The PASRR provisions of the Nursing Home Reform Act, amendments to the Social Security 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.
A resident review is an evaluation and determination conducted when an NF resident experiences a significant change in his or her physical or mental status.
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.
KEPRO is the state’s contracted vendor responsible for assisting AHCA, APD, and DCF with completion of the Level I PASRR screens, Level II PASRR evaluations and determinations and resident reviews for suspicion or diagnosis of SMI, ID or both.
Faxes will no longer be accepted by KEPRO after March 31, 2019.