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    162 Federal Street
    Salem, MA 01970
    Phone: 978-745-2440, ext. 126
    Fax: 978-741-8067

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OBRA (Omnibus Budget Reconciliation Act of 1987)

Federally mandated guidelines have been developed to insure that individuals with mental illness are appropriately admitted to nursing facilities and that they receive services that maximize their quality of life and level of functioning. The OBRA Pre-Admission Screening Program is a compliance effort based on assessments of individuals meeting the criteria prior to nursing facility placement.

What is OBRA?

The Omnibus Budget Reconciliation Act of 1987 (OBRA) is a federally mandated assessment program for those persons regardless of age or payer source who have a major mental illness and who are seeking nursing facility level of care in this state. The purpose of these evaluations is to determine the appropriateness of the placement In a nursing facility setting, to divert persons whose illness prevents them from functioning satisfactorily in such a setting and to make initial recommendations for treatment within a nursing facility.

Regardless of age or payer source, a pre-admission screening will be conducted on individuals with the following DSM-Vl diagnoses:

  • Schizophrenia- all types

  • Paranoia- all types NOT induced by medication
  • Atypical psychosis- all types NOT induced by medication
  • Schizoaffective disorder
  • Bipolar disorder
  • Major depression- must be 10 year duration with ONE of the following: inpatient psychiatric treatment OR ElectroConvulsive Treatment (ECT) OR medications
  • Anxiety disorders- must be 2 years in duration AND inpatient psychiatric treatment AND medication

Persons having any of the following disorders may be exempted by properly documenting cases of the following medical conditions:

  • Dementia- notes should include results from scans (CT, MRI, etc), neuropsychological testing, nursing and/or social work notes citing the progressive decline of cognitive and behavioral functioning over time. An MD MUST include the diagnosis of dementia on the official list of conditions receiving treatment.

  • Congestive hearth failure- END STAGE disease documented with 24-hour oxygen order
  • Chronic obstructive pulmonary disease- END STAGE disease documented with 24-hour oxygen order
  • Parkinson's disease- END STAGE disease documented
  • Huntington's chorea- END STAGE disease documented
  • Amyotrophic lateral sclerosis- END STAGE disease documented
  • Severe head injury
  • Comatose or ventilator dependency
  • Terminal illness- prognosis of six months or less
  • Convalescent care of thirty days or less immediately following an acute hospitalization

Who Can Make a Referral?

  • Primary referral sources include but are not limited to the following agencies:

  • Executive Office of Elder Affairs Aging Service Access Points (EOEA ASAPs)
  • Community hospitals: hospitals without psychiatric capacity and community organizations should contact local ASAP offices to perform a level of care evaluation for medical eligibility
  • DMH facilities
  • Psychiatric facilities: private psychiatric facilities may perform their own OBRA pre-admission screenings utilizing the standard tool and report results to the HES office. State facilities may contact the ASAP or HES.
  • Nursing facilities: nursing facilities housing patients who will exceed the thirty-day convalescent care exemption should also contact HES to initiate the Level II screening if one has not been preformed.

How Does the Process Work?

Once a referral has been made, an assessment will be performed to evaluate the nature and acuity of the mental illness condition at no cost to the individual or facility. Upon completion by an OBRA assessor or a psychiatric hospital, a letter of notification will be faxed and mailed to the Individual's local ASAP. This letter should be included in paperwork sent to the admissions department of the admitting nursing facility. The individual may be admitted to the facility only after all pre-admission forms have been completed.

Why Are Pre-admission Screenings Necessary?

As previously mentioned, OBRA is a federal mandate. The goal of the OBRA assessment program is to permit the admission to nursing facilities of persons with a mental illness, identifying initial recommendations for continued treatment of the stated psychiatric condition. A second goal is to exclude those persons whose mental illness is in an acute phase, rendering the individual unsafe to be placed in a nursing facility.

Individuals requiring "specialized services," or inpatient psychiatric care, would be excluded from admission until the exacerbation is brought under control. Notification of denial of admission will be faxed daily to the appropriate ASAP.

Is Anyone Exempt From This Process?

The only exception to this process are persons whose nursing facility is not receiving federal or state funding and whose cost is assumed privately. To date four facilities within the Commonwealth meet these criteria.

What Does it Cost?

Pre-Admission Screenings are performed at no cost to the individual or the facility.  Federal and state funds underwrite this program.

Who Receives a Copy of the OBRA Assessment?

Upon completion the assessments are mailed to the HES office where they are processed, catalogued, electronically stored and returned to the nursing facility that has accepted the individual. Each assessment that is received is thoroughly reviewed by a board-certified psychiatrist. A cover letter citing procedures for disputing the determination accompanies the original (or copy if requested from the archives) of each form sent to a facility.

It should be noted that 21,600 unique individuals have been screened by HES and its subcontractors, resulting in nearly 50,000 assessments since 1989. If your nursing facility has not received an assessment, please contact the OBRA offices.


Can the Findings of the Assessment be Disputed?

Under the Department of Mental Health regulations 104CM16.01(1), every individual or his/her representative has the right to appeal a decision made by HES or its subcontractors. The regulations guarantee the right to a fair hearing before an impartial hearing officer designated by the Division of Medical Assistance. To request an application for an impartial hearing, contact the following Division within thirty (30) days of the date of the assessment:

    Division of Medical Assistance-Board of Hearings
    2 Boylston Street
    Boston, MA 021 16
    TELEPHONE:  (617)210-5800
    TOLL FREE: 1-800-655-0338
    FAX: (617)210-5820

2009 Training



      EOEA/ MassHealth Office of Long Term Care, the Departments of Mental Health and Mental Retardation will offer a comprehensive training for all personnel involved with the OBRA/PASARR process. The Departments and their contractor, Health & Education Services, Inc., will be presenting information in a power point and lecture format.

      Each session will feature presentations by EOEA on the Level I form, Health & Education Services, Inc., on the Mental Illness regulations and the Department of Mental Retardation on the Mental Retardation regulations. Continuing Education Credits (3 units) have been approved for Social Workers (Category I), Nursing Home Administrators and Nursing Services.

      The lecture portion of the program will begin AFTER one-half hour of registration. Identical training will be held at the following locations:

      • March 30, 2009 8:30am- noon Hoagland-Pincus Center- SHREWBURY

      • May 26, 2009 8:30am- noon Cape Cod Community College-Hyannis

      • October 5, 2009 8:30am- noon Basketball Hall of Fame- Springfield

      • October 19, 2009 8:30am- noon Boston or Shrewsbury - to be determined

      COST OF THE TRAININGS WILL BE $15.00 per person and will cover hall rental and refreshments. MONEY WILL BE COLLECTED AT THE DOOR during the first half-hour of the scheduled time.



Federal Documents

  Federal Regulations Title 42-Public Health

  Federal Regulations OBRA/PASARR

  Frequently Asked Questions

For more information about the OBRA Program, contact:

    Health & Education Services, Inc.
    162 Federal Street
    Salem, MA 01970
    Telephone: (978) 745-2440 ext. 126


    Karen Vautour LICSW - OBRA Project Director

    Eliza Nieves - Administrative Assistant

    Jennifer Cosme - Administrative Assistant




To get a map and driving directions to a program, 
enter your location in the form next to the desired facility below and press "submit".

Hoagland-Pincus Conference Center
222 Maple Avenue
Shrewsbury, MA 02108


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Cape Cod Community College
2240 Iyannough Rd.
West Barnstable, MA 02668

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Basketball Hall of Fame
1000 West Columbus Ave
Springfield, MA 01105

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     131 Rantoul Street Beverly, MA   01915

Member of  Northeast Health System