Frequently Asked Questions
A PASRR, or Pre-Admission Screening Resident Review, is a federally mandated process to determine if an individual meets nursing facility level of care; has a mental illness or developmental disability/intellectual disability diagnosis; and to see if the client needs specialized services to treat their mental health or developmental issues and reduce behavioral symptoms that necessitated admission to a nursing facility.
||Why do we complete a PASRR on clients entering into a nursing facility?
The PASRR procedure was established to protect the civil rights of individuals with mental illness, intellectual disability, or a developmental disability being considered for nursing facility admission. PASRR ensures that the client is being placed in the least restrictive environment and that the client's service needs are adequately met.
||Who requires a PASRR prior to admission to a nursing facility?
Any individual that is applying to a Medicaid Certified Nursing Facility that has a diagnosis of mental illness, intellectual disability and/or developmental disability, or if the individual is considered to be homicidal and/or suicidal (a danger to self or others).
||How is the PASRR process started?
- A Level I application (DMS forms 703, 787, and 780) is faxed to Bock Associates.
- The application is reviewed to see if the applicant meets the Medicaid medical nursing home eligibility criteria.
- Bock Associates reviews the application to determine if the client meets PASRR criteria and then sends a fax to the referring agency regarding the outcome of the Level I review.
- If the client is determined to need a PASRR, an assessor from Bock Associates will call upon the referring agency to set up an interview of the client. Bock Associates, by federal law, has up to nine business days to complete the review.
- Once the review is completed by the assessor and returned to Bock Associates, it is reviewed by the Office of Long Term Care. The Office of Long Term Care oversees the PASRR process in Arkansas and is the agency responsible for determining if the client meets the Medicaid medical nursing home eligibility criteria.
- Bock Associates then issues a determination in writing to the referring agency. If the client is approved for nursing facility admission, they may then transfer to the nursing facility of choice. The nursing facility is responsible for contacting Bock Associates with the client's admission date.
- Bock Associates will then mail out the completed PASRR to the nursing facility. It is a federal law that all PASRR clients have a copy of the completed PASRR on their nursing facility record.
||Where do I obtain the Level I forms (703, 787, and 780) that are to be completed and faxed to Bock Associates for determining if my client needs a PASRR?
A copy of the Level I forms are provided on the internet at the following address: http://humanservices.arkansas.gov/dms/Pages/oltcForms.aspx
||How long does it take for Bock Associates to process my Level I screening once I have faxed it to their office?
We process all applications the same day if received prior to 3 pm. If you have not received a decision on an application within 1-2 business days, please contact Bock Associates to make sure we received the fax.
||Is there a way to ensure a quick review of my Level I application after it is received by Bock Associates?
If you fax a completed application with all areas filled in this will help speed up the review process. Make sure all signatures and dates are obtained before faxing the forms. Provide a next of kin for the applicant on page 1 of the 787 form. Make sure to fax any guardianship papers with the application if the client was unable to sign the application.
||Are there any documents that I can fax in with my Level I application to speed the review process?
Here is a list of documents that help us to determine the need for a PASRR:
- History and Physical
- Psychological Evaluation
- Medication Record (MAR)
- Discharge Summary from previous hospitalizations
- Power of Attorney/Legal Guardianship Papers
- IQ and/or Adaptive Behavior testing if the client is ID/DD
||Does a diagnosis of dementia trigger a PASRR screening?
Dementia as a stand-alone diagnosis does not trigger a PASRR unless the client is considered to be homicidal and/or suicidal (danger to self or others) OR the client has a pre-existing diagnosis of mental illness, intellectual disability, and/or developmental delay.
||What are the Mental Illness diagnoses that trigger a PASRR screening?
Current primary or secondary mental illness diagnosis as defined in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition Revised including Schizophrenia, Schizoaffective, Delusional Disorder, Psychosis, Major affective disorders (Bipolar, Major Depression, Dysthymia), Panic/Anxiety Disorder, Somatoform, Post-Traumatic Stress Disorder (PTSD), Personality Disorder, Obsessive-Compulsive Disorder (OCD), any treatment within the last two years for mental illness or symptoms of mental illness, or presenting evidence of mental illness including possible disturbance in orientation, affect, mood, and/or behavior.
||What is the definition of Developmental Disability?
According to ACT 729 of 1993, Section I, “Developmental Disability” means a disability of a person which:
- (1) is attributable to an intellectual disability, cerebral palsy, epilepsy, or autism;
(2) is attributable to any other condition of a person found to be closely related to an intellectual disability because it results in impairment of general intellectual functioning or adaptive behavior similar to those of intellectually disabled persons or requires treatment and services similar to those required for such persons; or
(3) is attributable to dyslexia resulting from a disability described in subdivision (1)(A) of this section;
(B) Originates before the person attains the age of twenty-two (22) years:
(C) Has continued or is expected to continue indefinitely; and
(D) Constitutes a substantial handicap to the person’s ability to function without appropriate support services including, but not limited to, planned recreational activities, medical services such as physical therapy and speech therapy, and possibilities for sheltered employment or job training.
||What is the definition of an Intellectual Disability?
Significantly sub average general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested prior to age 22. An individual is considered to have an intellectual disability if he/she has a level of intellectual disability (mild, moderate, severe, or profound), as described in American Association on Intellectual and Developmental Disabilities Manual (2010).
||What is a Hospital Exempted Discharge?
If your client is applying to a nursing home and meets the criteria listed below, he/she may qualify for an exempted hospital discharge. If the client does meet the criteria, please have the attending physician fill out the form "Exempted Hospital Discharge/Physician Certification of Need for NF Services". Once the Level I application AND the exempted hospital discharge form are received they will be forwarded to the Office of Long Term Care for approval.
- Client who is admitted to any NF directly from a hospital after receiving acute inpatient care at the hospital; AND
- Client requires NF services for the condition for which he/she received care at the hospital; AND
- Client's attending physician has certified that the individual is likely to require less than 30 days convalescent care in a nursing facility. Either the discharging hospital or admitting NF will be responsible for obtaining the physician certification and the Level I forms 703, 787, and 780.
If the individual remains in the NF beyond the 29th day following admission, a new DHHS-703 must be submitted to Bock Associates before the end of the 31st day. At that time, Bock Associates will complete a PASRR/Level II on the client.