| February,
2001
Department of Health and Human
Services
Office of Inspector General
Younger Nursing Facility
Residents With Mental Illness: Preadmission Screening and Resident Review (PASRR) Implementation
and Oversight
This inspection is one in a series of Office of Inspector
General reports on individuals with mental illness in nursing
facilities. A follow-up inspection to this report, "Younger
Nursing Facility Residents with Mental Illness: A Population
Unidentified" (OEI-05-99-00701) is an attempt to
determine the extent to which younger individuals with mental illness reside in nursing facilities.
Preadmission Screening and Resident Review (PASRR) -- Nursing
Facility Admission Requirements
The Social Security Act does not allow a nursing facility to
admit any resident who has a serious mental illness unless the
State mental health authority has determined that the individual,
because of a physical and mental condition, requires the level of
services provided by a nursing facility. In addition, the State
mental health authority must determine whether an individual
requires "specialized services" for their mental
illness, and must provide such services.
The Omnibus Budget Reconciliation Act of 1987 (OBRA-87)
mandated Preadmission Screening and Resident Reviews (PASRR). The
intent of the PASRR process is to ensure that only individuals
with serious mental illness who are in need of nursing facility
care be admitted and continue to reside in nursing facilities, and
to determine whether persons with serious mental illness need
specialized mental health services.
The Olmstead Decision
The 1999 Olmstead Supreme Court decision mandates that States
"provide community-based treatment for persons with mental
disabilities when the States treatment professionals determine
that such placement is appropriate." States must take into
consideration their resources and the needs of other people with
mental disabilities in making such determinations.
We collected information and data from Medicaid programs and
from surveys of State officials involved in mental health services
and nursing home care. We made onsite visits to 19
purposively-selected nursing facilities in five States.
We reviewed detailed information about 187 nursing facility
resident Medicaid beneficiaries, ages 22 to 64, with a serious
mental illness. 
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The complete text of this report is available in Portable Document (PDF) format.
