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 1) all applicants to a Medicaid-certified nursing facility be evaluated for serious mental illness (SMI) and/or intellectual disability; 2) be offered the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings); and 3) receive 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.

2012 Review of State PASRR Policies and Procedures National Report 

This Report reviews state PASRR Level II tools available to CMS from 2009 – 2011 and showed that state PASRR program designs did not comply with federal requirements to a significant extent.  Detailed reports provided to each state.

2013 Review of State PASRR Policies and Procedures National Report

This Report reviewed the same Level II criteria from the 2012 report with updated materials provided by states, and showed dramatic improvement in state PASRR program design.  Detailed reports provided to each state.  Includes discussion about the next report examining PASRR Level I design.

2014 Review of State PASRR Policies and Procedures National Report 

This Report reviews state PASRR Level I tools and MDS data. Shows that most state Level I initial screens have insufficient or overly restrictive triggers and fail to identify all individuals who should be referred to Level II. Detailed reports provided to each state.  Level I results validated by analysis of MDS data, showing that many NF residents with serious mental illness have not been appropriately identified by PASRR.

2015 Review of State PASRR Policies and Procedures National Report 

This Report updates the findings of the 2014 National Report on state PASRR Level I preliminary screening tools and MDS nursing home data.  Working with states, the Level I data elements were modified slightly, but analysis still indicates that Level I tools in many states do not contain the all of the necessary triggers to identify individuals who could have SMI or ID and should be fully evaluated by PASRR Level II. Nursing home data indicates that in most states PASRR underā€identifies individuals with serious mental illness, and to a lesser extent, intellectual disability — which corroborates the Level I findings. Detailed reports provided to each state.

2016 Review of State PASRR Policies and Procedures National Report 

This Report updates the findings of our 2015 National Report on nursing home data, and begins a new analysis of measures that states can use to help support quality monitoring and quality improvement (QM/QI) in their PASRR programs. Nursing home data continue to indicate that in most states, while PASRR is working fairly well at identifying individuals with intellectual disability (ID) and related conditions (RC), PASRR significantly underā€identifies individuals with serious mental illness (SMI).