Compliance with PASARR Recommendations for Medicaid Recipients in Nursing Homes

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Abstract
To determine the rate of compliance with placement and mental health recommendations of the preadmission screening and annual resident review (PASARR) program. A retrospective observational study using PASARR screening forms to identify recommendations of inpatient psychiatric care for people needing more care than nursing homes provide, alternate disposition for individuals needing less than nursing home level care, and recommendations for new mental health services when needed but not provided. Service use as indicated in Medicaid billing data during the following year was used to determine receipt of service. All Washington state Medicaid recipients screened from 1992 through 1993. Compliance rates for placement and service recommendations. Inpatient psychiatric care was recommended for four of the 523 Medicaid recipients (0.8%), all of whom received it. Screeners recommended alternate dispositions in 131 (25%) subjects, and compliance occurred in 29% of these. Recommendations for new services were made in 310 (59%) cases. Compliance rates averaged 35%, ranging from 73% for medication recommendations to 7% for consultation. Depressed individuals were less likely to receive recommended services. Many individuals needed additional mental health services but did not receive them, and a significant minority of patients could have been given an alternate disposition but rarely were.