Section 16.03.10.227 - PREADMISSION SCREENING AND RESIDENT REVIEW PROGRAM (PASRR)All Medicaid certified nursing facilities must participate in, cooperate with, and meet all requirements imposed by, the Preadmission Screening and Resident Review program, (PASRR) as set forth in 42 CFR, Part 483, Subpart C. (3-17-22)
01.Background and Purpose. The purpose of these provisions is to comply with and implement the PASRR requirements imposed on the state by federal law. The purpose of those requirements is to prevent the placement of individuals with mental illness (MI) or intellectual disabilities (ID) in a nursing facility unless their medical needs clearly indicate that they require the level of care provided by a nursing facility. This is accomplished by both pre-admission screening (PAS) and resident review (RR). Individuals, for whom it appears that a diagnosis of MI or ID is likely, are identified for further screening by means of a Level I screen. The actual PASRR is accomplished through a Level II screen where it is determined whether, because of the individual's physical and mental condition, they require the level of services provided by a nursing facility. If the individual with MI or ID is determined to require a nursing facility level of care, it must also be determined whether the individual requires specialized services. PASRR applies to all individuals entering or residing in a nursing facility, regardless of payment source. (3-17-22)02.Policy. It is the policy of the Department that the difficulty in providing specialized services in the nursing facility setting makes it generally inappropriate to place individuals needing specialized services in an nursing facility. This policy is supported by the background and development of the federal PASRR requirements, including the narrow definition of mental illness adopted by federal law. While recognizing that there are exceptions, it is envisioned that most individuals appropriate for nursing facility placement will not require services in excess of those required to be provided by nursing facilities by 42 CFR 483.45. (3-17-22)03.Inter-Agency Agreement. The state Medicaid agency will enter into a written agreement with the state mental health and intellectual disabilities authorities as required in 42 CFR 431.621(c). This agreement will, among other things, set forth respective duties and delegation of responsibilities, and any supplemental criteria to be used in making determinations. (3-17-22) a. The "State Mental Health Authority" (SMHA) in the Division of Behavioral Health of the Department, or its successor entity. (3-17-22)b. The "State Intellectual Disabilities or Developmental Disabilities Authority" (SDDA) in the Division of Family and Community Services of the Department, or its successor entity. (3-17-22)04.Coordination for PASRR. The PASRR process is a coordinated effort between the state Medicaid agency, the SMHA and SDDA, independent evaluators and the nursing facility. PASRR activities will be coordinated through the Bureau of Long Term Care (BLTC). BLTC is responsible for record retention and tracking functions. However, the nursing facility is responsible for assuring that all screens are obtained and for coordination with the BLTC, independent MI evaluators, the SMHA and SDDA, and their designees. (3-17-22) a. All required Level I screens and reviews must be completed and submitted to the BLTC prior to admission to the facility. (3-17-22)b. When a nursing facility identifies an individual with MI or ID through a Level I screen, or otherwise, the nursing facility is responsible for contacting the SMHA or SDDA (as appropriate), and assuring that a Level II screen is completed prior to admission to the facility, or in the case of an existing resident, completed in order to continue residing in the facility. (3-17-22)c. Resident Reviews (RR). An individual identified with MI or ID must be reviewed and a new determination made promptly after a significant change in their physical or mental condition. The facility must notify the BLTC of any such change within two (2) working days of its occurrence. For the purpose of this section, significant change for the participant's mental condition means a change that may require the provision of specialized services or an increase in such services. A significant change in physical condition is a change that renders the participant incapable of responding to MI or D.D. program interventions. (3-17-22)Idaho Admin. Code r. 16.03.10.227