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Pre-admission Screening and Resident Review (PASRR)

Federal Program Goals

Medicaid regulations require states to maintain a PASRR program to screen nursing facility (NF) applicants and residents for serious mental illness (SMI) or Intellectual Disabilities (ID). This will ensure NF applicants and residents with SMI or ID are:

  • Placed appropriately (in the least restrictive environment), and
  • Provided with the SMI/ID services they need.

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 (42 CFR 483.100 to 42 CFR 483.204).

Program Overview

PASRR includes Level I, Level II and Resident Review.

  • Level I is an initial screening conducted prior to NF admission. 
  • Level II and Resident Review evaluations are required for all NF applicants and residents identified with indicators of SMI/ID during the Level I screening or at any time during residency (unless the individual qualifies for an Exempted Hospital Discharge); and for any resident with confirmed SMI or ID with significant changes in their cognitive or physical conditions.

​Level I is an initial screening conducted prior to NF admission to identify individuals with indicators of SMI or ID. 

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.

Individuals identified with SMI or ID may receive further evaluation if the individual needs long-term care. ​

If the Level I screener finds SMI/ID indicators during the screening, the screener then notifies the Community Mental Health Program to request a Level II screening.

The Level II is a comprehensive evaluation, and the Resident Review is a brief consult. Both are performed by a QMHP, assigned by the local Community Mental Health Program.

The QMHP will determine if the individual meets diagnostic criteria for SMI or ID. Once SMI or ID is confirmed, the QMHP will:
  • Evaluate the individual’s SMI or ID symptoms, history and care needs
  • Recommend the most appropriate care setting
  • Determine if specialized services are needed (e.g., psychiatric hospitalization)

If the QMHP determines that the NF is the most appropriate setting, the determination may include recommendations for “services of a lesser intensity than Specialized Services” to meet the resident's needs.  Recommendations may include but not be limited to:

  • Be​havioral strategy recommendations, 
  • Referral to health care provider for medical interventions, or
  • Referral to health care provider with pharmacologic suggestions.​