Preadmission Screening and Resident Review (PASRR) | State Mental Health Authority (SMHA)

The Office of Behavioral Health acts as the State Mental Health Authority (SMHA) for the federally required Preadmission Screening and Resident Review (PASRR) program for individuals 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 of 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.

What is PASRR

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:

  1. all applicants to a Medicaid-certified nursing facility be evaluated for serious mental illness (SMI) and/or intellectual disability,
  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.

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.

Training

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. Contact PASRR manager Chellie Voss at michelle.voss@state.co.us to schedule training.

PASRR Technical Assistance Center

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 www.pasrrassist.org

Frequently Asked Questions

Question: I am looking for more information and training on how to submit PASRR documents, where can I find this?
Answer: Visit www.colorado.gov/hcpf/par

Question: I am trying to check on the status of a triggered PASRR Level II. Who can I get this information from?
Answer: Please contact the Colorado eQHealth PASRR team re: status of a request. They can be reached by email at Eq.pasrrco@eqhs.com

Question: Where can I get a copy of an old Notice of Determination (NOD) and/or Level II evaluation?
Answer: For any Level II evaluations and NODs issued prior to Sept.1, 2019, contact Chellie Voss at michelle.voss@state.co.us

**For Level II evaluations and NODs completed after Sept. 1,2019, please access the eQSuite for these documents. If you are having difficulty accessing or navigating eQSuite you can call customer service at 888.801.9355 or email their provider relations department at Co.Pr@eqhs.com**

Contact

To inquire more about PASRR Mental Illness (MI) Specialized Services (SS) and Nursing Facility (NF) determinations, please contact:

Chellie Voss OBRA | PASRR Manager
Office of Behavioral Health
michelle.voss@state.co.us| 720.646.2881