STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

Aging and Long-Term Support Administration

Home and Community Services Division

PO Box 45600, Olympia, WA 98504-5600

H14-069 - Procedure

September 30, 2014

TO: / Home and Community Services (HCS) Division Regional Administrators
Developmental Disabilities Administration (DDA) Regional Administrators
DDA Field Services Administrators
DDA Case Management Supervisors
DDA Case Managers
FROM: / Bea Rector, Director, Home and Community Services Division
Don Clintsman, Deputy Assistant Secretary, Developmental Disabilities Administration
SUBJECT: / Pre-Admission Screening and Resident Review (PASRR)
Purpose: / To remind staff of the PASRR process and to inform staff of the newly revised PASRR Level I form.
Background: / PASRR is a long-standing federal requirement (42 CFR §483.100 – 138) to ensure that individuals with serious mental illness (SMI) and/or intellectual disabilities or related conditions (ID/RC) are not inappropriately placed in nursing facilities for long term care. PASRR requires that all applicants to a Medicaid-certified nursing facility:
1.  Be evaluated for SMI and/or ID/RC;
2.  Be offered the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings); and
3.  Receive the services they need in those settings.
The PASRR process begins with a Level I screening which is used to identify those who may meet the criteria to be evaluated for specialized services. A Level I screen is required for every individual applying for admission in a Medicaid-certified nursing facility. The Level I screen must be performed prior to admission to the nursing home.
The professional referring the individual to the NF completes the PASRR Level I form. Hospitals are responsible for ensuring this form is complete and accurate before discharging an individual to a nursing facility.If the individual is admitting to the nursing facility from the community, either the physician or ARNP making the referral or DDA or HCS staff can complete the Level I form. A physician or ARNP must attest to the condition and sign the form if the individual meets one of the categories of individuals who may be admitted to a NF without a prior Level II evaluation, even though they have SMI and/or ID/RC (per 42 C.F.R. §483.130).
If SMI and/or ID/RC is identified or credibly suspected, a Level II evaluation is required to confirm that identification, determine whether the individual requires nursing facility level of care, and determine whether specialized services are required. With some exceptions, the Level II evaluation must be completed prior to admission to the nursing facility. The list of PASRR evaluators is available online at: http://www.dshs.wa.gov/dbhr/pasrr.shtml. Please note: If a person has both SMI and ID/RC, referrals to both the SMI PASRR contractor and the Developmental Disability Administration (DDA) regional PASRR coordinator are required
What’s new, changed, or
Clarified / The Level I form was recently revised. The new form must be used by facilities by November 1, 2014. Notification of the revised Level I form has been sent to nursing homes via a Dear Nursing Home Administrator letter and to physicians and hospitals via the Medicaid Provider Alert listserve.
ACTION: / The Department will provide additional information and training for any professional involved in the PASRR process, including DDA and HCS staff involved in the NF admission process, through two webinars on October 28 and October 30 (see registration links below).
·  Please register for one of the following dates:
o  October 28, 2014 from 2:30-4:00pm
o  October 30, 2014 from 9:00-10:30
RELATED REFERENCES: / ·  WAC 388-97-1920 through 388-97-2000
·  42 CFR 483.100-138
·  Health Care Authority’s Medicaid Provider Alert

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ATTACHMENT(S): / Level I Pre-Admission Screening and Resident Review
(DSHS Form 14-300)
RCS’ Dear NH Administrator Letter
CONTACT(S): / Debbie Blackner, Nursing Facility Case Management Program Manager, HCS

360-725-2557
Terry Hehemann, PASRR Program Manager, DDA

360-725-3456

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