Preadmission Screening and Resident Review Process (PASRR)

The PASRR provisions of the Nursing Home Reform Act (NHRA) amendments to the Medicaid Act, and implementing 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).

More specifically, PASRR requires that NF applicants and residents with a diagnosis or suspicion of SMI and/or ID, as those terms are defined in the regulations, are identified prior to their admission into an NF to determine whether the individual needs the level of services that an NF provides, and whether individuals who need NF services also need “specialized services.”  PASRR is required for all applicants to Medicaid-certified nursing facilities, regardless of the payer source. 

Section 409.985, Florida Statutes and Rule 59G-1.040, Florida Administrative Code (F.A.C.), contain the Florida law implementing federal laws governing PASRR. 

A Level I PASRR screen identifies whether an individual referred for admission into an NF has or is suspected of having an SMI and/or an ID diagnosis.

The Level II PASRR confirms or rules out an SMI and/or ID diagnosis.  It is an in-depth evaluation of the individual and is 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, the individual needs.

The Agency for Health Care Administration (AHCA) delegates responsibility for the PASRR process to the following Florida agencies:

Agency for Persons with Disabilities (APD)
APD is responsible for completing the PASRR Level II evaluations and determinations for intellectual disabilities (ID) or related conditions.

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

Department of Elder Affairs (DOEA)
DOEA’s 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.  A Level I PASRR screening determines whether an individual referred for admission into an NF has or is suspected of having an SMI or an ID.  The CARES program is also responsible for a request of a Level II PASRR evaluation when appropriate for adults. 

Department of Health (DOH)
The DOH is the Agency for Health Care Administration’s (AHCA) delegate for completion of the Level I PASRR screen for children under the age of 21 years seeking entry to an NF.  The Children’s Multidisciplinary Assessment Team (CMAT) within DOH performs the Level I PASRR screening for children.  A Level I PASRR screening determines whether an individual referred for admission into an NF has or is suspected of having an SMI or an ID.  The CMAT is also responsible for a request of a Level II PASRR evaluation for any child residing in an NF when appropriate.

KEPRO
KEPRO is the state-designated contracted entity responsible for completing the PASRR Level II evaluations for suspicion or diagnosis of SMI.

Links to Regulations

Florida Administrative Code Rule 59G-1.040

Section 409.985, Florida Statutes

42 C.F.R. § 483.100-108

42 U.S.C. § 1396r

42 U.S.C. 1396a

Forms

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Preadmission Screen and Resident Review (PASRR) Level I Form, (incorporated by reference in Rule 59G-1.040, F.A.C.) [323KB]

Preadmission Screen and Resident Review (PASRR) Resident Review – Evaluation Request Form, (incorporated by reference in Rule 59G-1.040, F.A.C.) [176KB]

Frequently Asked Questions (FAQs)

PASRR FAQs [78KB]