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Preadmission Screening and Resident Review

Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care. PASRR requires that Medicaid-certified nursing facilities:

  1. Evaluate all applicants for serious mental illness (SMI) and/or intellectual disability (ID)
  2. Offered all applicants the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings)
  3. Provide all applicants the services they need in those settings

PASRR is an important tool for states to use in rebalancing services away from institutions and towards supporting people in their homes, and to comply with the Supreme Court decision, Olmstead vs L.C. (1999), under the Americans with Disabilities Act, individuals with disabilities cannot be required to be institutionalized to receive public benefits that could be furnished in community-based settings. PASRR can also advance person-centered care planning by assuring that psychological, psychiatric, and functional needs are considered along with personal goals and preferences in planning long-term care.

In brief, the PASRR process requires that all applicants to Medicaid-certified nursing facilities be given a preliminary assessment to determine whether they might have SMI or ID. This is called a "Level I screen." Those individuals who test positive at Level I are then evaluated in depth, called "Level II" PASRR. The results of this evaluation result in a determination of need, determination of appropriate setting, and a set of recommendations for services to inform the individual's plan of care.

Regulations governing PASRR are found in the Code of Federal Regulations, primarily at 42 CFR 483.100-138.

On February 14, 2020 the Centers for Medicare & Medicaid Services published a Notice of Proposed Rule Making and Fact Sheet related to PASRR. On April 17, 2020, the Centers for Medicare & Medicaid Services extended the comment period to May 20, 2020.

Review of State PASRR Policies and Procedures National Reports 

These reports provide a broad overview of states’ PASRR activities. Specific topics include: states’ collection of quality measures; responses to the PASRR-related question on the Minimum Data Set; and factors influencing PASRR-related expenditures and federal reimbursement.