PASRR Newsletter
Volume 2 - February 2024
PASRR
Is a federally mandated program, applicable to all Medicaid certified nursing facility applicants. The program determines if individuals with a serious mental illness (SMI), intellectual disability /developmental disability or related conditions (ID/DD/RC) require nursing facility services, considering the least restrictive setting or any specialized services.
PASRR 2023 Data
Level I Screenings Submitted
| 496,395
| 100%
|
Negative Screenings (includes cases closed as EHD)
| 317,795
| 64%
|
Level II Attempts (includes cases closed as No SMI, Categoricals, and Duplicates)
| 161,201
| 32%
|
Level II Evaluations & Determinations Completed
| 17,399
| 4%
|
Hot Topic – Expedited Cases (Hospitals)
During the holidays, the Department noticed an increased number of expedited case requests from hospitals. PASRR cases are processed based on the Level I Screenings submission date and are expedited on a case-by-case basis. When cases are expedited, it delays other cases that are in the contractor’s queue. Therefore, we continue to encourage hospitals to submit the Level I Screening as soon as they are aware the individual will discharge to a skilled nursing facility (SNF).
The following is a brief outline of the PASRR process:
After the Level I Screening indicates the individual is positive for SMI, it is electronically sent to DHCS’ contractor, for review and processing. The contractor (Kepro) will contact the hospital within 24 hours of receiving a positive SMI Level I Screening to determine if a Level II Evaluation is needed and complete the evaluation within three to five days. Once the Level II Evaluation is complete, it is electronically sent to DHCS and reviewed by a Consulting Psychologist. Once this review is complete, the Determination letter will be available within 24 hours in the PASRR Online System for the facility to access.
For individuals with ID/DD/RC, the Department of Developmental Services Regional Centers will determine whether a Level II Evaluation is needed within 24 to 72 hours of a positive Level I Screening and have seven to nine business days to complete an ID/DD/RC Level II Evaluation and Determination (PASRR Summary Report).
Hot Topic – Exempted Hospital Discharge (EHD) (SNFs)
It has come to the Department’s attention that SNFs are utilizing the exempted hospital discharge (EHD) option in the PASRR Level I Screening for individuals who are not being admitted from a hospital. SNFs must not utilize the EHD option unless a SNF is completing the Level I Screening on the behalf of a hospital.
The only exemption under which a hospital is not required to fully complete the PASRR process is if the individual discharging to a SNF qualifies for an EHD. Under this process, a Level 1 Screening is still required, but the EHD question can be marked “Yes” in the PASRR Online System. The case will close and an EHD letter is produced. The Level II Evaluation is not required for cases that close as an EHD.
All criteria listed below must apply to meet the 30-day EHD exemption:
- The individual is directly admitted to the SNF from a hospital after receiving acute inpatient care at the hospital; and
- The individual requires SNF services for the same condition the individual was receiving care for in the hospital; and
- The attending physician has certified prior to SNF admission that the individual’s stay is likely to require less than 30 calendar days of NF services.
An EHD cannot be applied to someone who is being admitted to a SNF from home, a health home, or any other setting distinct from a hospital. When the EHD is applied and the SNF expects that the individual will exceed the 30-day period, the SNF must complete a Level I Screening as a Resident Review by the 40th calendar day after admission.
If an individual is entering a SNF from any setting besides a hospital and the individual is expected to stay at the SNF for less than 15 days, then the SNF must report this information in Section IV – Categorical Determination of the Level I Screening. This will trigger a Categorical Review by DHCS’ contractor to determine if a Level II Evaluation is necessary.
PASRR Level II Evaluations Contacts
Phone: (888) 201-0614
| Phone: (833) 421-0061
|
Fax: (844) 523-6388
| Fax: (916) 654-3256
|
Email: CAPASRR@kepro.com
| N/A
|
Upcoming EventsCurrent Projects
- Level I Screening revisions
- California PASRR Regulations
- Quality Monitoring Plan
PASRR Resources
