When Medicaid recipients enter a nursing home, the Pre-Admission Screening and Review (PASRR, pronounced pay-sar) assessment is done to determine whether they have been appropriately placed for care. It is often done in conjunction with the ULTC 100.2 and other associated forms for long term care planning by the Options for Long Term Care agency. Most individuals will only undergo the initial Level I screening, but those who are determined to have a major mental illness or developmental disability may have to undergo a Level II screening. A Level II screening may be required if an individual is receiving psychotropic drugs.
The PASRR forms are available from the Colorado Department of Human Services.
Level I and II screenings
The Level I PASRR is a one-page document asking questions about diagnoses for mental illnesses or developmental disabilities, including histories, presentation of symptoms, prescriptions and referrals. The form tries to determine whether the individual meets the criteria for care in a nursing home, and can be both safely and effectively treated there for the presenting diagnosis. If any of the questions are answered yes, a Level II screening is usually necessary. Generally if an individual has Alzheimer’s or other dementia related impairment, is terminally ill, needs only convalescent care less than 60 days or in a comatose or vegetative state, but is determined to have a mental illnesses or developmental disability, this does not prohibit them from entering a nursing home. For other criteria, individuals with mental illnesses or developmental disabilities will need a Level II screen and appropriate care planning to be admitted to a nursing home.
A Level II PASRR is a more qualitative document designed to capture the care plan and how a facility is going to care for an individual with mental illnesses or developmental disability. This includes involving physician and psychiatrist orders for medication, medical condition, personal and behavioral management.
Major Mental Illnesses
If an individual is determined to have a major mental illness (i.e. schizophrenia, paranoia, major affective disorder or other primary diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (DSM IVTR), he/she will be referred to the Community Mental Health Center for the Level II screen. It will include:
- A medical history
- An exam of body systems
- A neurological evaluation
- A psychosocial evaluation
- A functional assessment for activities of daily living
- A psychiatric evaluation
Individuals with developmental disabilities (i.e. indefinite functional limitation in three areas of: self-care, understanding/use of language, learning, mobility, self-direction or capacity for individual living) will be referred to the Community Center Board for a Level II screen. It must include:
- A medical history (with presenting problems, independent functioning ability, medications, responses to neuroleptics, mood stabilizers, anti-depressants, anti-anxiety sedatives and anti-Parkinsonian agents)
- Self-monitoring ability of health status, medication, nutritional status, toileting, dressing, grooming and eating
- Sensorimotor development (for ambulation, transfer skills, dexterity, etc)
- Speech and language development
- Social development (interpersonal skills, relationship skills, recreation-leisure skills)
- Academic/educational development
- Vocational development
- Independent living development
- Affective development (interests, emotional expression, judgment making, decision-making ability)
- Presence of maladaptive or inappropriate behaviors
The Community Center Board is responsible for making a care plan to meet their mental health needs, separate from the physical care plan for the nursing home. They must also approve transfers between nursing homes. The individual must need nursing care services in addition to services for the disability to be admitted to a nursing home.
For more information or help, please contact us at 303-333-3482.