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The Office of Behavioral Health acts at the State Mental Health Authority (SMHA) for the federally required Preadmission Screening and Resident Review (PASRR) program for clients entering Medicaid Certified Nursing Facilities within Colorado, which is managed by the Colorado Department of Health Care Policy and Finance.
The SMHA is responsible for making the Mental Illness (MI) Specialized Services (SS) and Nursing Facility (NF) determinations, based upon an evaluation conducted by an independent entity. The SMHA makes timely determinations based on these independent Level II evaluations conducted on NF applicants and residents. Determinations made by the SMHA are based upon the above evaluations and contain all required information including any MI needs that are to be addressed in the NF plan of care.
Although the SMHA does not perform the evaluation, it receives the evaluation report and as a practical matter, the report may be part of or attached to the determination notice produced by the SMHA. The SMHA notifies the State Medicaid Agency (SMA) of any NF residents with Serious Mental Illness (SMI) whom the SMHA becomes aware of that did not receive a Level II evaluation before admission, and any problems with PASRR that are the SMHA’s responsibility to address.
PASRR determinations made by the SMHA cannot be countermanded by the SMA through the claims payment process or through other utilization control/review processes, or by the Colorado Department of Public Health and Environment (CDPHE), survey and certification agency, or by any receiving facility or other involved entities.
For more information about the Colorado PASRR program, please visit the website here.
Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care. PASRR requires that:
PASRR is an important tool for states to use in rebalancing services away from institutions and towards supporting people in their homes, and to comply with the Supreme Court decision, Olmstead vs L.C. (1999), under the Americans with Disabilities Act, individuals with disabilities cannot be required to be institutionalized to receive public benefits that could be furnished in community-based settings. PASRR can also advance person-centered care planning by assuring that psychological, psychiatric, and functional needs are considered along with personal goals and preferences in planning long term care.
In brief, the PASRR process requires that all applicants to Medicaid-certified Nursing Facilities be given a preliminary assessment to determine whether they might have SMI or (ID). This is called a "Level I screen." Those individuals who test positive at Level I are then evaluated in depth, called "Level II" PASRR. The results of this evaluation result in a determination of need, determination of appropriate setting, and a set of recommendations for services to inform the individual's plan of care. Regulations governing PASRR are found in the Code of Federal Regulations, primarily at 42 CFR 483.100-138.
The Office of Behavioral Health regularly offers trainings for those involved with the Preadmission Screening and Resident Review (PASRR) process. PASRR is a federal requirement to help ensure that individuals are not inappropriately placed in nursing facilities for long-term care. PASRR requires that all applicants to Medicaid-certified nursing facilities be evaluated for serious mental illness and intellectual and developmental disabilities.
The trainings, which are available for nursing facilities, hospital administrators, hospital case managers, Mental Health Center evaluators, health care workers, and anyone else involved in the PASRR process, go over the PASRR requirements as well as what is a trigger for further (Level 2) evaluation. These trainings also provide more information regarding the need for PASRR and what requirements hospitals, nursing facilities, and single entry points need to follow in order to maintain their compliance.
OBH has increased its ability to offer the trainings, now making them available one to two times per month upon request. Contact PASRR manager Becky Huckaby at email@example.com to schedule training.
The PASRR Technical Assistance Center helps states fulfill the goals of Preadmission Screening and Resident Review. Family members, consumers, and providers can access background information and tools related to PASRR at http://www.pasrrassist.org/
ACF (Alternative Care Facility): an assisted living residence with additional credentials to provide housing under HCBS-MI
ALR (Assisted Living Residence): a group home licensed by CDPHE
BHO (Behavioral Health Organization): Managed care agencies for Medicaid MH services in CO.
CMHC (Community Mental Health Center): the community provider of mental health services for persons with Medicaid and other health insurances.
CMHI-FL (Colorado Mental Health Institute at Fort Logan): one of two Colorado state hospitals, Ft. Logan serves the Metro- Denver population
CMHI-P (Colorado Mental Health Institute at Pueblo): one of two Colorado state hospitals, CMHI Pueblo serves all of Colorado with exception to the Denver metro area.
CMS (The Center for Medicare and Medicaid Services): US federal agency which administers Medicare, Medicaid, and the State Children's Health Insurance Program
Designated Facility: Hospitals and CMHCs that can legally hold certifications under CRS 27-65
DIDD (Division of Intellectual and Developmental Disabilities): The State IDD Authority that is responsible for the public IDD system in CO. The IDD OBRA Coordinator must approve all IDD PASRR evaluations prior to NF admission. This agency is housed at HCPF
H&P (History and Physical): A complete physical exam including history and review of systems required for PASRR
HCBS-MI (Home and Community Based Services for Individuals with Mental Illness): An alternative to NF placement that includes ACFs, home based services and non-medical transportation.
HCPF (Health Care Policy and Finance): The State Medicaid Authority
IDD (Intellectual/Developmental Disability): In CO a condition occurring before the age of 22 that significantly impacts age appropriate development.
IMD (Institute for Mental Disease): A federal classification that determines eligibility for Medicaid payment. Any facility over 16 beds with over 50% MI residents is not eligible for Federal Medicaid dollars.
Level I: PASRR tool used to identify a ‘suspicion’ of MI or IDD
Level II: The in-depth PASRR evaluation that is completed on any individual who is identified as having a PASRR condition (major mental illness or intellectual/developmental disability
LOC (Level of Care): Any MI resident must meet NF LOC, or the level of disability requiring nursing facility to maintain health, safety and well-being
LOS (Length of Stay):
LTC (Long Term Care): a designation of 6 months or longer, residing in a nursing facility
MMI (Major Mental Illness): For PASRR purposes include the following diagnoses: Major Depression, Bipolar disorder, Cyclothymia, Dysthymia, Schizoaffective disorder, Schizophrenia, Psychotic DO NOS, and Delusional Disorder NOS.
NF (Nursing Facility): provides a type of residential care. It is a place of residence for people who require continual nursing care and have significant difficulty coping with the required activities of daily living.
OBH (Office of Behavioral Health): The State Mental Health Authority that is responsible for the public mental health system in CO. The OBH OBRA Coordinator acts as PASRR Mental Health Authority must approve all PASRR evaluations prior to NF admission.
OBRA (Omnibus Budget Reconciliation Act): Annual bill that reconciles the Senate and House budget bills. OBRA ’87 included the Nursing Home Reform Act that mandated PASRR.
PASRR (Pre-Admission Screen and Resident Review): The evaluations that determine the diagnoses and service needs for NF residents. PASs must be completed prior to NF admission.
Placement Facility: a facility with a signed agreement with a designated agency to provide 27-65 services under the designated agency’s designation umbrella.
Placement Facility Agreement: The written agreement required by CRS 27-65 between the Designated Facility holding the certification and the Placement Facility that allows the facility to legally hold an involuntary resident.
Respite: A temporary (30 days per calendar year) stay in a NF for HCBS clients to give their caregiver time off. NOT a short cut for permanent NF admission and NOT an exemption from PASRR.
SURC: The Statewide Utilization Review Contractor for Colorado. PASRR, Private Duty Nursing, 5615 and Hospital Back-Up.
TSH: Thyroid Stimulating Hormone – Required for all PASRR clients with major affective disorders.
ULTC-100.2: Uniform Long Term Care – The seven-page form determining level of care, required for Medicaid payment for NF stays.
To inquire more about PASRR Mental Illness (MI) Specialized Services (SS) and Nursing Facility (NF) determinations, please contact:
Rebecca Huckaby, OBRA | PASRR Manager
Office of Behavioral Health
firstname.lastname@example.org | 303.866.7414