About Bock Associates

A division of Emeritus Corporation, Bock Associates is an experienced national firm that specializes in PASRR assessment services tailored to the needs of state human service programs. Bock Associates was one of the first national providers of PASRR services and was involved in PASRR related activities prior to the passage of the legislation. Since the release of the regulations, we have performed all phases of PASRR program implementation, management, and review. In addition to completing over 300,000 Level II assessments, Bock Associates has performed the following PASRR activities:

Designed unique sets of assessment protocols and training material
Reviewed and processed over 150,000 Level I Clinical Reviews and Medicaid Nursing Facility Level of Care screens
Recruited and trained hundreds of clinical professionals to complete assessments
Created computerized PASRR tracking systems, used by staff, assessors, and clients to collect and analyze data on thousands of clients and assessments.

Bock Associates was founded to meet a growing, national demand for management consulting related to the Minnesota Developmental Programming System (MDPS), a computerized assessment and individualized treatment planning system, developed by Dr. Bock, for individuals with developmental disabilities (DD). The MDPS was designed to assist intermediate care facilities in complying with new Medicaid regulation, which required the ICFs to conduct standardized functional assessments of, and develop individualized plan of care for all residents.
‍
In 1985, Bock Associates was awarded contracts from the Illinois Department of Public Aid, the Indiana Department of Mental Health and Developmental Disabilities, and the Indiana Department of Public Welfare to collect, manage, and track data on approximately 11,000 individuals with intellectual or developmental disabilities, who were residing in nursing facilities in their respective states. Illinois and Indiana were two of three Midwestern states that were cited by CMS for nursing facility certification deficiencies. Bock Associates was the prime contractor assisting both states in complying with CMS's directive. CMS's experience in these two states prompted the eventual passage of the PASRR legislation OBRA '87. In 1988 Bock Associates was awarded its first PASRR related contract from the State of Louisiana. Since that time, we have provided PASRR consultation to twelve states in seven CMS regions.

PASRR History

In 1982, the U.S. Department of Health and Human Services proposed significant changes in the nursing facility survey and certification program. The program was very controversial and its implementation was delated until the National Academy of Sciences' IOM Committee on Nursing Home Regulation completed a comprehensive study of nursing facility regulations. Concurrent with the research being conducted by the IOM Committee, CMS identified three states in which there were thought to be large numbers of individuals with ID/RC inappropriately placed in nursing facilities. These three states were ordered to identify individuals who were residing in nursing facilities and who had or were suspected of having a diagnosis of ID/RC, assess their needs for services, develop active treatment plans, and research alternative placements for those individuals who had been inappropriately placed in nursing facilities. These states were informed that their failure to comply with CMS's directive would result in de-certification from participation in the Medicaid program. Bock Associates played a key role in assisting two of these states, Illinois and Indiana, in complying with CMS's directives.

In 1987, Congress relied heavily on the recommendations from the IOM and CMS's experience to develop Section 1919(f)(8)(A) of the Social Security Act. The legislative intent of these amendments, and CMS's subsequent regulations, was to ensure appropriate placement for individuals with mental illness, intellectual disabilities, or related condition. Congress enacted a series of technical amendments to OBRA '87 in OBRA '90 and on November 23rd, 1992, CMS published its interim final rule for PASRR in the Federal Register. The requirements of the final rule became effective on January 29th, 1993. On October 19th, 1996 the President signed P.L. 104-315 (the Act), which amended Title XIX of the Social Security Act to replace "annual resident reviews" with "significant change reviews" for those residents experiencing a substantial positive or negative change in their physical or mental condition.

To meet the requirements of OBRA '87, OBRA '90 and CMS's final rule for PASRR and P.L. 104-315, each state must have processes in place that responds to the following statutory requirements specified in the Federal legislation:

Completion of a Level I screen to identify, for a PASRR referral, those individuals applying for admission to a Medicaid-certified nursing facility for which it appears that a diagnosis of MI and/or ID/RC is likely, regardless of their source of payment.
Completion of a comprehensive PASRR Level II evaluation of residents who have experienced a change in their physical or mental condition or applicants to Medicaid-certified nursing facilities who are identified in the Level I screening as suspected of having a diagnosis of MI and/or ID/RC. This evaluation is personalized to the needs of the individual with the goal of recommending service and placement options that provide the individual with the opportunity to flourish in the least restrictive environment that is capable of meeting their unique needs.
An accessible and timely appeals process for individuals who feel adversely affected by the Level II evaluation process.

In February of 2020, CMS published the first significant proposed PASRR rule changes in over two decades. Following the release of the proposed changes stakeholders were encouraged to read and submit comments and questions for consideration. Due to the high number of questions and comments submitted, coupled with the timing of the pandemic, responses to submitted questions and any subsequent modifications to the proposed rules have not been released.

The proposed rule changes address many areas including: timeliness, diagnostic criteria for SMI and ID, additional Level II exceptions, and specialized definitions.