Pre-admission screening and resident review (PASRR)
Congress developed the Preadmission Screening and Resident Review (PASRR) program to ensure that admission and retention of people with serious mental illness in nursing and boarding care facilities is appropriate, as part of the Omnibus Budget Reconciliation Act (OBRA) 1987 commonly referred to as OBRA regulations. Federal Medicaid law and regulations require states
to have a PASRR program to determine whether nursing facility applicants and residents meet nursing facility level of care and/or require specialized services for mental health care.
Under the PASRR program, the Medicaid regulation prohibits Medicaid certified nursing facilities (NFs) from admitting any person with a serious mental illness (SMI) unless the state mental health authority (SMHA) or state Medicaid agency has determined that the person requires the level of services the facility provides. Further, the SMHA must determine whether the person requires specialized services to treat mental illness. If placing the person in a NF is deemed appropriate and the person requires specialized mental health services, the SMHA must provide or arrange the provision of such services. The SMHA also must review the needs of NF residents with SMI for NF services and specialized care. The SMHA delegates admission and determination decisions to an entity without direct or indirect ties to a nursing facility.
In Minnesota, the SMHA has delegated responsibilities for PASRR to the county human service agency as the local mental health authority (LMHA) in the county where the person is physically located. This may not be the county of financial responsibility. Regulations require that states complete specific procedures for preadmission screening to identify people who have or are suspected of having a mental illness. All applicants to either a Medicaid certified NF or boarding care facility, regardless of income, assets, or funding sources, must receive a Preadmission Screen (PAS) and Level I screening prior to admission.
Nursing facilities must not admit any new resident with a serious mental illness before a PASRR determination is made, which indicates the person requires NF services and which determines whether the person needs specialized services. No federal payment may be made for NF services provided to a person with a serious mental illness who has not been screened and approved for admission.