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Pre-admission Screening and Resident Review (PASRR)

Medicaid regulations require states to maintain a PASRR program to screen nursing facility applicants and residents for serious mental illness.

PASRR is part of the Federal Omnibus Budget Reconciliation Act. The rules regarding the PASRR process are found in the Code of Federal Regulations Part 483, Subpart C. Volume 57, No. 230

Purpose of PASRR – Federal Program Goals

Ensure that Nursing Facility (NF) applicants for long-term care and residents with Serious Mental Illness (SMI) or Intellectual Disabilities (ID) are:

  • Identified
  • Placed Appropriately (least restrictively)
  • Provided with the SMI/ID services they need.

(42CFR483.100 to 42CFR483.204)

PASRR Program Overview

PASRR are federal requirements to evaluate all individuals who will be admitted to a Medicare/Medicaid certified NF, regardless of payment source, for indicators of SMI or ID.

Elements of PASRR

PASRR includes Level I, Level II and Resident Review.

  • Level I is an initial screening conducted prior to NF admission to identify individuals with indicators of SMI who are requesting NF services. Those individuals identified with SMI may receive further evaluation if the individual needs long term care. The level I screen is conducted by hospital discharge planners, hospice/home health agencies, medical office social workers, APD, AAA specialists and case managers and Private Admission Assessment (PAA) contractors.
  • Level II and Resident Review evaluations are available for all NF applicants and residents identified with indicators of SMI. They are provided by MH professionals. The Level II is a comprehensive evaluation and the Resident Review is a brief consult. The Level II is required for any NF resident prior to admission with SMI indicators unless determined to meet the criteria for Exempted Hospital Discharge (the level I screener contacts the local CMHP to request the Level II), for those identified with indicators at any time during residency and for any resident with confirmed SMI with significant changes in cognitive or physical conditions.
  • Resident Review and Level II provides for SMI are Qualified Mental Health Professionals through the local Community Mental Health Programs.
  • Resident Review and Level II Process begins by determining if the individual meets diagnostic criteria for SMI. Once that is confirmed the following are determined:
    • Evaluates the individual’s SMI symptoms, history and care needs
    • Recommends the most appropriate care setting
    • Determines if specialized services are needed (currently psychiatric hospitalization)
  • If NF is determined most appropriate setting it may include recommendations for “services of a lesser intensity than Specialized Services” to meet the residents SMI needs including but not limited to; behavioral strategy recommendations, referral to health care provider for medical interventions or referral to health care provider with pharmacologic suggestions.


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