Illinois Preadmission Screening and Resident Review (PASRR)

Help Desk staff will be available to return calls and emails on the weekends, however support resources are always available for review through the Illinois PASRR Tools and Resources page.

PASRR was established as part of the de-institutionalization process to ensure people with disabilities (i.e., Serious Mental Illness, Intellectual and/or Developmental Disabilities):

• are not inappropriately institutionalized in a NF
• receive services in the least restrictive setting, and that
• needed services/supports are identified for the NF to provide.

PASRR is an important tool for states to use in rebalancing services away from institutions and towards supporting people in their homes, and to comply with the Supreme Court decision, Olmstead vs L.C. (1999), under the Americans with Disabilities Act, individuals with disabilities cannot be required to be institutionalized to receive public benefits that could be furnished in community-based settings. The goal of PASRR is to optimize an individual’s placement success, treatment success, and ultimately, an individual’s quality of life.

PASRR Level I Screens need to be initiated on behalf of a person seeking NF admission, regardless of their payor source as soon as the need for a NF becomes evident. This process begins when the treating provider or designee submits the Level I Screen electronically via AssessmentPro. This federal-required screen determines if a potential NF applicant has a known or suspected PASRR condition (i.e., a Serious Mental Health (SMI) condition or an Intellectual and/or Developmental Disability (ID/DD)). In most cases, the screening results in an immediate NF approval due to no suspected disability.

We recommend submitting all screens at least 2-3 days in advance of the person’s discharge in order to avoid potential delays in the event that a comprehensive Level II assessment is required.

In cases where the screen requires a clinical review to verify the potential presence of an SMI/ID/DD by Maximus, the submitter will receive an outcome within 5 hours or less. If that review results in the need for a comprehensive Level II assessment, an assessor will be engaged either through Maximus on behalf of DMH or through DDD/ISCs depending on disability type suspected. MH PASRR Level II assessments will be completed within 72 hours or less from receipt of screen.

*Concurrent with the above process and for all preadmission PASRR screens,

CCU/DRS will also be notified that DON and Choices for Care Consultation are needed.

All persons seeking entry into a Medicaid funded NF, regardless of payer source, diagnoses, or current location must be screened prior to NF admission.

Note the following exception: Swing beds. A swing bed is a bed that changes (or "swings") between providing hospital services and providing Medicare or Medicaid nursing facility services. According to the Final Rule for PASRR published in 1992 (55 FR 10951), PASRR does not apply to swing beds.

Pre-Admission Screen—Providers will submit the Level I before admission to a Medicaid certified NF. Expected turnaround time for the Level I is 6 business hours. Maximus encourages providers to begin discharge planning as soon as possible. If they think the person might need NF placement, they should submit the Level I.

This prevents delays in discharge if the person needs a Level II assessment. Expected turnaround time for Level II is less than 72 hours. Resident Review—Providers will submit the Level I screen if the person has an expiring time limited stay or has a significant change in status during their stay. By significant change, consider if the person’s plan of care needs to be modified to incorporate services/supports for any identified behavioral health changes.

The turnaround time for PASRR determinations vary from instantaneous up to 72 hours, depending on the person’s clinical characteristics. If there is no known or suspected Serious Mental Health (SMI) condition and/or an Intellectual and/or Developmental Disability (ID/DD)), the determination is immediate and the submitter is able to print the determination upon submitting the Level I.

If a SMI/ID/DD is suspected, Maximus will review the screen within 6 hours or less to determine if an expedited NF admission is possible using a PASRR categorical or exemption.

If neither applies, Maximus will conduct a comprehensive Level II MH assessment withing 72 hours of a Level I submission or refer screens with a suspicion of ID/DD to DDD/ISCs.

The Department of Human Services - Division of Developmental Disabilities (DDD)/ Independent Service Coordination (ISC) Agencies will conduct Level II assessments for persons with known or suspected DD or dual conditions (SMI +DD). Maximus will alert the ISCs when a Level II assessment is needed.

A Level II assessment is an in-depth assessment which determines if a person has a qualifying PASRR condition (i.e., Serious Mental Illness (SMI), Intellectual Disability and/or Developmental Disability (ID/DD)) and if so, whether the person requires the level of service provided by a NF and also, whether or not the individual requires specialized services for their qualifying PASRR condition.

Maximus will conduct Level II assessments for persons with known or suspected SMI on behalf of the Illinois Department of Human Services (IDHS)/Division of Mental Health (DMH). The IDHS/Division of Developmental Disabilities (DDD), will retain responsibility for conducting Level II assessments for those with an Intellectual Disability and/or Developmental Disability (ID/DD) and/or Dual conditions.

A Summary of Findings report includes a synopsis of information gathered following completion of a comprehensive PASRR Level II MH evaluation as well as the final assessment determination.

After Maximus receives the assessor’s completed Level II MH assessment, our Quality Clinicians (QC) review all submitted information, including the medical record and supporting interviews. The QC then documents if the person appears psychiatrically stable, if NF care is appropriate (meaning the person meets medical necessity for NF admission), and what types of services a person would need to be successful in a NF.

Submitters of Level I Screens will have access to these reports through AssessmentPro, as will the NF once they have admitted the person.