PASRR Status Change
A status change is defined by the presence of newly emerging or changing conditions or needs. These should
be reported to HPES PASRR department by submitting a Level I screen and may occur in one of three ways:
- If the individual's physical status changes significantly, such that his/her Intellectual or Developmental Disabilities needs are
more likely to respond to treatment, the facility should report such changes to HPES for an screening of
need for further assessment (Level II)
- If a serious mental illness or Intellectual or Developmental Disabilities/ related condition was not discovered at the preadmission
screen, and that condition later emerged or was discovered, the facility should report those
symptoms, diagnoses, etc., to the HPES PASRR department to assess for further screening needs.
The facility should monitor data on the MDS to identify any issues which might be positive indicators
of a mental disability
- If an individual has been previously screened for the PASRR population, begins to exhibit increased
symptoms or behavioral problems, these should be reported to HPES to assess for further screening
HPES may request additional medical record information to determine further need for an early Level II ARR
Time Limited Admissions Which Require Level I Updates
The referral source completes the North Carolina Level I Screening Form and contacts the
PASRR contractor for a PASRR number:
- If a Level II screening is not needed, a time limit and a PASRR number is assigned by
the PASRR contractor with an alpha character ending of D, E, or F.
- If the individual is a Medicaid recipient, the referral source contacts Medicaid's fiscal
agent (1-800-688-6696 or 1-919-851-8888) and proceeds with the Medicaid nursing
facility prior approval process (refer to Chapter 3, Prior Approval).
The receiving nursing facility submits the North Carolina Nursing Facilities Tracking Form to
the PASRR contractor.
- If the resident is to remain beyond the authorized time frame, the receiving facility
contacts the PASRR contractor prior to the end-date to update the Level I information
(contact within 5 days for a 7-day authorization; contact within 25 days for a 30-day
authorization; contact within 50 days for a 60-day authorization)
- If approved, the PASRR contractor issues the new PASRR number.
- If a Level II screen is needed, the PASRR contractor completes the Level II evaluation.
- If approved through the Level II process, the facility contacts Medicaid's fiscal agent to
update the prior approval
The following situations define temporary time-limited nursing facility admissions for MI/ IDD/ RC applicants
meeting federal and state specified criteria. These admissions will be permitted following submission of the
Level I screen by the referral source. A subsequent HPES authorization number is issued with an "end-date"
for the time limited stay. Prior to expiration of that time period, the receiving facility must update
the Level I screen if the individual's stay is expected to exceed the allotted time frame. This may result in a
Level II face to face assessment.
- Convalescent Care admissions are Federally allowed without a Level II screen, as long as all of the
following conditions are met: 1) Admission to a NF occurs directly from a general hospital after
receiving acute inpatient medical care, and; 2) NF services are required for the hospitalized condition,
and; 3) the attending physician has certified that NF care is unlikely to exceed 30 calendar days. This
physician certification must be provided to HPES at the time of the screen.
Clearly, persons whose admission for convalescence is likely to exceed 30 days should not apply for this
exemption. If at any time it appears that the individual's stay may exceed 30 days, and no later than the
25th calendar day, the receiving facility must submit an updated Level I screen to determine whether the
person will continue to require NF care and to assess for further screening needs (Level II process)
- Provisional Admission allows for temporary (7 day) admission of persons whose delirium precluded the
ability to make an accurate diagnosis. Facilities with admissions approved under this category must
follow Level I screening procedures for an update, at such time that the delirium clears or no later than
the 5th calendar day following admission. The submission of an updated Level I screen on the 5th
calendar day will determine need for continued care and for further assessment under the Level II
- Emergency Admission applies to Nursing Facility Applicants who have evidence of MI and/or IDD/RC
and require temporary nursing facility admission in an emergency protective services situation (NF care
is approved for no greater than 7 calendar days).
If at any time it appears that the individual's stay may exceed 7 days (Provisional & Emergency admissions),
no later than the 5th calendar day, the receiving facility must submit an updated Level I screen to HPES to
determine whether the person continues to require NF care and to assess whether further screening under the
Level II process may be necessary. This standard applies if:
- based on the MI/IDD/RC individual's physical and/ or environmental status, there is a sudden
and unexpected need for immediate NF placement;
- the above need requires temporary placement until alternative services/ placement can be secured
and no other placement options are available
- Respite allows temporary (7 day) care for an individual with MI/IDD/RC to allow respite for the
caretaker to whom the individual will return following the temporary stay. If at any time it appears that
the individual's stay may exceed 7 days, no later than the 5th calendar day, the receiving facility must
submit an updated Level I screen.
Transferred/ Discharged/ Deceased MI/ IDD/ RC Residents which Require Updated Level I Screens
Information in this category must be reported to HPES for all residents enrolled in the PASRR process who
meet criteria below:
- Transfer/Discharge of MI/IDD/RC residents: NFs must report to HPES any persons with MI, IDD, or
conditions related to IDD (RC) who are discharged from the facility. Unless there has been a significant
change in their status, tracking information, (submitted via a tracking form discussed in detail in Section
IV.B of this document), is the only information that will be required. Status changes for both MI and
IDD/RC residents must be reported to HPES through the process described in Section II.D.i of this
- Deceased MI/IDD residents: NFs must report deceased MI/IDD resident information to HPES using
the tracking process discussed in Section IV.B of this document.
HPES State of North Carolina
PASRR Screening Requirements
Conditions Which Do Not Reqiure An Updated Level I Screen
The following circumstances do not require an update to the Level I process for nursing home residents:
- Re-admissions after hospitalization or temporary leave for persons who have had a PASRR screen do
not require a Level I or Level II screen before the readmission occurs. Under PASRR regulations, a
temporary absence is defined as one in which the individual planned to return to that facility or to
another facility at the end of the absence
Although a re-admission does not require a PAS (Level II) screen before admission, any significant
change in status should prompt such a referral following the individual's return to the facility. For
example, a resident with MI who is treated in a psychiatric unit receives a new resident assessment at
That resident assessment should trigger an updated Level I referral, to determine whether the
individual's annual PASRR review should be performed sooner than its annual due date. While not
required, in some cases it may be advisable that a Level II be requested before the resident's return to
the nursing facility. If an evaluation is performed earlier than the annual due date, the individual's
anniversary date for subsequent reviews will be one year following the change in status evaluation.
Status change procedures are discussed in Section II.D.i.
- Transfers who have had a prior Level I and did not require a Level II evaluation do not require an
update to the Level I, unless there has been a significant change in status as addressed earlier in this