Health Law Daily CMS overhauls preadmission screening and resident review regulations
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Thursday, February 20, 2020

CMS overhauls preadmission screening and resident review regulations

By Rebecca Mayo, J.D.

The Preadmission Screening and Resident Review requirements are being updated to more accurately reflect currently accepted medical standards and definitions.

The regulations relating to the Preadmission Screening and Resident Review (PASRR) have not been updated since 1992 and CMS has received considerable feedback about the regulations being outdated. In an effort to modernize the requirements for PASRR, a new proposed rule would make the process more streamlined and person-centered. The proposed rule would incorporate statutory changes, reflect updates to diagnostic criteria for mental illness and intellectual disability, as well as reduce duplicative requirements and other administrative burdens on State PASRR programs (Proposed rule, 85 FR 9990, February 20, 2020).

PASRR. PASRR required states to create a system to assess the needs of individuals with mental illness (MI) or intellectual disability (ID) applying to, or already residing in, Medicaid-certified nursing facilities (NFs). This screening was done to ensure that individuals were not being placed in NFs unnecessarily or without adequate supports. The state mental health authority (SMHA) or state intellectual disability authority (SIDA) was required to determine whether individuals with MI or ID who were applying to or were living in Medicaid-certified NFs actually required the level of services offered by the NF and whether they needed additional or specialized services for MI and ID beyond the services typically provided in a NF.

Goals. PASRR was created as part of the Omnibus Budget Reconciliation Act of 1987. CMS then published initial criterial for the PASRR programs in the State Medicaid Manual in 1989. PASRR was revised in 1990 and CMS published the final PASRR rule in 1992 to reflect those changes. In 1996, Public Law 104-315 removed the requirement that resident review be performed annually and provided instead that the review should be performed upon a significant change in the resident’s physical or mental condition. However, CMS has not issued additional regulations since the 1992 final rule so the regulations do not currently reflect the statutory change. CMS received feedback that portions of the regulations are unclear, illogical, duplicative, or out of touch with current long-term care practices. The proposed rule aims to update and streamline the regulations to provide the most effective method of improving implementation of PASRR nationwide.

Changes. The proposed rule makes a number of technical corrections, such as removing the word "annual" before "resident review" to be more in line with the actual requirements. It also explains what would trigger a resident review since it is no longer done annually, and what the time frames would be for having a review done. Some terms would be replaced to reflect current medical terminology and some definitions would be updated to be more consistent with currently used definitions, such as those used in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

The proposed rule would also prove a restatement of the basic requirements of the PASRR program to reflect current statutory requirements. The PASRR program would require: identification of all applicants for admission to, and residents of, Medicaid-certified NFs who have possible MI or ID; preadmission screening of all eligible new admissions with MI or ID who apply to Medicaid NIFs and tracking of individuals with possible MI or ID admitted under preadmission screening exceptions; and resident review of eligible residents with MI or ID.

Additionally, a new requirement would describe the State Medicaid Agency’s PASRR responsibilities. These responsibilities would include ensuring and enforcing the PASRR program’s compliance with federal regulations, executing and enforcing written interagency agreement among the SMA, SMHA, and SIDA, designating an entity to perform the evaluations for individuals with MI, and ensuring timely and accurate reporting of data. The responsibility of ensuring timely and accurate reporting data would place the ultimate responsibility of ensuring that data that the PASRR program gathers and submits on PASRR program activities, is reported to the Secretary.

MainStory: TopStory ProposedRules CMSNews LTCHNews MedicaidNews QualityNews SNFNews

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