PASRR Determination and TAR Process
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What is a PASRR Determination?
If the Level 1 Screening is positive for an individual as having, or suspected of having, a PASRR condition, i.e., serious mental illness (SMI), intellectual disability (ID), or developmental disability (DD), or related conditions (RC), then a Level 2 Evaluation will be performed. The Level 2 Evaluation helps determine the most appropriate placement of an individual, considering the least restrictive setting, and whether specialized services are needed. A PASRR Determination means a decision made by the mental illness (MI) or ID state Authority, delivered by a provider, which includes placement and treatment recommendations that are most appropriate for an individual, including the need for specialized services.
The Department of Health Care Services (DHCS) is the MI Authority, and the Department of Developmental Services (DDS) is the ID Authority for the State of California.
What is a PASRR Categorical Determination?
Categorical Determinations allow states to omit the full Level 2 Evaluation in certain circumstances that are time-limited or where the need for NF level of services is clear. For additional information, please see the PASRR Technical Assistance Center (PTAC). The MI or ID Authority may make Categorical Determinations as to whether NF services are needed under the following categories:
A. Brief Stay (Time limited)
Provisional admissions pending further assessment in emergency situations requiring protective services, with placement in a NF not to exceed six days.
Finite stays of less than 15 days to provide respite to in-home caregivers to whom the individual with SMI or ID/DD or RC is expected to return following the brief NF stay.
B. Delirium:
Provisional admissions pending further assessment in cases of delirium where accurate diagnosis cannot be made until the delirium clears. The individual must have a primary diagnosis of delirium, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
C. Severe Physical illness:
There is a severe physical condition such as coma, ventilator dependence, or neurocognitive disorder (dementia) that prevents the individual from engaging with others, communicating effectively, and/or participating in mental health care.
D. Terminal Illness:
The individual has a terminal illness that is currently being treated under palliative, comfort, or hospice care.
Note: Please see the PASRR General Overview FAQs for NF types that are subject to PASRR.
What documents are required for a Categorical Determination?
Supporting documentation for a Categorical Determination includes, but is not limited to, hospital records, physician's evaluations, election of hospice status, direct consultation with a clinical provider, and records of community mental health centers.
How are PASRR Determinations recorded?
Any Determination made by the MI or ID state authority, should be recorded by the facility in the individual’s medical record. The facility is also responsible for ensuring the Determination letter is recorded in the resident’s care plan.
What is the difference between an exempted hospital discharge (EHD) and a Categorical Determination?
A hospital discharging an individual to a NF is exempted from completing the entire PASRR process if the stay is expected to last no more than 30 calendar days. This is called an EHD. The EHD is the only exemption that would allow a facility to forego the PASRR process. A Level 1 Screening is still required, but the EHD question can be marked “Yes” in the PASRR Online system, which will complete the PASRR process for the hospital.
A Categorical Determination permits a state to omit the Level 2 Evaluation in certain circumstances that are time-limited or where the need for NF services is clear. While the evaluation process is abbreviated, a Categorical Determination is not an “exemption.” For additional information, please see the PASRR Technical Assistance Center (PTAC).
Note: Please see the PASRR General Overview FAQs for hospital facility types that are subject to PASRR.
Determination Letters
What is a Determination letter?
A Determination letter is a notice generated by the MI or ID Authority to notify an evaluated individual, and the individual’s legal representative, attending physician, and provider, of the individual’s need for NF level of care and specialized services.
This notice also provides instructions on how to appeal the Determination.
DHCS PASRR Consulting Psychologists are responsible for creating an individualized Determination letter for SMI Level 2 Evaluations, and these letters are electronically available to the facility using the PASRR Online System.
DDS Regional Center staff are responsible for creating an individualized Determination letter (PASRR Summary Report) for ID/DD or RC Level 2 Evaluations, and these letters are sent directly to the facility by DDS Regional Centers.
Who is responsible for distributing the Determination letter?
The facility that administers the Level 1 Screening which identifies suspected or diagnosed SMI, ID/DD, or RC resulting in a Determination will receive the state Determination letter and is responsible for distributing copies of the Determination letter to the:
Individual and the individual’s legal representative;
Admitting or retaining NF; and
Individual or individual’s attending physician.
Can previous Determination letters be accessed?
Once the electronic File Exchange occurs from the discharging to receiving facility, the Determination letter is no longer accessible to the discharging facility using the PASRR Online System.
Can you see Determination letters that were submitted from other hospitals?
No. Determination letters issued for individuals in other facilities cannot be accessed using the PASRR Online System.
Are Determination letters sent using the electronic File Exchange only?
DHCS SMI Determination letters can be sent electronically using the File Exchange feature within the PASRR Online System, by email, or a hard copy of the letter can be printed and given to the NF when the individual is transferred.
DDS Determination letters (PASRR Summary Reports) are sent to the facility directly from DDS Regional Centers.
How does the conservator get a copy of the Determination letter?
The facility can print and provide a copy of the Determination letter to the appropriate parties listed on the distribution list of the letter, including any other person involved in the care and treatment of that individual.
Will I need to check the PASRR Online System for a Determination letter, or once it is completed, will I be notified?
The facility is responsible for checking the PASRR Online System for Determination letters related to SMI Level 2 Evaluations. DDS Determination letters (PASRR Summary Reports) are sent to the facility directly from DDS Regional Centers.
How long does it take to receive a PASRR Determination?
Federal mandate requires the PASRR Determination be available within an annual average of seven to nine working days from the date the Level 1 Screening was submitted. However, DHCS' target for SMI Level 2 Evaluations and Determinations is three to five days.
DDS Regional Centers have seven to nine business days to complete an ID/DD or RC Level 2 Evaluation and Determination.
A hospital should start the PASRR process with a Level 1 Screening at admission, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation, if needed, and Determination, prior to discharge.
How and when can a facility follow-up on the receipt of the determination letter, and who is the point of contact if the response is not timely?
After the SMI Level 2 Evaluation concludes, the facility can expect the Determination letter within 24 hours from the submission of the evaluation in the PASRR Online System. Please review the closed case list in the PASRR system for the Determination letter. If the Determination letter has not been generated, please send a secure email with the PASRR client identification number to the PASRR@dhcs.ca.gov.
DDS Regional Centers have seven to nine business days to complete an ID/DD or RC Level 2 Evaluation. If the Determination has not been received after this time, you can contact DDS as follows:
Phone: (916) 653-0791
Fax: (916) 654-3256
How long does documentation stay in the PASRR Online System?
The PASRR screenings and letters stay with the case, and the case can travel from facility to facility using the electronic File Exchange within the PASRR Online System indefinitely.
Is it okay to proceed with a transfer to NF while waiting for a PASRR Determination?
No. The PASRR process must be complete prior to discharging the individual to the NF. This includes the Level 1 Screening, a Level 2 Evaluation, if needed, and a Determination.
Does the patient get a copy of the PASRR documentation?
The individual should receive copies of all PASRR letters. Examples of such letters include, but are not limited to, a Letter of No Need, a Letter of Need, a Categorical Determination letter, Determination letter, or an Attempt letter. Level 1 Screenings are optional to provide.
If a Level 2 Evaluation and final Determination indicate the NF is not the appropriate level of care, where can I find alternative placement resources?
DHCS will issue a Determination letter with the recommended services. If the Determination letter indicates that a NF is not the appropriate setting for the individual, it will include alternative recommended placement and services that the discharging facility should take into consideration to help ensure the individual is placed at a facility that best meets their needs.
Below is an example of alternative placements and services that may be provided in DHCS’ SMI Determination letter.
The following alternative placements and services may be found through county resources:
Residential Options:
Residential Care Facility for the Elderly
Residential Care Facility for the Chronically Ill
Continuing Care Retirement Community
Adult Residential Facility
Home Health Services
In-Home Support Services Program
Healthcare Services:
Individual Mental Health Rehabilitation
Targeted Case Management
Medication Support Services
Community Based Adult Service
Adult/older Adult system of Care
Personal Care Services Program
Social Support Services:
Family Caregiver Support Program
Long-Term Care Ombudsman Program
Supplemental Nutrition Assistance Program
Vocational Rehabilitation Services
Alzheimer's Association
Alzheimer's Day Care Resource Center
Adult Protection Services
Senior Services:
Senior Companion Program
Health Insurance Counselling and Advocacy
Multipurpose Senior Services Program
Senior Community Services Employment Program
Senior Information and Assistance Program
Program of All Inclusive Care for the Elderly
Senior Care Action Network
DDS does not include this information in their ID/DD or RC final Determinations (PASRR Summary Reports).
Treatment Authorization Requests (TARs)
I have questions about the TAR process. Who can I contact?
For all TAR related inquiries, please call (800) 541-5555. Please also refer to the PASRR section (preadmis) of the Medi-Cal Provider Manual.
Will TAR reimbursement be based on the date of admittance or the date the Level 1 Screening is submitted?
TAR reimbursement is determined by the date the PASRR process was completed prior to NF admission.
What do I submit with a TAR for a Categorical Determination?
Please submit the Categorical Determination letter along with the TAR. If a Categorical letter is not available online, please contact the DHCS IT Service Desk via email or by phone as follows:
DHCS IT Service Desk hours are Monday to Friday 7:30 am to 5:30 pm. It is closed on weekends and state holidays. If calling, please leave a detailed message that includes your name, email address, your facility name, phone number, the PASRR Case Identification (CID) Number, if applicable, and other details about the nature of your call.
Request for Reconsiderations (Provider Appeal Process)
What is the appeal process if a provider doesn’t agree with the Determination?
If an individual, the family/court appointed conservator, guardian, or legal representative, or the hospital or NF disagrees with the DHCS SMI Determination, a PASRR Request for Reconsideration (provider appeal) can be requested. Please follow the steps below to submit a Reconsideration Request through the PASRR online system:
Log into the PASRR system using the direct link: https://portal.dhcs.ca.gov.
On your dashboard, select the “Reconsideration" dropdown menu.
Click “Reconsideration List."
Search for the case in question using the CID#.
Under the Action column, click “Submit Reconsideration Request."
Complete the required fields on the form:
Click Submit to finalize your Reconsideration Request.
Monitor your Level I Case List for the Reconsideration Letter.
If the PASRR system is offline for more than 24 hours, please follow the steps below to submit a PDF Reconsideration Request by mail, fax, or email: Click on the Request for Reconsideration form to download and select “Save as” to save it to your computer.
Submit the completed form to DHCS via mail, fax, or email.
Mail:
Department of Health Care Services
Clinical Assurance Division
PASRR Section
P.O. Box 997419 MS 4507
Sacramento, CA 95899-7419
Fax:
(916) 319-0980
Email:
PASRR@DHCS.CA.GOV
If you want to submit a Request for Reconsideration (provider appeal) for an ID/DD or RC Determination (PASRR Summary Report), please contact DDS directly as follows:
Phone: (916) 653-0791
Fax: (916) 654-3256
During the Level 2 Evaluation or the Request for Reconsideration (provider appeal) process is there any opportunity for provider-to-provider contact?
Yes, please direct all SMI Level 2 Evaluations inquires to DHCS’ contactor, Acentra, as follows:
Please direct all SMI Determination and Request for Reconsideration (provider appeal) inquiries to DHCS as follows:
Please direct all ID/DD or RC Level 2 Evaluation, Determination (PASRR Summary Report), and Request for Reconsideration (provider appeal) inquiries to DDS, as follows:
Phone: (916) 653-0791
Fax: (916) 654-3256
Who would submit the Request for Reconsideration (provider appeal), and what is the turnaround time for a response?
The individual, the family/court appointed conservator, guardian, or legal representative, or the hospital or NF can submit the Request for Reconsideration within 90 days from the date of the Determination letter.
DHCS will respond to the Request for Reconsideration (provider appeal) within three to five business days. DDS Regional Centers have seven to nine business days to complete the PASRR process, including Requests for Reconsideration.
State Fair Hearing (Patient or Resident Appeal Process)
What if the patient or resident does not agree with the Request for Reconsideration outcome?
If dissatisfied with the Request of Reconsideration outcome, the individual or resident can request a State Fair Hearing with the California Department of Social Services (CDSS) online, by phone, or by sending a completed State Hearing Request form by email, regular mail, or fax.
To request a State Hearing:
Online: State Hearing Requests
email: Send a completed State Hearing Request Form to: ScopeofBenefits@dss.ca.gov
Fax: Send a completed State Hearing Request Form to (833) 281-0905
Phone: Call (800) 743-8525
Telecommunication Device for the Deaf (TDD) users: Call (800) 952-8349
Regular Mail: Send a completed State Hearing Request Form to:
California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 9-17-37
Sacramento, CA 94244-2430
