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​PASRR Program Information

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Pre-Admission Screening and Resident Review (PASRR) Background

The Nursing Home Reform Act was passed as part of the Omnibus Budget Reconciliation Act of 1987 (OBRA-87), and amended by Public Law 100-203 and
101-508, creating the Preadmission Screening and Resident Review (PASRR) process.  (Refer to the Code of Federal Regulations (CFR) title 42, part 483, sections 483.100-483.138 to view PASRR regulations).

The California Department of Health Care Services (DHCS), Mental Health Services Division, PASRR Section is responsible for reviewing Level Is that appear to have errors, monitoring the third party contractor that performs Level II evaluations and issuing Determination Letters.  Level I screenings are completed online by GACH and/or NFs for each resident that is going to be admitted to a Medicaid certified nursing facility. The purpose of the Level I Screening is to identify a resident who has a mental illness or is suspected of having a mental illness, an intellectual/developmental disability, or a related condition to determine if specialized services are needed during their stay in a nursing facility. 

When the Level I Screening identifies a resident has a diagnosis or symptoms of a mental illness, the referral is sent electronically to the Level II contractor that will work with the facility and resident to schedule and complete a Level II evaluation within four working days.  When the Level I Screening Document identifies a resident with an intellectual/developmental disability (IDD) or related condition, the system will inform the individual completing the Level I to print the form and send it to the California Department of Developmental Services (CDDS).

A Level II evaluation is necessary to ensure that the resident identified with MI or IDD is residing in a facility that can provide the necessary level of care and specialized services. Federal law requires that DHCS contract with a third party entity with the capacity to perform detailed clinical Level II evaluations.
After the Level II evaluation is completed, the form is sent electronically to DHCS clinical staff that review the information and create a Determination Letter which includes treatment and placement recommendations.  The Determination Letter is sent electronically to the facility where the resident resides with instruction that it must be retained in their medical record and distributed to family members, caregivers, the treating physician, and the conservator as appropriate.

Online PASRR Statistics

System Acceptance

Online PASRR was made available for public use on January 2, 2015. Enrollment has steadily increased in the following months. As of May 31, 2015, 853 California Nursing Facilities have enrolled in Online PASRR, with a total of 3,900 registered users.
Month
Facilities Enrolled
Users Enrolled
January, 2015
14
63
February, 2015
185
264
March, 2015
360
1554
April, 2015
622
2598
May, 2015
853
3900
 
 Online PASRR Enrollment line graph

End-to-End Processing Time

PASRR is a federally mandated screening process for all long-term nursing facility residents that is conducted in three stages: a Level I Screening performed at General Acute Care Hospitals and Nursing Facilities state-wide, a Level II Evaluation conducted by an independent contractor, and generation of a Determination Letter by DHCS Consulting Psychologists. CMS requires that this entire process be completed in 7-9 days. In 2014, California was out of compliance with this requirement. Online PASRR was designed to solve this problem. The average end-to-end processing time for the PASRR screening process in California has decreased from 53 days in June, 2014, to 5 days in May, 2015. The red line in the graph below depicts the federally mandated 9 day completion time. California has been in compliance with the federal standard since February, 2015.
 
Month
End-to-End Processing Time (Days)
June, 2014
53
January, 2015
14.77
February, 2015
8.9
March, 2015
6.39
April, 2015
4.95
May, 2015
5.02
 
Online PASRR End-to-End Processing time graph showing decrease in processing time from 50 days in June 2014 to 5 days in May2015 

Generation of PASRR Determination Letters

Following the completion of the Level II PASRR Evaluation by the independent contractor, DHCS Consulting Psychologists use the information in the Evaluation to write a Determination Letter that is shared with the Nursing Facility and the resident. Online PASRR suggests Determination Letter text based on the Level II Evaluation and expedites the Determination Letter process. As a result, a long-standing back log of cases has been cleared, and DHCS Consulting Psychologists are able to generate, on average, 700 Determination Letters each month.
 
Month
Determination Letters Generated
January, 2015
264
February, 2015
665
March, 2015
730
April, 2015
708
May, 2015
636
 
Online PASRR Determination Letters Generated line graph from Jan 2015 to May 2015

Online PASRR Cases

Each month, California DHCS receives approximately 1,000 positive Level I PASRR Screenings, each of which requires a Level II Evaluation. Prior to implementation of Online PASRR, the state required, on average, 2-3 weeks to enter the Level I PASRR Screening information and transmit it to the Independent Contractor. This delay often resulted in the resident being unavailable for a Level II Evaluation. Online PASRR has decreased the average time between Level I submission and transfer to the Independent Contractor to less than one day. Concomitantly, the number of cases that are closed due the resident being unavailable for Evaluation has decreased by 74%.
 
Month
Total Cases
Cases with Resident Unavailable
January, 2015
1007
456
February, 2015
998
299
March, 2015
1087
231
April, 2015
1016
152
May, 2015
959
117

Online PASSR Cases
Last modified on: 8/3/2015 8:27 AM