 |
This Web site is a component of the SAMHSA Health Information Network. |
|
Screening for Mental Illness in Nursing Facility Applicants:
Understanding Federal Requirements
II. Introduction
The process of screening and determining whether nursing facility (NF) services and specialized mental health care are needed by nursing facility applicants and residents is called the Preadmission Screening and Resident Review (PASRR) program. The PASRR program is a required component of each State's Medicaid plan. State Medicaid agencies bear the ultimate responsibility for PASRR program operations, although State Mental Health Authorities have specific responsibilities under Federal statute and regulations.
More than a decade after Congress enacted the PASRR program to prevent the inappropriate admission and retention of people with mental disabilities in nursing facilities, many concerns regarding the efficacy and effectiveness of the legislation remain. In fact, organizations such as the Society for Social Work Leadership in Health Care, the American Psychiatric Association, and the American Association for Geriatric Psychiatry conclude that while the program's goals are laudable, PASRR creates logistical barriers for persons requiring nursing facility placements and does not ensure access to appropriate (i.e., medically necessary) psychiatric services.
This literature review is part of a larger study, "An Evaluation of PASRR and Mental Health Services for Persons in Nursing Facilities," funded by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration. The purpose of the study is to conduct research and analysis on the (1) intent, scope, and jurisdiction of PASRR; (2) implementation of PASRR at the State and nursing facility level; and (3) effect PASRR has had on the identification of people with serious mental illness in nursing facilities.
A number of resources were searched for literature on treatment of people with mental illness residing in nursing homes, PASRR, and related issues such as the use of the Minimum Data Set (MDS) and the status of Institutions for Mental Diseases (IMDs). The search covered a variety of electronic bibliographic databases, including Medline, HealthStar, PsycINFO, Mental Health Abstracts, Ageline, Social SciSearch, Dissertation Abstracts, Embase, and the Health & Wellness Database. In addition, the library collection of the Mental Health Policy Resource Center, developed between 1988 and 1996, was searched. The collection contains an extensive compilation of published and unpublished literature on issues related to all aspects of mental health policy, including mental illness and nursing homes. In addition, the Centers for Medicare and Medicaid Services (CMS) provided technical consultation.
This literature review provides a base of information for the larger study and identifies key policy issues concerning PASRR legislation as it exists today and, more generally, individuals in need of mental health services in nursing facilities. This paper details the PASRR policy as specified in the statute and regulations. It examines several key policy issues discussed in the literature, clarifies some of the most frequently asked questions regarding PASRR, and highlights many of the pervasive policy questions that remain unanswered in the research.
This paper is limited in several important ways. Although an extensive general literature details the implementation and impact of nursing home reform under the Omnibus Budget Reconciliation Act of 1987 (OBRA, 1987), literature that addresses PASRR specifically is less developed (Alexakos et al., 1995; Colenda et al., 1999; Marek et al., 1996; Snowden and Roy-Byrne, 1998). For example, studies that examine the effect of OBRA 1987 on the use of psychotropic drugs and physical restraint in nursing facilities only indirectly address the effect of PASRR on the appropriateness of mental health services in nursing facilities.2 Additionally, little formal research has been conducted on the implementation of PASRR across States. In 2001, the Office of the Inspector General (OIG), U. S. Department of Health and Human Services, released two reports concerning mental illness in nursing facilities for the non-elderly adult population. One report (OIG, An Unidentified Population, 2001) attempted to determine how many younger individuals with mental illness reside in nursing facilities. A companion report (OIG, PASRR Implementation and Oversight, 2001) explored the PASRR screening process for younger Medicaid beneficiaries in five States.
As a result, the implementation experience described in this literature review relies heavily on findings from a study conducted by the Bazelon Center3 (1996), supplemented by other relevant studies of PASRR and mental health issues in nursing facilities. Although the Bazelon Center study surveyed Medicaid directors in all 50 States, the District of Columbia, and Puerto Rico, the response rate was only 63 percent. Therefore, no information is available on the States that chose not to participate in the study. In addition, inconsistencies arose in the way States reported (or did not report) data, affecting the item response rates for the survey. Despite these limitations, the Bazelon Center study provides valuable data for understanding how States vary in their implementation of PASRR.
2 The Office of Inspector General conducted PASRR-related studies in Chicago and New York. The Chicago study surveyed all States regarding their systems for treating Medicaid recipients with mental illness in nursing facilities. The New York study assessed the appropriateness of Medicare Part B payments to Medicare beneficiaries living in nursing facilities.
3 The Judge David L. Bazelon Center for Mental Health Law is a nonprofit legal advocacy organization based in Washington, DC. Judge Bazelon was the Federal appeals court judge whose landmark decisions pioneered the field of mental health law.
Table of Contents | Previous | Next
|
|
