8. Who can complete a Level I screen?
The Federal regulations are not prescriptive to allow States to design their PASRR processes. In California, a Level I screen can be completed by a designated facility staff person with reasonable understanding of medical terminology and the healthcare needs of the individual served in NFs. Facilities may designate staff who will perform screens and separate staff responsible for data entry. Depending on the facility, this could include clerical staff.
9. When do I need to complete a Level I Screening?
A Level I Screen (DHCS 6170) must be completed for each person entering a Medicaid-certified Nursing Facility regardless of payer source. Not every screening will result in a Level II evaluation. The DHCS PASRR Level I Screening will not lead to a Level II evaluation under the following conditions:
- The resident does not have a Mental Illness (or the suspicion of a Mental Illness). Facilities should print and retain the PASRR Level I Screening form DHCS 6170 and the accompanying “No Need” letter in the resident’s chart.
- The stay at a Nursing Facility will be less than 30 days. If your resident will be at your facility for less than 30 days a Level I screen will not go to DHCS. This “30-day exemption” must be verified by a doctor. Print and retain the PASRR Level I Screening Document DHCS 6170 in the resident’s chart. In the event the resident’s stay does exceed 30 days please complete the Level I screen no later than 40 calendar days from the date the resident was admitted.
10. How long does it take to create the "need" letter, or the "no need" letter?
The letter is immediately created and available electronically through the online system when the Level I screening is completed.
11. How long will it take before we can expect the Level II evaluator at our facility to evaluate the resident?
The Contractor will contact you within four working days of receiving the Level I screen. The Contractor will do a brief screening to ensure the resident is available for the evaluation and schedule a time for the evaluator to meet with the appropriate staff, review pertinent records and talk to the resident.
12. How long does it take to receive a determination letter?
The determination letter is made immediately available to the facility in the new IT system within 7-9 working days.
13. As an Administrator, can I view information about residents that were cared for in other facilities?
No. Your access to information is limited to the residents served in your facility.
14. I need access to multiple facilities in the online PASRR system. What is the process to obtain this access?
Submit an enrollment request form (http://www.dhcs.ca.gov/services/MH/Documents/PASRRIT_UID.xls) for each facility you require access. The forms must be submitted by the Administrator for each facility. You will receive a different user-id per facility.
15. Can there be multiple administrators per facility?
Yes, DHCS recommends having multiple administrators as a backup. Also remember that only Administrators can see every screening. A User can only see screenings that he/she originated. If your facility has a business practice of having the business office initiate a Level I, and then passing it off to the nursing staff to complete the diagnosis section of the Level I, then every user must be an Administrator.
16. I am having trouble logging in?
If you forgot the password when you log on, send an E-mail to DHCS at ITServiceDesk@dhcs.ca.gov or call us at (916) 440-7000 describing that you forgot the login password. We will send you an encrypted e-mail with a temporary password and you can reset the password.
If you forgot the answers to your security questions, you must also send an E-mail to DHCS at ITServiceDesk@dhcs.ca.gov or call us at (916) 440-7000 describing that you forgot the answers to your security questions. You can still use your login password and then, once you are on the PASRR system, reset your security questions. Remember, the answers to your security questions are case-sensitive!
17. If a Nursing Facility is not a Medi-Cal or Medicare Provider and serves only Private Pay Residents, is the facility required to do a Pre-Admission Level I Screening for Mental Illness?
If a NF is not a Medi-Cal certified provider, the PASRR process is not required.
18. Is a care facility required to send a new PASRR each time a resident is hospitalized and returns from the hospital?
No. You must submit a Level I screening when:
There is a significant change in the resident’s physical illness or mental health.
If there is not significant change in the resident’s condition, TAR may request a new PASRR Level I approximately every two years.
19. How do I know if my temporary PASRR password has expired?
Temporary passwords are only good for 4 days. If you have not created a permanent password within the 4 days, you will see a “Not authorized to use this system” error message. You will also see this message if you have attempted to type in the password and were unsuccessful more than three times. When you receive that error message, please contact DHCS to reset your password. You can email us at ITServiceDesk@dhcs.ca.gov or call us at (916) 440-7000. We will send you an encrypted e-mail with a new temporary password.
20. Should I submit another PASRR logon request form if my facility and users have not received a DHCS PASRR temporary password?
Please do not submit another PASRR login if you have already sent DHCS a request. You should receive the encrypted password within a week of submission. If you have not received an email within that timeframe, please send an email ITServiceDesk@dhcs.ca.gov or call the IT Service Desk at (916) 440-7000 to request the status of their submitted PASRRIT_UID request form.
21. How can I add new users or delete old users?
If you want to add or delete a user, the Log-on request form should be completed by the Administrator and the new or deleted users should be highlighted. You can submit the form by emailing ITServiceDesk@dhcs.ca.gov.
22. I did not understand what the roles were when I signed my facility up for the new system. Can I change the roles of the user/administrator myself?
No, Users cannot change the roles of users/administrators without DHCS review/approval. To change roles, the facility PASRR Online administrator must submit a revised Log-on request form with the role changes highlighted. Then the form must emailed to ITServiceDesk@dhcs.ca.gov.
23. I have received the following error message every time I logon: “Looks like our site had a bit of an issue”… Sorry for the problem – we’ve been notified and we’ll try to fix this problem as early as possible.”
This error message appears when you select “Save credentials” when logging in. When you check the “Remember my credentials” box, the sign in URL changes. Please use the login URL “https://pasrr.dhcs.ca.gov” and do not save your credentials.
24. If I print the PASRR form and send it in, can I also enter it online?
No, you should always use the online system to enter PASRRs if you are registered. If you turn in a paper form after you have registered, we will return the Level I screening and ask that you enter it. If you are not a registered user yet, please notify your facility administrator who can submit an Administrator User Requests for your facility to enroll you in the online system.
25. How can I find the latest news from the PASRR department, especially about the training that you conduct?
Please go to http://www.dhcs.ca.gov/services/MH/Pages/PASRR.aspx for the latest updates.
26. When I try to change my password, my system just hangs. What should I do?
For the system to work correctly, you must disable the Pop-up blocker or allow the DHCS website to be a trusted site. The pop-up blocker is dependent of the browser you are using.
Go to Tools > Internet Options > Security > Trusted Sites > Sites
Click Close > Ok
Go to ‘Customize and Control Chrome’ > Settings > Show Advanced Settings
Under Privacy option, click ‘Content settings’
Under Pop-ups, click ‘Manage exceptions’
Type in “*.pasrr.dhcs.ca.gov” in the Hostname pattern textbox. Make sure the setting selected is ‘Allow’
Click Done > Done. Close the Control window
Safari does not have an "allowed sites" function. To enable pop-ups only for certain websites in Safari, you will have to turn off the pop-up blocker while on the site and turn it on again when leaving the site.
Go to Settings > uncheck ‘Block Pop-up Windows’
PASRR is a federally required program which applies to all Medicaid-certified Nursing Facilities. PASRR is a part of California’s Medicaid program under Title 19 of the Social Security Act and can be referenced in 1919 (b)(3)(F) and 1919 (e)(7) of the Social Security Act.
Medicaid-certified Nursing Facilities cannot admit any resident, regardless of payer source, that have a mental illness or intellectual disability unless the DHCS PASRR Level I screening has been completed.
The Code of Federal Regulations (CFR) Title 42 section 483.100-483.138 establishes guidelines for the implementation of the PASRR program. Please refer to 42 CFR 431.621 for State requirements with respect to nursing facilities. Please also view Section 4.39 of the California State Plan regarding requirements specified in 42 CFR 431.621 (c).
28. If resident is admitted on the weekend and the admitting nurse is unable to go online, can we use the form and complete it manually?
No. Paper submissions will no longer be accepted effective June 30, 2015. The DHCS 6170 must be an electronic submission.
29. Do we need to submit all PASRRs online or only the ones that will trigger a Level II?
All Level I PASRR screens must be submitted electronically.
30. If you do preadmission but the resident does not show up, how do you get them off the web site?
Facilities cannot remove them. Contact DHCS and staff can close the case.
31. If the resident does not trigger for any MI/ID on admission, but does in the MDS, should the facility submit another PASRR?
Yes. This submission would be a Resident Review.
There are no federal requirements regarding who must request Level I screens, but all residents who apply to or reside in a Medicaid-certified nursing facility, regardless of payer or referral source, are required to receive a Level I screen to identify residents with a MI or IDD.
In California, many Intermediate Care Facilities (ICFs) are targeted for residents with developmental disabilities. In that case, ICFs are required to complete a PASRR screen for submission to DDS. Additional information is available at: http://www.dds.ca.gov
There is no federal guideline specific to PASRR that defines “significant change in condition.” CMS recommends that you refer to the MDS 3.0 to make a decision on whether the resident has had a “significant change in condition.” According to the MDS 3.0 manual a “significant change” is a decline or improvement in a resident’s status that:
- Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, is not “self-limiting” (for declines only);
- Impacts more than one area of the resident’s health status; and
- Requires interdisciplinary review and/or revision of the care plan.”
If your resident has experienced a significant change of condition, you must complete a new Level I PASRR screen, regardless of the date of the last PASRR screen, and note that a significant change of condition has occurred.
34. After admission, a resident in a SNF starts having significant disruption. Should /can a facility do a Resident Review status change?
Significant disruption refers to residents whose mental health disorder may have been stable with treatment and/or medication but experienced a disruption for some reason that has impacted their daily living. For example, a resident who is stable on medication but then stops taking it may experience an increase in mental health symptoms that requires the resident to need assistance in regaining stability. The status change indicated by a significant disruption triggers a PASRR Level I Resident Review.
35. If PASRR is done upon admit and records do not state any mental disorder but days after admit info is provided stating resident does have a mental disorder, do we do another PASRR?
Yes this would be submitted as a Resident Review because of a significant change in condition.
2 CFR 483.100-138 is largely mute about the timing of Resident Reviews. Recall that the CFR still describes an annual Resident Review; it has not been updated to reflect subsequent legislative changes. In its current form, the CFR implies – but does not explicitly require – that the Resident Review should be conducted as close as possible to the anniversary of the resident's Preadmission Screen or Resident Review. It would be reasonable to conclude that Resident Reviews should be performed as soon as possible once a significant change in status is detected. But again, there are no average annual requirements, as there are with Preadmission Screens.
The removal of the Section 1919(e)(7)(B)(iii) of the Social Security Act repealing the annual requirement is quoted below. Note that timing is left unspecified:
REVIEW REQUIRED UPON CHANGE IN RESIDENT'S CONDITION: A review and determination under clause (i) or (ii) must be conducted promptly after a nursing facility has notified the State mental health authority or State intellectual or developmental disability authority, as applicable, under subsection (b)(3)(E) with respect to a mentally ill or mentally retarded resident, that there has been a significant change in the resident's physical or mental condition.
From a person-centered perspective, the NF should refer a resident to the state mental health or intellectual disability authority as quickly as possible. For its part, the relevant state authority should arrange for a Resident Review as soon as practically possible. Proper speed can help ensure that a thorough evaluation can be conducted and appropriate adjustments can be made to the resident's plan of care.
37. If a resident temporarily left the facility, do we need to do another PASRR?
If a resident is temporarily absent from the facility because they required routine medical treatment but maintain a bed hold at the facility or are out on a pass to visit with family or friends, a new PASRR is not required.
No. The Balanced Budget act of 1996 eliminated the requirement for annual resident review, specifying that reviews are required instead, upon significant changes in condition. A Level I screening and Level II evaluation (if necessary) must be conducted promptly when there has been a significant change in the resident’s physical or mental condition (within an annual average of 7-9 working days).
39. Does the new PASRR need to be completed for existing long term residents?
Yes. If you have a resident who has been in your facility and has never received a PASRR, it is necessary to complete a PASRR. If they have had a PASRR at some time in the past and have no change in condition, it is not necessary to complete a PASRR. However, it is considered good practice to submit a new PASRR annually for all residents.
A resident who has a dual diagnosis of Mental Illness and Intellectual Developmental Disorder is required to have a Level I Screening by both DHCS and DDS. Once the Online Level I screening is complete please print a copy and send it to:
The California Department of Developmental Services (CDDS),
Federal Programs Operations Section
1600 9th Street, Room 320, MS 3-9
Sacramento, CA 95814
Or fax to CDDS at (916) 654-3256
The facility Administrator or User that entered the Level I screen will print a copy of the DHCS 6170, Need or No Need letter and the Determination Letter and provide it to the conservators.
Until the enrollment system is automated, support is available Monday through Friday 7am-5pm, excluding State holidays through ITServiceDesk@dhcs.ca.gov or by contacting the DHCS IT Service Desk at (916) 440-7000.
The TAR reimbursement is based on the date of admission.
44. If the resident is admitted on the weekend and no one is available to complete a PASRR, will we be penalized when completing the PASRR during the week?
This is a possibility. Federal law prohibits payment for Nursing Facility services until the PASRR screening has been completed. Therefore, it is likely that the facility will not be reimbursed for services if a resident is admitted on a weekend and a PASRR is not completed. Questions about TAR issues can be directed to 1-800-541-5555 (outside of California, please call 916-636-1980).
No physician’s signature is required; however, if the resident requires less than 30 days of care at a Nursing Facility the “box” confirming that the treating physician acknowledges the information provided is true should be checked and the online system will prompt you to enter the name of the treating physician.
46. What does it mean "suspected" mental illness?
Suspected mental illness refers to indications of mental illness (such as odd behaviors, sad affect, anxiety, hallucinations, delusions, psychiatric medications, self-report of mental illness, etc.) either documented or as noted in the impressions of the one conducting the Level I PASRR screen. In the absence of a formal diagnosis, suspected mental illness on the Level I PASRR screen would lead to a Level II evaluation to determine if these symptoms constitute a mental illness. In summary, any time you observe something in the resident or their documentation that you believe may suggest a mental illness, this suspicion should be recorded in the screen.
47. In the section of the new DHCS 6170, is the person completing the form required to document a diagnosis, such as “anxiety disorder” or “generalized anxiety,” or can I report symptoms of a suspected MI/IDD?
You can report either symptoms or a diagnosis. If you report symptoms, we can send out an evaluator to assess whether there is a diagnosable mental illness or not. Remember, PASRR screening is both for residents with a mental illness or SUSPECTED mental illness, so symptoms of mental illness such as depression, anxiety, hallucinations, or delusions would suffice.
48. If the resident has diagnosis of dementia upon admission and has medication for depression or anxiety, do we still code that as MI?
Yes, this situation would be coded as suspected MI since the medications could be for the MI. When the evaluator contacts the facility they will conduct a prescreen to determine if the resident can actively participate in the Level II evaluation.
49. How should a facility address situations when a resident is taking psychiatric medications but also has a diagnosis of dementia with behavioral disturbance?
Some patients with behavioral disturbance and dementia may still be able to benefit from mental health services if the person can still converse with others, participate in a mental health interview, and make their needs known. Their Level I screen should indicate a suspected mental illness.
If the primary diagnosis is a dementia/neurocognitive disorder and/or psychiatric medications are being prescribed due to secondary symptoms related to or due to a primary dementia/neurocognitive disorder, you would not need to record a behavioral disturbance and/or symptoms.
However, if there is a history of a mental illness and the primary diagnosis is not a dementia/neurocognitive disorder or if the diagnosis of a dementia/neurocognitive disorder is unclear or questionable, you should record symptoms (i.e. anxiety, depression, psychosis, behavioral issues (i.e. refusing care, not eating)) because a mental illness in such a case is suspected and could be unrelated to a dementia/neurocognitive disorder.
50. What types of documentation are needed for a resident to be determined to have a neurocognitive disorder? For example, MDs’ progress notes, resident interview, psychological assessment, etc.?
A neuropsychological assessment would be optimal to determine if a resident has a neurocognitive disorder and is able to engage meaningfully in mental health treatment. In the absence of a neuropsychological evaluation, it is recommended that the chart, hospital discharge summary, history and physical, and other available documentation be reviewed to ascertain whether there may be a diagnosis or history of a neurocognitive disorder.
51. Is dementia with psychosis disorder a diagnosis that would lead to a Level II evaluation?
Dementia (currently referred to as neurocognitive disorder) would not qualify ONLY in cases where it is the primary diagnosis and the resident is unable to benefit from mental health treatment or to participate in a mental health interview. If the resident has a diagnosis of psychosis (in addition to dementia) and could participate in a mental health interview and could benefit from specialized mental health services, they would qualify as having a suspected mental illness.
52. Is Pseudobulbar affect considered to be a mental illness?
Pseudobulbar affect (PBA), emotional liability, labile affect, or emotional incontinence refers to a neurologic disorder characterized by involuntary crying or uncontrollable episodes of crying and/or laughing, or other emotional displays. PBA occurs secondary to a neurologic disease or brain injury. Therefore, this condition would not be considered a MI.
53. What is a County Mental Health Plan?
Specialty mental health services are authorized and provided to Medi-Cal beneficiaries through County Medi-Cal Mental Health Plans (MHPs). All of the MHPs are part of county mental health or behavioral health departments. The MHP can provide services through its own employees, or through contract providers.
Residents are entitled to a specialty mental health service if the service is both a covered service under the Medi-Cal program, and is medically necessary. Covered services are provided only if they are also medically necessary. The complete description of these covered services can be found in the Medi-Cal regulations at Title 9, California Code of Regulations (CCR) beginning with section 1810.100.
54. What happens next when the Level I Screening submitted by a facility has a positive result?
Your facility will receive a call from a PASRR representative to discuss the submitted level I screening and the specific Resident it addresses.
55. Who will call my facility as a representative of PASRR?
Your facility will be contacted by an employee of APS Healthcare, a subsidiary of KePRO. APS Healthcare is under contract with the State Department of Health Care Services as the provider of Level II Preadmission Screening and Resident Review evaluations.
56. What questions will the PASRR representative ask during this call?
The representative will ask a number of questions about the Resident’s mental and physical well-being, upcoming appointments, and current room/bed number assignment. In some instances, additional more detailed questions may be asked about prescribed medications, diagnoses and activity level.
57. Who will the PASRR representative want to speak to at my facility?
The representative will ask to speak to the Charge Nurse or Nursing Supervisor assigned to the station caring for the Resident. It is possible the representative may also ask to speak with a Social Services Director or other key supervisory staff to ensure the necessary information is collected during the call.
58. Why is my facility asked these questions?
The representative asks such questions, on a case by case basis, for a number of reasons.
· First, they need to verify that the Resident has not been discharged and is in fact capable of participating in the evaluation.
· Second, they need to clarify any questions that have arisen from information provided on the Level I screening.
· Third, they may need to clarify the intensity of the Resident’s mental health symptoms.
All this information is used to decide if the true need for a Level II evaluation exists.