for NF services or those residing in an NF when appropriate.

KEPRO
KEPRO is the state’s contracted vendor responsible for completing the Level II PASRR evaluations and determinations for suspicion or diagnosis of SMI, ID or both.

Links to Regulations

Forms

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Frequently Asked Questions (FAQs)

PASRR FAQs [94KB]