Programs & Services

Pre-Admission Review

Pre-Admission Review is actually two screening processes that are required by state law prior to an individual entering a Medicaid certified nursing facility, Pre-Admission Screening Resident Review (PASRR) and Level of Care (LOC). These review processes are conducted by PASSPORT staff at the Area Agency on Aging.

The Pre-Admission Screening Resident Review (PASSRR) process requires that all applicants to Medicaid certified nursing facilities, regardless of payment source or diagnosis, be screened for serious mental illness and mental retardation/ developmental disabilities. The process is in place to ensure that individuals with indications of mental illness or developmental disabilities receive long term care services and treatment in the most appropriate care setting. If the screening process identifies symptoms of mental illness or mental retardation, the individual is referred to the appropriate agency for further evaluation.

The Level of Care process is the state of Ohio's screening process for individuals seeking Medicaid reimbursement for their stay in a Medicaid certified facility. Often individuals mistakenly assume that Medicaid will pay for nursing home care once they have exhausted their financial resources. While financial eligibility is a criterion for Medicaid paid nursing home care, there are also physical criteria that determine whether Medicaid will pay.

Level of care is an in-person assessment, performed by a licensed professional, of an individual's ability to perform typical daily tasks on their own. There is also a component of cognitive awareness in the assessment process, so the evaluation is a mix of self-report, observation and demonstration of the individual's ability to complete common daily tasks. The assessment results in a determination of what type or degree of service is needed and appropriate to meet the individual's needs.

Daily tasks are divided into two categories: activities of daily living (commonly referred to as ADLs) and instrumental activities of daily living (commonly referred to as IADLs).

Activities of daily living are those personal or self-care skills performed, with or without the use of assistive devices, on a regular basis that enable an individual to meet basic life needs for food, hygiene and appearance. ADLs include bathing, grooming, toileting, dressing and eating.

Instrumental activities of daily living refer to those skills performed, with or without the use of assistive devices, on a regular basis that enable the individual to independently manage their living arrangement. IADLs include shopping, meal preparation, housekeeping, heavy chores, yardwork and or home maintenance, personal laundry and accessing community services (telephoning, accessing transportation, managing legal and/or financial affairs).

There are three levels of care defined by the Ohio Administrative Code: protective, intermediate and skilled.

Protective Level of Care:
Individual does not meet criteria for skilled or intermediate level of care and requires one of the following:

• Supervision of one ADL and assistance with three IADLs,
  or
• Supervision of self-administration of medication and assistance with three IADLs;
  or
• Supervision to prevent harm, due to cognitive impairment, but less than 24 hours a day.

Persons meeting the protective level of care are not eligible for nursing facility care under Medicaid payment, but may be appropriate for a group home or the RSS program.

Intermediate Level of Care:
Individual must meet protective level of care criteria, but not skilled level of care criteria, and the individual must require at least one of the following:

• Hands-on assistance with two ADLs;
• Hands-on assistance with at least one ADL and is unable to perform self-administration of medication and requires medication administration be performed by another person;
• One or more skilled nursing or rehabilitation services at less than a skilled level of care;
• Due to cognitive impairment, requires the presence of another person on a 24 hour a day basis, for the purpose of preventing harm.

Skilled Level of Care:
Individual must meet protective and intermediate level of care criteria, have an unstable* condition and must require at least one of the following:

• Skilled nursing service provided at skilled care level daily (here skilled nursing services is those specific tasks which must be delivered by a licensed practical nurse (LPN) under the supervision of a registered nurse (RN);
  or,
• Skilled rehabilitation service at a skilled level five days a week.

* Unstable condition defined here means that the individual's condition changes frequently and/or rapidly, so that constant monitoring and/or frequent adjustment of treatment is required.