Iowa Preadmission Screening and Resident Review (PASRR)

Yes, always. A new Level I will always be needed when a NF resident is psychiatrically hospitalized. This is considered a status change and must be reported via a new Level I screen. Because the individual is already a NF resident, this is a submission of a Resident Review (RR), also known as a Status Change (SC) rather than a Preadmission Screening (PAS).

This can be identified on the Level I screen under the Reason for Screening (NF resident who is currently hospitalized in a psychiatric hospital/unit and an evaluation is needed to ensure NF readmission is appropriate) and/or under Status Change (Increased behavioral, psychiatric, or mood related symptoms). The status change must be submitted within 14 days of when the person has returned to the NF, but if there is any doubt about whether the level of services may change as a result of the behavioral health change that led to hospitalization, the NF may ask the hospital to submit the Level I so a Level II can be completed prior to the individual’s return to the NF.

Required and requested information should be uploaded directly into the PASRR record via the Iowa PASRR Database whenever possible as it is much faster and more secure. If you don’t know how to use the upload function, access the training guide on the IA PASRR Providers webpage or contact the IA Help Desk (email: IowaPASRR@maximus.com or phone: 833.907.2777). While uploading will help the process move faster and is preferred, you may also fax documents to (877.431.9568).

Do not copy and paste the H&P or any other supporting documents into the comment section, as this section is meant for dialog between reviewer and Level I submitter.

With any PASRR, whether it is Level I screen or a Level II assessment, it is valid for placement in an Iowa NF only for 60 days from the date of the outcome. If the person has not been placed in an Iowa NF within 60 days of the finalized date on the Level I or Level II Summary of Findings, then a new PASRR is required.

Unless the Level II determination indicates otherwise, it is a non-time limited approval with no expiration date for the person’s NF length of stay. If there is no expiration date, the PASRR remains valid unless there is a significant change in status for the person, involving either significant improvement or worsening of their PASRR condition/behavioral health.

Level II PASRR determinations (including EHDs and other categorical outcomes) that indicate a short-term approval will include a number of days for which they are approved and a specific expiration date. The accepting NF should be working mightily to see that the person is discharged to a lower level of care on or prior to the expiration. If the person will not discharge prior to expiration, the facility must submit a Resident Review Level I for consideration, and note barriers to discharge, 7-10 days prior to the expiration date on the PASRR.

Yes, always. All persons who may be placed in a NF must have a PASRR prior to NF admission. In cases where a person is at a hospital, whether admitted or not, it is the hospital, rather than the potential receiving NF or NFMI, which should submit the LI screen to initiate the PASRR process.

No. After completion, you’ll need to contact the Iowa PASRR Help Desk using one of the methods listed here:

• Email: IowaPASRR@maximus.com
• Phone: 833-907-2777

You should be looking at the PASRR and the associated care plans frequently, and at a minimum, each time you review the care plan, service delivery, or have a care conference. Ask yourselves if the current PASRR continues to reflect the individual’s behavioral health status and service needs. You do not need to submit a new PASRR unless or until the individual experiences a significant change in status or you have reason to believe that they may need different services from what the current PASRR identifies.

Note: Any PASRR Level II outcome that has an expiration date will require the submission of a new Level I screen 7-10 days prior to the expiration date if the individual is expected to remain in the nursing facility beyond the date of expiration. 

A ServiceMatters review is triggered for every individual who has a Level II PASRR with one or more specialized services identified in the Summary of Findings and 50% of those Level II outcomes where no specialized services are identified. Much more detail about when and how that happens is available in the ServiceMatters training webinar, other webinars that cover PASRR compliance, and many/most of the face-to-face full day training events as well.

Note: It is important for nursing facilities to understand that PASRR compliant care planning and service delivery is required for every individual who has a Level II outcome, whether specialized services have been identified, whether a ServiceMatters review has been triggered or not. The elements required for PASRR compliant care planning are the same that DIAL expects, as part of licensing, for all care plans for all NF residents, whether they are in the PASRR population or not. 

You receive technical assistance usually within 14 business days of the ServiceMatters review completion. To locate this written technical assistance, log into the Iowa PASRR Database from the Iowa PASRR Providers webpage and locate the IID for the individual. In the Episodes tab, select the ServiceMatters Assessment ID (AID). The system does not automatically notify you of these outcomes/letters, so you will need to check after waiting at least 14 business days. 

Please remember that the contracted average turnaround time is 5 calendar days or less, which begin counting on the day the Level II assessment is triggered. The Iowa PASRR Program manager, Lila Starr, has asked providers to please not contact the IA PASRR Help Desk to request updates on the status of an assessment, because the submitting person/agency can monitor completion on the database. We can never provide an exact date of (expected) completion prior to actual completion. Submitters can watch for the outcome to appear on the Iowa PASRR database, as the full Level II summary of findings will appear and be available to download/print/save, at the moment it is completed.