Clinical Eligibility Determination

Clinical Eligibility Determination A. A Pre-Admission Screening and Resident Review (PASRR) Level I must be performed prior to admission to a Medicaid certified nursing facility (NF), except for the exclusions listed under Miss. Admin. Code Part 207, Rule 1.2., to: 1. Assess the person’s clinical eligibility and need for NF services. a) A person must meet the Division of Medicaid’s specific numerical threshold for clinical eligibility, or be approved based on a secondary review, in order to be considered clinically eligible. b) Clinical eligibility determinations, which are unable to be determined by the Division of Medicaid, will be submitted to a Mississippi licensed physician for the determination. c) A person must also have signed physician’s orders upon admission to the NF. 2. Confirm whether or not the person has a mental illness (MI), an intellectual disability/developmental disability (ID/DD) and/or a related condition (RC), and/or 3. Assess whether the person requires specialized rehabilitative services or supplemental services and supports. B. If the PASRR Level I confirms that an individual has MI, ID/DD and/or an RC, or if specialized rehabilitative services or supplemental services and supports are required then the individual must complete a PASRR Level II prior to admission to the NF. [Refer to Miss. Admin. Code Part 206, Chapter 3] C. The PASRR Level I must be submitted to the Division of Medicaid via the Envision web portal upon completion. The completed PASRR Level I must be faxed to the Division of Medicaid if the provider is not a Mississippi Medicaid provider. D. The provider who performs the PASRR Level I certification must retain the document in the person’s medical record and must make it available to the Division of Medicaid upon request.