NC PASRR FAQs and Definitions

Definitions

• SMI - or Serious Mental Illness, is evident if an individual is known or suspected to have a combination of a major psychiatric condition and a recent history of treatment for, and/or symptoms of that condition. A primary diagnosis of dementia or a sole psychiatric diagnosis of an organic disorder is excluded.
• MR, or Mental Retardation, involves a measure of intellectual functioning that exists concurrently with adaptive functioning deficits.
• RC - or a Related Condition, is any severe or chronic disability such as cerebral palsy, autism, or a head injury that manifests itself prior to age 22, continues indefinitely, and results in substantial functional limitations.

Frequently Asked Questions

PASRR Related

1. Who is Subject to PASRR Screens?
2. Facilities Not Subject to Level I and Level II Screens
3. Applicants for Whom a Level II May be Postponed
4. What If Residence is Expected to Extend Beyond the End Date?
5. What are PASRR Short Term approvals?
6. Who Performs PASRR Evaluations?

Frequently Asked Questions Answers

PASRR Related

1. Who is Subject to PASRR Screens?

All applicants to and residents of Medicaid-certified nursing facilities, whether they are funded by Medicaid or utilize other sources of payment, must be screened through the Level I and, if appropriate, the Level II process.

2. Facilities Not Subject to Level I and Level II Screens

Adult care homes, hospital swing beds, CAP services, and nursing facilities that are not Medicaid-certified are exempt from Level I or Level II PASRR screens. A small number of nursing facilities in North Carolina have a “distinct part” that participates in the Medicaid program as a nursing facility and another “distinct part” that participates in the Medicare program as a skilled nursing facility. Persons seeking admission to the Medicare distinct part, as long as that “part” is not Medicaid-certified, are also exempt from the Level I and Level II processes.

3. Applicants for Whom a Level II May be Postponed

Federal and state rules allow short-term nursing facility admissions for some applicants with SMI, MR or RC. These time-limited approvals are authorized by the PASRR contractor during the Level I screen process when any of the following four circumstances are applicable:

• Convalescent care (30-day approval): applies to admissions to nursing facilities directly from acute care hospitals. The individual must need 30 days or less nursing facility care for the hospitalization condition and the attending physician must provide certification that nursing facility stay is not expected to exceed 30 days
• Emergency (7-day approval): applies to situations where the individual needs emergency protective service placement
• Delirium (7-day approval): applies to individuals suspected as having SMI, MR, or RC, however a delirium state affects accurate completion of the Level I and/or Level II processes
• Respite (7-day approval): applies to individuals whose in-home caregivers need temporary respite

4. What If Residence is Expected to Extend Beyond the End Date?

If residence in the facility is expected to extend beyond the end date, further approval and screening must be obtained through the PASRR contractor before the authorized period ends. The admitting facility is responsible for initiating further screening through an updated Level I screen:

• within five (5) calendar days of the individual’s date of admission for seven (7) day approvals
• within twenty-five (25) calendar days for thirty (30) day approvals, and
• within fifty (50) calendar days for sixty (60) day approvals.

If the individual is Medicaid-eligible and is approved for continued stay through the updated Level I/II process, Medicaid’s fiscal agent’s Prior Approval Unit must be contacted for payment to continue