This regulation governs the relationship between PASARR (Pre-Admission Screening and Resident Review) determinations and other Medicaid processes for nursing facilities. It establishes that PASARR determinations made by state mental health or intellectual disability authorities cannot be overridden by the state Medicaid agency or survey/certification agency, and can only be overturned through the formal appeals process. It also requires coordination between PASARR and routine resident assessments to avoid duplicative testing.
View official source§ 483.108 Relationship of PASARR to other Medicaid processes. (a) PASARR determinations made by the State mental health or intellectual disability authorities cannot be countermanded by the State Medicaid agency, either in the claims process or through other utilization control/review processes or by the State survey and certification agency. Only appeals determinations made through the system specified in subpart E of this part may overturn a PASARR determination made by the State mental health or intellectual disability authorities. (b) In making their determinations, however, the State mental health and intellectual disability authorities must not use criteria relating to the need for NF care or specialized services that are inconsistent with this regulation and any supplementary criteria adopted by the State Medicaid agency under its approved State plan. (c) To the maximum extent practicable, in order to avoid duplicative testing and effort, the PASARR must be coordinated with the routine resident assessments required by § 483.20(b).