The purpose of this bulletin is to provide guidance on the Preadmission Screening and Resident Review (PASRR) requirements outlined in 42 CFR sections 483.100-138 and APL 23-004 Skilled Nursing Facilities-Long Term Care Benefit Standardization and Transitions of Members to Managed Care (dated March 14, 2023).

All general acute care hospitals (GACH) are responsible for completing the PASRR process prior to discharging a member to a skilled nursing facility (SNF) and submitting PASRR documentation to the managed care health plan (MCP) with the SNF request for prior authorization. SNFs are responsible for completing the PASRR process when a member is admitted directly from the community.

Preadmission Screening

The Preadmission Screening (PAS) determines if a member may have a serious mental illness (SMI) or an intellectual disability/developmental disability/related conditions (ID/DD/RC). If a Level I screening is positive, a Level II evaluation must be performed to determine if SNF care is appropriate.

Resident Review

The Resident Review (RR) is a requirement for members currently residing in a SNF who have SMI or ID/DD/RC and must be completed when there is a significant change in condition to determine if the member still requires the level of services provided.

Requirements beginning May 1, 2023:

• Anthem Blue Cross (Anthem) must receive and review PASRR documentation from GACHs or SNFs as part of the prior authorization request review process. Anthem will confirm PASRR completion before approving the request for the SNF stay. This serves to confirm that GACHs performed the PAS prior to discharging a member to a SNF and that SNFs performed the PAS when a member was admitted directly from the community.
• Anthem has the right to restrict payments to the provider of SNF services if the PAS was not completed prior to a member’s admission.
• When there is a significant change in a SNF resident’s physical or mental health condition, MCPs must ensure that SNFs start a RR by submitting a Level I screening to restart the PASRR process.

If you need examples of PASRR documentation or have any questions, reach out to your Long-term Services and Supports (LTSS) Liaison at AnthemLTSS@Anthem.com or visit dhcs.ca.gov/services/MH/Pages/PASRR.aspx.