Ensuring individuals receive the most appropriate long-term care is a critical aspect of healthcare. Misplacement in nursing facilities, particularly for those with serious mental illness (SMI) or intellectual disability (ID), not only impacts individual well-being but also strains healthcare systems. Preadmission Screening and Resident Review (PASRR) emerges as a vital set of Long Term Care Tools To Evaluate Criteria For Admission, designed to prevent inappropriate nursing home placements and promote care in the most suitable setting.
Understanding PASRR: A Key Tool for Long Term Care Evaluation
PASRR is a federal mandate for all Medicaid-certified nursing facilities. It acts as a crucial mechanism to ensure that individuals seeking admission are thoroughly evaluated for SMI and/or ID. This evaluation process guarantees that every applicant is considered for the most integrated and appropriate care setting, whether it be in their community, a nursing facility when necessary, or even acute care settings for short-term needs. Furthermore, PASRR mandates that individuals receive the specific services required to support their needs within these chosen settings.
PASRR’s significance is underscored by its role in helping states rebalance their long-term care systems. It actively encourages a shift away from institutionalization and towards community-based support, aligning with the principles established in the landmark Olmstead vs L.C. Supreme Court decision. This decision, grounded in the Americans with Disabilities Act, affirms that individuals with disabilities have the right to receive services in community settings rather than being forced into institutions to access public benefits. Beyond placement, PASRR promotes person-centered care planning by ensuring that psychological, psychiatric, and functional needs, alongside personal preferences and goals, are integral to the long-term care planning process.
The Two-Tiered PASRR Evaluation Process
The PASRR process employs a two-level screening system to effectively evaluate applicants. Initially, all applicants to Medicaid-certified nursing facilities undergo a Level I screen. This preliminary assessment is designed to identify individuals who might have SMI or ID, acting as an initial filter to flag cases requiring more in-depth review.
Those who screen positive at Level I proceed to a more comprehensive Level II PASRR evaluation. This in-depth assessment delves into the individual’s specific needs and conditions. The outcome of the Level II evaluation is multi-faceted, resulting in:
- A determination of the individual’s need for nursing facility services.
- A determination of the most appropriate setting to meet those needs.
- A set of service recommendations that are crucial for informing the individual’s personalized plan of care.
Regulatory Framework and Updates to PASRR
The regulations governing PASRR are primarily detailed in the Code of Federal Regulations (CFR), specifically within 42 CFR 483.100-138. These regulations provide the framework for how PASRR is implemented and managed.
The Centers for Medicare & Medicaid Services (CMS) actively updates and refines PASRR guidelines to ensure its effectiveness and relevance. For instance, in February 2020, CMS issued a Notice of Proposed Rule Making and a Fact Sheet related to PASRR, indicating ongoing developments and adjustments in the program.
Conclusion: PASRR as a Cornerstone of Responsible Long-Term Care Admission
PASRR stands as a critical tool within the landscape of long-term care. By providing a structured and federally mandated process to evaluate criteria for admission, PASRR protects vulnerable individuals from inappropriate institutionalization and promotes access to care in the most integrated and suitable settings. Its emphasis on person-centered planning and community-based services makes PASRR an essential component of a responsible and effective long-term care system.
