The Pre-Admission Screening and Resident Review (PASRR) Office at the Ohio Department of Mental Health (ODMH) works to make sure that people are placed in the appropriate environment when they need intensive treatment and services.
To help ensure that individuals were not inappropriately placed in nursing facilities (NFs), the Omnibus Budget Reconciliation Act of 1987 (OBRA 87, Pub. L. 100-203) introduced Preadmission Screening and Resident Review (PASRR). PASRR requires that all applicants to a Medicaid-certified nursing facility are evaluated for mental illness (MI) and/or mental retardation or related conditions (MR); are placed in the most appropriate setting (whether in the NF or in the community); and receive assessments that identify the services they need in those settings. (Center for Medicare and Medicaid Services, May 1, 2012.)
PASRR was in many respects ahead of its time. OBRA 87 predated the Americans with Disabilities Act (ADA) by three years, and the PASRR Final Rule, published in 1992 (57 FR 56450), foreshadowed the seminal Supreme Court decision, Olmstead v. L.C. (1999, 527 U.S. 581). The Olmstead decision held that the ADA applied to individuals with mental and intellectual disabilities, as well as to individuals with physical disabilities, and that all individuals have the right to live in the "least restrictive setting" possible.
In brief, PASRR requires that all applicants to Medicaid-certified NFs be assessed to determine whether they might have MI or MR. This is called a "Level I screen." The purpose of a Level I screen is to identify individuals whose total needs require that they receive additional services for their intellectual disabilities or serious mental illness. Those individuals who "test positive" at Level I are then evaluated in depth to confirm the determination of MI/MR for PASRR purposes, and the "Level II" assessment produces a set of recommendations for necessary services that are meant to inform the individual's plan of care.
In 1994, regulations governing PASRR were incorporated into the Code of Federal Regulations at 42 CFR 483.100-138. To assist the States in conducting the necessary evaluations and determinations, CMS allows States to claim an enhanced 75 percent match on all PASRR-related activities. PASRR is not classified as a service, but rather as a special kind of administrative activity, and is a mandatory part of the basic Medicaid State Plan.