South Dakota Preadmission Screening and Resident Review (PASRR)

FAQs

Maximus performs Pre-Admission Screening and Resident Review (PASRR) Level I screens and Level II Mental Health evaluations on individuals who are applying to or residing in Medicaid-certified nursing homes.

This federally mandated assessment process is used to determine whether the nursing home is the appropriate placement for individuals with mental illness, intellectual disabilities, or developmental disabilities. PASRR functions as an essential method to help match individuals with the care and services they need. Maximus also performs nursing facility Level of Care Determinations for all Level II evaluations.

For information about South Dakota PASRR policies or procedures, contact South Dakota Program Manager, Emily Johnson:

For information on Level I referral submissions or inquiries regarding a specific case, contact the Maximus – South Dakota PASRR Help Desk:

The Maximus – South Dakota Help Desk is available 8 a.m. – 5 p.m. CT, Monday – Friday.

Preadmission Screening and Resident Review (PASRR) is a federally mandated screening process dating back to 1987. PASRR was created as a part of the Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act and PASRR requirements were also added to the Social Security Act as sections 1919 (b) (3) (F) and 1919 (e) (7).

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.

The purpose of a Level I Screen, also known as an identification screen, looks at an individual’s clinical characteristics to establish whether or not they may have a known or suspected PASRR condition. A PASRR condition includes a diagnosis of a Serious Mental Health (SMI) condition and/or an Intellectual and/or Developmental Disability (ID/DD).

If a person has a known or suspected PASRR condition, they will receive a comprehensive Level II assessment to determine if their condition qualifies under the PASRR program, the appropriateness of a NF setting for the person, and any services they may need while in the NF.

All persons seeking entry into a Medicaid funded NF, regardless of payer source, diagnoses, or current location must be screened prior to NF admission. Although the Final Rule for PASRR does not require Level I Screens for people going to a swing bed, currently South Dakota Policies and Procedures do require that a Level I Screen be completed for people needing a swing bed (and Level II evaluation, as applicable).

Maximus will review your Level I Screen and submitted documentation within 1 business day and determine if the individual does have a confirmed or suspected PASRR condition and if so, if a categorical determination applies or if the person needs a Level II evaluation.

Once the Level I Determination has been made, you will receive a Cisco Secure Email from Maximus with your Level I Outcome.

If required documentation is not submitted with your Level I Screen, your screen will be placed on hold for up to 10 business days if it is not received. On the 10th day, this screen will expire due to a lack of required documentation. If the need for a nursing facility is still needed, you must resubmit your Level I Screen and required documentation to Maximus.

  • Convalescent (Less than 100 Days)-Person is admitting to a NF from a medical hospital admission for an acute medical or functional need and is expected to require less than 100 days of NF care
  • Serious Physical Illness-Person has a severe physical illness which results in a level of impairment so severe that the person could not be expected to benefit from specialized services for their disability
  • Terminal Illness-Person has a documented need for hospice or there is a documented life expectancy of 6 months or less
  • Respite-A physician has identified the need for a respite stay in a NF for the person for 30 days or less
  • 75 and Older-If no other categorical determinations apply and the person is 75 years old or older

An individualized Level II evaluation will be completed, which includes a comprehensive review of the person’s needs and an interview with the person (and his/her guardian, if applicable) and with other caregivers. If the Level I review determines that the person has confirmed or suspected serious mental illness, Maximus will complete the Level II Evaluation and Summary of Findings and the State Mental Health Authority will then finalize the determination.

If the Level I review determines that the person has a confirmed or suspected Intellectual or Developmental Disability (I/DD), the State Intellectual Disability Authority (SIDA) will complete the Level II Evaluation and finalize the determination.

If the person has dual serious mental illness and I/DD, both Maximus and SIDA will contact the provider as they will each complete the Level II Evaluation and the final determination will be finalized through communication between the State Mental Health Authority and SIDA. 

The Level II determination will be finalized within 7-9 business days. This timeframe is from submission of the complete and accurate Level I screen to the date of determination.