PASRR/Significant Change in Status Requirements

August 2, 2011

DAL: DRS-NH 11-08

RE: PASRR/Significant Change in Status Requirements

Dear Administrator:

The purpose of this letter is to remind you that residential health care facility (RHCF) residents who have been previously identified through the PASRR (Preadmission Screen Resident Review) process as having mental illness or mental retardation and have experienced a significant change in status require a new Level II PASRR evaluation. In addition, this letter introduces a new PASRR NYS Level II Adult Mental Health Evaluation Report. This letter supersedes DQS/DAL #05-07 (July 6, 2005).

Guidelines for identifying a significant change in status can be found in the Minimum Data Set (MDS) 3.0 User's Manual Section 2.6. The PASRR definition for a significant change in status is the same as the MDS 3.0 definition which states, "A significant change is a decline or improvement in a resident's status that:

  • Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions; is not 'self-limiting' (for declines only);
  • Impacts more than one area of the resident's health status; and
  • Requires interdisciplinary review and/or revision of the health care plan."

Referrals for a Level II evaluation must be made as soon as the significant change is evident. The facility should not wait until the MDS significant change in status assessment is complete. When a resident is transferred to an acute care facility, and the RHCF suspects the resident has experienced a significant change in status, the RHCF must collaborate with the acute care facility to ensure a timely PASRR referral is made.

Island Peer Review Organization (IPRO) has been awarded the NYS Department of Health (DOH) contract to conduct PASRR NYS Level II Mental Health evaluations. Level II referrals can be initiated by contacting IPRO at 1-800-633-9441 or (516)-326-2110. The Office for People with Developmental Disabilities (OPWDD, formerly OMRDD) is responsible for PASRR Level II mental retardation/developmental disability evaluations. Evaluations are conducted by the local Developmental Disabilities Service Office (DDSO). For contact information, see Attachment A.

Effective September 1, 2011, Level II Adult Mental Health evaluations will result in the issuance of a PASRR NYS Level II Adult Mental Health Evaluation Report (Attachment B). This report provides the PASRR evaluator's placement and mental health services recommendation. The receiving entity must review this information and incorporate it into the resident's overall plan of care, including discharge planning. Individuals who desire to reside in the community cannot be admitted to a RHCF if their needs can be met in the appropriate community setting. Medicaid funding is not available when required Level II PASRR evaluations have not been conducted or when the individual has been admitted to the RHCF despite a Level II placement recommendation determining the individual is not appropriate for RHCF placement. For those recommended for RHCF placement, the report may include a recommendation for mental health services of lesser intensity. The RHCF must be able to provide or arrange for these services if recommended. Individuals recommended for specialized services may not be admitted to the RHCF. Specialized services in NYS are defined in the Medicaid State Plan under Title XIX of the Social Security Act as follows:

For mental illness, specialized services means the services specified by the State which result in an individual plan of care that demands hospitalization. The care plan must include one or more of the following:

  • Hospital level of assessment or diagnosis of recent behavioral change;
  • Intensive observation, protection, assistance or supervision from the professional staff of the hospital;
  • Introduction or change in medication or other somatic treatment that needs frequent round the clock monitoring by professional staff.

The plan must be developed and supervised by an interdisciplinary team which includes a physician, qualified mental health professionals and, as appropriate, other professionals. The plan must be directed towards diagnosing and reducing the resident's behavioral symptoms that necessitated hospitalization, so as to improve his or her independent functioning to a level that permits reduction in the intensity of mental health services to below the level of specialized services at the earliest possible time.

IPRO is responsible for ensuring the PASRR NYS Level II Adult Mental Health Evaluation Report is received by all required parties. The report must be interpreted and explained to the individual, and where applicable, the individual's legal representative. The referring entity is responsible for this interpretation and explanation. A referring facility representative must date and sign the report indicating that the interpretation and explanation has been provided.

The DOH will continue to review compliance to ensure Level II referrals and recommendations are implemented in a timely and appropriate manner consistent with federal requirements. Questions regarding significant change in status can be directed to the DOH Bureau of Nursing Home Quality Assurance at 518-408-1282. Questions regarding the new PASRR NYS Level II Adult Mental Health Evaluation Report can be directed to IPRO at 1-800-633-9441 or (516)-326-2110.


Mark Kissinger

Deputy Commissioner

Office of Long Term Care