Case Management

Mentor moment: Improve PASRR processes to prepare for healthcare reform

Case Management Weekly, May 26, 2010

The following article is adapted from HCPro’s resource for hospital case managers—www.CaseManagementMentor.com—a free blog dedicated to connecting hospital case managers to industry pacesetters, peers, and best practices.

Before discharge planners refer patients (regardless of payer source) to a Medicaid-certified nursing facility, they must screen them for serious mental illness (SMI) or mental retardation (MR).

Preadmission Screening and Resident Review (PASRR) is a federal mandate that protects individuals with SMI or MR from placement in facilities that can’t provide their specialized level of care.

The PASRR program uses two levels to screen patients for these conditions.

All prospective nursing facility residents must undergo a Level I screen. “The Level I screener makes judgments about the adequacy of existing information to rule out SMI or MR,” according to CMS’ website.

Level I screeners can’t make or verify diagnoses. Discharge planners typically perform these screens by completing a form using information contained in the medical record. They can’t draw conclusions beyond the following:

  • Documented evidence is sufficient to rule out SMI/MR; individual can be admitted into the nursing facility.
  • SMI/MR can’t be ruled out, and thus a Level II Individualized Evaluation is required.
  • Documented information is sufficient to apply certain predetermined criteria and make a categorical determination.

A Level I screen typically takes 24 hours, according to a 2006 report by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The Level II screen is more complex, and therefore more time consuming. The SAMHSA report estimates that a Level II screen can take seven to nine days. Because patients remain in the hospital for a Level II screen, this process can significantly increase a patient’s LOS.

Jackie Birmingham, RN, MS, discussee PASRRs in An Overlooked Element of Health-Care Reform: PASRRs” published recently in the Curaspan Connections newsletter. Because healthcare reform will increase the number of nursing facility referrals, Birmingham suggests hospitals improve their processes to screen patients quickly. 

“With more patients qualifying for nursing home coverage and therefore more Level I screening, there will be more Level II screening as well. You can therefore expect longer lengths of stay for more patients unless a plan is in place to screen, process and document cases in a timely manner. If you anticipate that a patient will need a nursing home, you’d better clear Level I quickly,” Birmingham writes.

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