MDS Alert

Here's what you need to know and code about the PASRR.

The MDS 2.0 doesn't alert you to the fact that your facility isn't in step with Preadmission Screening and Resident Review (PASRR) evaluation requirements. But "there's a question on the MDS 3.0 asking about that (A1500)," notes Marilyn Mines, RN, RAC-CT, BC, manager of clinical services for FR&R Healthcare Consulting in Deerfield, Ill.

MDS item A1500, which is completed only on an admission assessment, asks the question: "Has the resident been evaluated by Level II PASRR and determined to have a serious mental illness and/or mental retardation or a related condition?" (see the MDS item on this page).

The nuts and bolts: Anyone who applies for admission to a Medicaid-certified nursing facility needs a Level 1 identification screen to identify whether he might have statutorily defined mental illness or mental retardation (MI or MR), according to a CMS Webcast, "Mental Illness in Nursing Homes" (http://surveyortraining.cms.hhs.gov/pubs/VideoInformation.aspx?cid=1066). A person identified by the Level 1 screen as having potential serious MI or MR requires a state-performed PASRR Level II evaluation to determine whether nursing home placement is needed -- and, if so, what specialized services the state is responsible to provide or arrange for the person to receive.

Also: If you complete a significant change assessment on a resident on a Level II PASRR, the nursing home must notify the "state mental health authority, mental retardation or developmental disability authority," states the MDS 3.0 RAI User's Manual.

The manual instructs you to:

"1. Complete if A0310A = 01 (Admission Assessment).

2. Review the Level I PASRR form to determine whether a Level II PASRR was required.

3. Review the PASRR report provided by the State if Level II screening was required."

"• Code 0, no: if any of the following apply:

PASRR Level I screening did not result in a referral for Level II screening, or

Level II screening determined that the resident does not have a serious mental illness and/or mental retardation-related condition, or

PASRR screening is not required because the resident was admitted from a hospital after requiring acute inpatient care, is receiving services for the condition for which he or she received care in the hospital, and the attending physician has certified before admission that the resident is likely to require less than 30 days of nursing home care, or

PASRR was not performed as required. If subsequent PASRR LevelII concludes that serious mental illness and/or mental retardation-related condition is present, change response to 1, yes.

• Code 1, yes: if PASRR Level II screening determined that the resident has a serious mental illness and/or mental retardation-related condition.

• Code 9, not a Medicaid-certified unit: if the bed is not in a Medicaid-certified nursing home. The PASRR process does not apply to nursing home units that are not certified by Medicaid (unless a State requires otherwise) and therefore the question is not applicable.

Note that the requirement is based on the certification of the part of the nursing home the resident will occupy, not the source of payment. In a nursing home in which some parts are Medicaid certified and some are not,this question applies when a resident is admitted, or transferred to, a Medicaid certified part of the building."

Editor's note: The above instructions are included in the MDS 3.0 RAI manual as of press time, although CMS could update the instructions. If that occurs, MDS Alert will notify readers in an upcoming issue.