1000, Introduction and Definitions

Revision 20-0; Effective August 25, 2020

Preadmission Screening and Resident Review (PASRR) is a federal requirement as documented in the Code of Federal Regulations, Title 42, Part 483, Subpart C, §483.100 through 138. PASRR is a process to identify people with a mental illness (MI), intellectual disability (ID) or developmental disability (DD), which is also known as a related condition (RC), who apply to, or reside in, a Medicaid-certified nursing facility (NF) to ensure the appropriateness of NF admission. PASRR is also intended to ensure that people with MI, ID or DD are receiving all the agreed upon specialized services.

In Texas, local intellectual and developmental disability authorities (LIDDAs), local mental health authorities (LMHAs) and local behavioral health authorities (LBHAs) play key roles in the PASRR process.

Texas Health and Human Services Commission (HHSC) rules governing PASRR are contained in:

  • 26 Texas Administrative Code (TAC), Chapter 303, Preadmission Screening and Resident Review (for LIDDAs, LMHAs and LBHAs);
  • 25 TAC, Chapter 412, Local Mental Health Authority Responsibilities (for LMHAs and LMHAs); and
  • 40 TAC, Chapter 19, Subchapter BB, Nursing Facility Requirements for Licensure and Medicaid Certification (for NFs).

This handbook provides additional instructions and procedures for LMHAs and LBHAs in implementing PASRR requirements.

1100 Definitions

Revision 20-0; Effective August 25, 2020 

The following words and terms, when used in this handbook, have the following meanings unless the context clearly indicates otherwise.

Acute care hospital — A facility in which a person receives short-term treatment for a severe physical injury or episode of physical illness, an urgent medical condition or recovery from surgery and: 

  • may include a long-term acute care hospital, an emergency room within an acute care hospital or an inpatient rehabilitation hospital. 
  • does not include a stand-alone psychiatric hospital or a psychiatric hospital within an acute care hospital. 

Adult Needs and Strengths Assessment (ANSA) Tool — The Texas uniform assessment tool developed for adult behavioral health services. It is intended to prevent duplicate assessments by multiple parties, decrease unnecessary psychological testing, aid in identifying placement and treatment needs, and inform case planning decisions. Its assessments help support decision making, including level of care and service planning, to facilitate quality improvement initiatives and to allow for outcomes monitoring. 

Community living options — A process by which the LIDDA provides information to a person and their legally authorized representative (LAR) about the range of community living services, supports and programs the person may be eligible for, and discusses services and supports the person will need to live in the community, as well as individual preferences and barriers to community living.  The Community Living Options (CLO) apply only if the person has a dual diagnosis of mental illness (MI) and intellectual disability or developmental disability (ID/DD). 

Collateral contact — An individual such as family member, previous provider or caregiver, who is knowledgeable about the person seeking admission to a nursing facility (NF) or the resident, and who may support or corroborate information provided by the person or resident. 

Comprehensive care plan — A service plan developed by an NF to meet the person’s medical, nursing, mental and psychological needs. 

Exempted hospital discharge — A category of NF admission that occurs when a physician has certified that a person who is being discharged from an acute care hospital is likely to require less than 30 days of NF services for the condition for which the person was hospitalized. 

Expedited admission — A category of NF admission that occurs when a person is coming from an acute care hospital or another NF and meets the criteria for one of the following categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite or coma. 

Habilitative Service Plan (HSP) — Used by LIDDAs to: 

  • describe the desired outcomes of an individual with ID or DD residing in an NF and identify specialized services provided. 
  • document community living educational and exploration activities. 
  • document barriers to transitioning to community living and the solutions to those barriers. 

Intellectual and Developmental Disability (IDD) Habilitative Specialized Services — Helps people learn, keep or improve skills for everyday life activities. It is different from rehabilitation because IDD habilitative specialized services teaches a new skill that a person has not learned before and rehabilitation teaches people to recover a previously learned skill. People are learning how to do something for the first time. It can include learning how to walk, bathe, speak and more. 

The following specialized services are available to an individual with ID or DD: 

  • Habilitation coordination; 
  • Day habilitation; 
  • Independent living skills training; 
  • Behavioral support; 
  • Employment assistance; and 
  • Supported employment. 

Interdisciplinary Team (IDT) — Consists of these required members (Note: Mandatory participants of the IDT are bolded below. An IDT without all mandatory participants is invalid and must be reconvened.):    

  • a person with MI, ID or DD; 
  • the person's LAR, if any; 
  • a registered nurse from the NF with responsibility for the person; 
  • a representative of the: 
    • LIDDA, if the person has ID or DD; 
    • LMHA or LBHA, if the person has MI; or 
    • LIDDA and the LMHA or LBHA, if the person has MI and DD, or MI and ID. 
  • others as follows: 
    • a concerned person whose inclusion is requested by the resident or LAR; 
    • a person specified by the resident, LAR, NF, LIDDA, LMHA or LBHA, as applicable, who is professionally qualified, certified or licensed with special training and experience in the diagnosis, management, needs and treatment of people with MI, ID or DD; or 
    • a representative of the appropriate school district if the person is school age and inclusion of the district representative is requested by the person or LAR. 

Individual — A person whose active PASRR evaluation (PE) or resident review is positive for MI and who is age 21 or older. 

Local authority (LA) — In this handbook, LA means a local intellectual and developmental disability authority (LIDDA) and/or a local behavioral health authority (LBHA) or local mental health authority (LMHA). 

Local authority update meeting — Meetings held at any time by the LA after the initial meeting to add, change or remove services, or to discuss transfers, transitions or discharges. The results of these meetings are recorded on the PASRR Comprehensive Service Plan (PCSP) form as an LA update. Attendees for LA updates are determined by the reason for the update meeting as stated in the PCSP Item by Item Guide.   

Legally Authorized Representative (LAR) — A person authorized by law to act on behalf of a person seeking admission to an NF or currently an NF resident, and is the parent of a minor child, the legal guardian or the surrogate decision maker. (See limitations on authority of surrogate decision maker in the definition of “surrogate decision maker.” Also, see the Intellectual and Developmental Disability Preadmission Screening and Resident Review (IDD-PASRR) Handbook, Appendix III, Legal Authority to Make Decisions.) 

Local Behavioral Health Authority (LBHA) — An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code, §533.0356.  

Local Intellectual and Developmental Disability Authority (LIDDA) — An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code, §533A.035. LIDDAs serve as the point of entry for publicly funded intellectual and developmental disability (IDD) programs. 

Local Mental Health Authority (LMHA) — An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code, §533.035. The LMHA is the state contracted agency that serves as the point of entry for publicly funded MI programs.  

Licensed Practitioner of the Healing Arts — A staff member who is a: 

  • physician; 
  • registered nurse (RN); 
  • licensed professional counselor (LPC); 
  • licensed clinical social worker (LCSW); 
  • psychologist; 
  • advanced practice registered nurse (APRN); 
  • physician assistant (PA); or 
  • licensed marriage and family therapist (LMFT). 

Long Term Care Online Portal — A web-based application used by Medicaid providers to submit forms, screenings, evaluations and other information. 

Medicaid managed care organization (MCO) service coordinator — The staff person assigned by a resident’s Medicaid MCO to ensure access to, and coordination of, additional Medicaid services that are needed. 

Minimum Data Set assessment — A standardized collection of demographic and clinical information that describes a person's overall condition, which a licensed NF in Texas is required to submit into the Long Term Care Online Portal (LTCOP) for people admitted into the facility and each quarter thereafter. 

Mental Health Services — The delivery system for providing adult mental health services in Texas designed to meet people’s needs and strengths to achieve the best possible results. This service delivery system is based on the Texas Resiliency and Recovery (TRR) model.   

Mental Illness (MI) — Serious MI, as defined in the Code of Federal Regulations, 42 CFR §483.102(b)(1). 

Mental Illness/Dementia Resident Review (Form 1012) — Form 1012 assists NFs in determining if a previously negative PASRR Level 1 (PL1) form, that has already been submitted to the LTCOP, needs to be changed to a positive PL1 for MI.   

MI specialized services — Available to people who are PASRR positive for MI, as described in the Texas Resilience and Recovery Utilization Management Guidelines, including: 

  • Skills training and development (individual and/or group); 
  • Routine case management (21 years of age or older); 
  • Medication training and support services (individual and group); 
  • Pharmacological management; 
  • Psychosocial rehabilitation services (individual and/or group);  
  • Psychiatric diagnostic evaluation; and  
  • Supportive housing, which includes alternate placement assistance and transitioning to the community. 

Nursing facility (NF) — A Medicaid-certified facility that is licensed in accordance with the Texas Health and Safety Code, Chapter 242. 

NF PASRR support activities — Consistent with 40 TAC §19.2703, actions an NF coordinates with a LIDDA, LMHA or LBHA to facilitate the successful provision of IDD habilitative specialized services or MI specialized services, including: 

  • arranging transportation for a person to participate in an IDD habilitative specialized service or an MI specialized service outside the facility; 
  • sending a person to a scheduled IDD habilitative specialized service or MI specialized service with food and medications required by the resident; and 
  • stating in the comprehensive care plan an agreement to avoid, when possible, scheduling NF services at times that conflict with IDD habilitative specialized services or MI specialized services. 

NF specialized services — The following specialized services available to a person with ID or DD: 

  • Habilitative therapy services; 
  • Customized manual wheelchair (CMWC); and 
  • Durable medical equipment (DME). 

PASRR Comprehensive Service Plan (PCSP) form — The form completed to record the results of the initial IDT meeting. The PCSP form is also completed when there is an LA update meeting, a quarterly meeting or an annual IDT meeting.  

PASRR evaluation (PE) — A face-to-face evaluation: 

  • of a person seeking admission to an NF who is suspected of having MI, ID or DD; 
  • performed by a LIDDA, LHMA or LBHA to determine if the person has an MI, ID or DD diagnosis and, if so, to: 
    •   assess the person's need for care in an NF; 
    •   assess the person's need for specialized services; and 
    •   identify alternate placement options. 

PASRR Level I (PL1) screening — The process of screening a person seeking admission to an NF to identify whether the person is suspected of having MI, ID or DD. 

Peer provider — A staff member who: 

  • has received a high school diploma or a high school equivalency certificate issued in accordance with the law or the issuing state; and 
  • has at least one cumulative year of receiving mental health services for a disorder that is treated in the target population for Texas. 

Person-Centered Recovery Plan (PCRP) — Uses a recovery orientation and team approach that includes the individual, formal supports and natural supports to best support the individual’s recovery and goals. 

Pharmacological management — The in-depth management of psychopharmacological agents to treat a person’s mental health symptoms. 

Preadmission process — A category of NF admission: 

  • from a community setting, such as a private home, an assisted living facility, a group home, a psychiatric hospital or jail, but not an acute care hospital or another NF; and 
  • that is not an expedited admission or an exempted hospital discharge. 

Pre-Admission Screening and Resident Review (PASRR) Evaluation Summary Report (Form 1014) —  A summary of the results of a person’s positive PASRR evaluation.   

Qualified Mental Health Professional-Community Services (QMHP-CS) — A staff member who is credentialed as a QMHP-CS who has demonstrated and documented competency in the work to be performed and: 

  • has a bachelor's degree from an accredited college or university with a minimum number of hours that is equivalent to a major (as determined by the LMHA or MCO in accordance with TAC §412.316(d) of this title, relating to Competency and Credentialing) in psychology, social work, medicine, nursing, rehabilitation, counseling, sociology, human growth and development, physician assistant, gerontology, special education, educational psychology, early childhood education or early childhood intervention. 
  • is a registered nurse. 
  • completes an alternative credentialing process as determined by the LMHA or MCO in accordance with TAC §412.316(c) and (d) of this title relating to (Competency and Credentialing). 

Referring entity — The entity that refers a person to an NF, such as a hospital, attending physician, LAR or other personal representative selected by the person, a family member of the person or a representative from an emergency placement source, such as law enforcement. 

Resident — A person who resides in an NF and receives services provided by professional nursing personnel of the facility. 

Resident review — A face-to-face evaluation of a person performed by a LIDDA, LMHA or LBHA: 

  • for a person with MI, ID or DD who experienced a significant change in status to: 
    • assess the person's need for continued care in an NF; 
    • assess the person's need for specialized services; and 
    • identify alternate placement options. 
  • for a person suspected of having MI, ID or DD, to determine whether the person has MI, ID or DD and if so to: 
    • assess the person's need for continued care in an NF; 
    • assess the person's need for specialized services; and 
    • identify alternate placement options. 

Registered nurse (RN) — A person licensed to practice professional nursing as an RN in accordance with Texas Occupations Code, Chapter 301. 

Service coordination — Assistance in accessing medical, social, educational and other appropriate services and supports, including alternate placement assistance, that will help a person achieve a quality of life and community participation acceptable to the person and LAR on the person's behalf. 

Service coordinator — An employee of a LIDDA who provides service coordination to persons with IDD. If a person is dually PASRR positive (MI and IDD), the service coordinator takes the lead in coordinating specialized services and SPT meetings. 

Specialized services — The following support services, other than NF services, that are identified through the PE or resident review and may be provided to a person who has a PE or resident review that is positive for MI, ID or DD:  

  • NF specialized services;  
  • IDD habilitative specialized services; and 
  • MI specialized services. 

Service Planning Team (SPT) — A team convened by a LIDDA staff person who develops, reviews and revises the HSP and the transition plan for a person who is PASRR positive for IDD or IDD and MI. the team must include: 

  • The person; 
  • Person’s LAR, if any; 
  • Habilitation coordinator for discussions and service planning related to specialized services or the service coordinator for discussions related to transition planning if the person is transitioning to the community; 
  • MCO service coordinator, if the person does not object; 
  • While the person is in an NF: 
    • An NF staff person familiar with the person’s needs; and 
    • A person providing a specialized service to the person or a representative of a provider agency that is providing specialized services for the person. 
  • If the person is transitioning to the community: 
    • A representative from the community program provider, if one has been selected; and  
    • A relocation specialist. 
    • A representative from the LMHA or LBHA, if the person has MI; and 
  • Other participants on the SPT may include: 
    • A concerned person whose inclusion is requested by the person or the LAR; and 
    • At the discretion of the LIDDA, a person who is directly involved in the delivery of services to people with ID or DD. 

Surrogate decision maker — An actively involved family member of a person who has been identified by an IDT, in accordance with Texas Health and Safety Code §313.004, and who is available and willing to consent to medical treatment on behalf of the person. 

Texas Resiliency and Recovery (TRR) — The term that describes the service delivery system in Texas for community mental health services. The system’s mission is to foster resilience and recovery with respect to MI. A primary aim of HHSC’s service delivery system is to ensure the provision of interventions and evidence-based practices with empirical support to promote recovery and resilience from mental health disorders.  

Transition plan — A plan developed by the SPT that describes the activities, timetable, responsibilities, services and essential supports involved in assisting a person to transition from residing in an NF to living in the community. The transition plan is developed for people who are PASRR positive for IDD only or dual IDD/MI only.