Preadmission Screening and Resident Review
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The Department of Health Care Services is pleased to announce that California has met its obligation to become preadmission compliant by July 1, 2023. All hospitals discharging to a SNF are submitting the Level I Screenings, ensuring the PASRR process is completed before discharging an Individual to Medicaid certified Skilled Nursing Facilities (SNFs) and are submitting completed PASRR verification and as needed, documentation to the Managed Care Plans (MCPs) with SNF referral for prior authorization.MCP requirements effective May 1, 2023
MCPs are reviewing prior authorization requests for SNF placement to confirm the PASRR process was completed. Hospitals discharging to a SNF and SNFs must include the following information as a note in the prior authorization request:
- Confirmation that the PASRR Level I Screening was completed;
- Whether the Level I Screening result is negative or positive for SMI and/or ID/DD/RC; and
- The PASRR CID.
Hospitals discharging to a SNF and SNFs can find this information on the Level I Screening results that is immediately generated by the PASRR Online System once a Level I Screening is completed. If the Level I Screening result is negative for SMI or ID/DD/RC, the case is closed and MCPs will issue approval of the prior authorization request if the required information is received. However, if the Level I Screening result is positive for SMI or ID/DD/RC and the case advances to a Level II Evaluation, the MCP’s approval of the prior authorization will be pending. Once the PASRR process is completed, hospitals discharging to a SNF and SNFs must provide the resulting Level II Evaluation Letter to the MCP within three calendar days of issuance to obtain approval of the prior authorization request for SNF placement. Hospitals discharging to a SNF may proceed with discharging Members and SNFs may admit Members upon receipt of the MCP's approval.
SNFs must confirm that the Member’s physician office obtained the prior authorization for SNF placement or initiate the prior authorization request with the MCP and include the physician’s order for SNF placement. SNFs will NOT admit individuals from the hospitals without the completed PASRR process. If the SNFs accept admission without the completed PASRR process, Federal Financial Participation (FFP) will only be available for services after the PASRR process is completed.
About PASRR
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), PASRR Section is responsible for determining if individuals with serious mental illness (SMI) and/or intellectual/developmental disability (ID/DD) or related conditions (RC) require:
- Nursing facility services, considering the least restrictive setting
- Specialized services
This is achieved by completing the PASRR process. The PASRR process consists of a Level I Screening, Level II Evaluation, and a final Determination.
Level I Screening
The Screening is submitted online by the facility and is a tool that helps identify possible SMI and/or ID/DD/RC.
Level II Evaluation
If the Screening is positive for possible SMI and/or ID/DD/RC, then a Level II Evaluation will be performed. The Level II Evaluation helps determine placement and specialized services. The Department of Health Care Services (DHCS) is responsible for SMI Level II Evaluations, which by law must be performed by a third party contractor. The Department of Developmental Services (DDS) is responsible for ID/DD/RC Evaluations.
Determination
The SMI Determination will be available online and will include placement and treatment recommendations for the individual. The ID/DD/RC Determinations will be issued by DDS, please contact DDS for questions regarding the Determination.
Contact
Department of Health Care Services
All PASRR questions/requests need to be directed to the DHCS IT Service Desk. IT Service Desk requires a first name, last name, and phone number before a work order ticket can be created.
For questions related to a Level I Screening, Level II Evaluation, or Determination, please include the PASRR CID#.
DHCS IT Service Desk can be reached by email or by phone:
- Email: ITServiceDesk@dhcs.ca.gov
- Phone: (800) 579-0874 and select option 2
Support is available Monday through Friday from 7:30am – 5:30pm. Requests will not be processed after business hours, weekends, or state holidays.
For after-hours assistance with the PASRR Online System, please see the on call schedule below. Please note: Assistance at these numbers is for emergencies regarding PASRR system outages and will only be available outside of normal business hours (I.e. After 5PM on weekdays, weekends, and on holidays).
Kepro (Acentra) contact information:
*Please note, Kepro is transitioning to the name Acentra. The process should be complete in the coming months.
Treatment Authorization Requests (TAR)
If you have questions related to TAR submissions or payment, please contact
Department of Developmental Services (DDS)
For questions related to ID/DD/RC Level II Evaluations and Determinations, please contact DDS.
- Phone: (833) 421-0061
- Fax: (916) 654-3256
California Department of Social Services (CDSS)
If you are dissatisfied with the Reconsideration process, you can request a State Fair Hearing with CDSS.