PASRR - Introduction
a. Explanatory Statement. The Preadmission Screening and Resident Review (PASRR) program seeks to ensure that individuals who are otherwise eligible for care in a nursing facility (NF) and who also have a mental illness, intellectual disability, or other related condition, receive the additional care necessary to meet their needs. Individuals whose needs for specialized services due to mental illness, intellectual disability, or other related conditions, which are too great for NFs to provide, will be referred to a more appropriate level of care and service. Through the PASRR evaluation, the Department or its agent determines whether:
- The individual has a mental illness, intellectual disability or other related condition.
- If so, whether the individual requires specialized services.
- Whether the individual requires nursing facility level of care.
The general eligibility for NF level of care is not a subject of this manual. Individuals may not be admitted to NFs due to a diagnosis of mental illness, intellectual disability, or other related conditions alone; individuals must meet the general medical eligibility requirements for NF level of care, as determined by the Department's agent, currently Goold Health Systems.
Change in Condition PASRR reviews, after the initial screening, assessment and admission, will not result in changes in eligibility for NF level of care, unless the individual's needs are greater than an NF can provide. Changes noted through PASRR Change in Condition reviews after admission may result in changes in the level or intensity of specialized services, including referral to a more intensive level of care outside the NF.
b. Authority. Screening and evaluation through the PASRR program is required for participation in MaineCare. Persons who do not comply with the requirements of the PASRR program may be denied payment for services provided in an NF. Similarly, NFs that do not comply may have MaineCare billings disallowed. The required elements of a PASRR program are described in detail at 42 CFR Ch IV, Subpart C (§483.100 et seq.). The Electronic Code of Federal Regulations is available at http://ecfr.gpoaccess.gov.
This manual is published under the authority of the Maine Department of Health and Human Services (DHHS). DHHS acts as the State's Medicaid agency and authority for mental health and intellectual disabilities. This manual coincides with the requirements of the MaineCare Manual as described at 10-144 CMR Ch II, Section 67.05-1. This section of the MaineCare Manual may be accessed online at: http://www.maine.gov/sos/cec/rules/10/ch101.htm
For further information or technical assistance for the PASRR program, please contact the Department's current agent, APS Healthcare. Users of this manual are encouraged to contact their Provider Relations Specialist in the DHHS Office of MaineCare Services for questions related to MaineCare, or the Office of Licensing and Regulatory Services for questions related to licensing requirements. Addresses and phone numbers can be found in the Directory section of this manual.