Overview
Requirement
PASRR Level I Process and Outcomes
Out-of-State Arrangements
Frequently Asked Questions
Important Contact Information
Department Communications
Other Resources
Overview
Preadmission Screening and Resident Review (PASRR) is a federal requirement under Section 1919(e)(7) of the Social Security Act and Chapter 42 of the Code of Federal Regulations, Sections 483.100 through 483.138. For states to have its Medicaid plan approved by the Centers of Medicare and Medicaid (CMS) it must maintain a Preadmission Screening and Resident Review (PASRR) program that compiles with the relevant federal laws and regulations. Preadmission screening and Resident Review ensures that individuals are placed in the most appropriate setting for their needs and not inappropriately placed in a long term care NF. PASRR applies only to individuals, regardless of payer source, who are entering a Medicaid Certified Nursing Facility.
There are two levels to the PASRR process – 1) screening and 2) evaluation and determination. The PASRR Level l is a screening to determine whether an individual is suspected of a Mental Illness (MI) and/or and Intellectual Disability (ID). The PASRR Level ll evaluation and determination determines if there is a MI and /or ID and issues a determination if specialized services are required and the most appropriate setting to receive those services.
Individuals applying for admission to a Medicaid certified nursing facility (NF) regardless of funding as per the Federal regulations are required to have a PASRR Level I screening prior to admission to the NF in order for a state to receive federal financial participation for Medicaid reimbursement of nursing home care. Individuals determined to require Specialized Services through the PASRR Level II process are prohibited from being admitted to a NF, or remaining in a NF.
The PASRR Level l Screening may be completed by a Social Worker (Certified, Licensed Masters Level)*, or a Registered Nurse (APN, RN, MSN) or Physician and\or Physician Assistant.
*State, county and municipal employees are exempt from social work licensing or certification requirements pursuant to NJSA 45:15BB-5(f)
Requirement
The Level I PASRR Screening Tool must be completed for all applicants to a nursing facility (NF), prior to admission, regardless of whether or not Medicaid is payer for the applicant. Medicaid-certified NF may include facilities that are certified by both Medicaid and Medicare, or the Medicaid-certified distinct part of a larger institution.
The Level I PASRR Screening Tool (LTC-26) can be found on the Division of Aging Services forms page.
PASRR Level I Process and Outcomes
Acute Care and Rehabilitation Hospitals – It is necessary for the hospital discharge planner to initiate the completion of the Level I PASRR Screening Tool for all discharges to a Medicaid certified NF.
NF Admissions from the Community – NF staff must coordinate the completion of the Level I PASRR Screening Tool for all admissions to a Medicaid certified NF.
NF Admissions for Respite Stay – Individuals being admitted to a Medicaid-certified NF for a county or state-approved respite stay can be exempt from the Level II evaluation and Determination utilizing Categorical Determinations. DMHAS and/or DDD must be contacted to apply the categorical determination.
Level 1 Outcomes:
- If the Level I is negative, then the individual can be admitted to the NF. A copy of the Level I must accompany the individual to the NF and must be placed on the active medical chart.
- If the Level I is positive for serious mental illness then a copy of the Level I must be faxed to the Division of Mental Health and Addiction Services (DMHAS) for a Level II Evaluation and Determination.
- If the Level I is positive for intellectual disability or a related condition then a copy of the Level I must be faxed to the Division of Developmental Disabilities (DDD) for a Level II Evaluation and Determination.
- If the Level I is positive for serious mental illness AND mental retardation or a related condition, then a copies of the Level I must be faxed to both DMHAS and DDD for a Level II Evaluation and Determination.
After completion of a positive Level I Screen, the discharge planner must issue written notice (LTC-29) to the individual and his or her legal representative that the individual is being referred for a Level II evaluation for MI and/or DD and is being referred to DMHAS and/or DDD. A copy of the letter can be downloaded here.
Exempted Hospital Discharge - Individuals discharged from an acute hospitalization directly to a NF for continued treatment of a condition expected to require less than 30 days of admission may exempt from PASRR requirements with physician certification. If after 30 days the individual remains in the NF for more than 30 days, the NF must complete the Level II Evaluation and Determination process by day 40.
Out-of-State Arrangements
An individual being referred for NF admission from a state other than New Jersey must have a completed Level I, and if positive, a completed Level II Evaluation and Determination, prior to admission. It is the responsibility of the admitting NF in New Jersey to ensure receipt of those PASRR documents from the referring state. It is recommended that the referring state use NJ PASRR forms and submit to the NJ Level II authority.
If the individual is on Medicaid, either in New Jersey or another state, or will be Medicaid eligible in 180 days, the referring facility must contact the appropriate Office of Community Choice Options Regional Field Office at the number below and request an Out-of-State packet. The Office of Community Choice Options manager will walk the referrer through the process.
Frequently Asked Questions
Important Contact Information
PASRR Level I Process
Division of Aging Services
(609) 588-6675
Office of Community Choice Options
|
Northern Regional Office
Serving Bergen, Essex, Hudson, Hunterdon, Middlesex, Morris, Passaic, Somerset, Sussex, Union and Warren Counties.
|
(732) 777-4650
|
45 Kilmer Road
2nd Floor
Edison, NJ 08817
Fax: (732) 777-4681
|
|
Southern Regional Office
Serving Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, Monmouth, Ocean and Salem Counties.
|
(609) 704-6050
|
852 S. White Horse Pike
Hammonton, NJ 08037
Fax: (609) 704-6055
|
PASRR Level II Process
|
Division of Mental Health and Addiction Services
|
|
Statewide PASRR Coordinator
|
(609) 438-4152 or -4146
|
Fax: (609) 341-2307
|
|
Division of Developmental Disabilities Regional Offices
|
|
Newark Office for
Bergen, Essex, Hudson counties
|
(973) 693-5058
|
All DDD Positive Level l screen referrals are to be faxed to the DDD Central fax number at (609) 341-2349.
|
|
Plainfield Office for Hunterdon, Somerset, Union counties
|
(908) 226-7800
|
|
Flanders Office for Morris, Passaic, Sussex, Warren counties
|
(973) 927-2600
|
|
Freehold Office for
Middlesex, Monmouth, Ocean counties
|
(732) 863-4500
|
|
Trenton Office for Burlington and Mercer counties
|
(609) 584-1340
|
|
Mays Landing Office for
Atlantic, Cape May, Cumberland counties
|
(609) 476-5200
|
|
Voorhess Office for Camden, Gloucester, Salem counties
|
(856) 770-6366
|
Department Communications
Other Resources
