Pre-Admission Screening and Annual Resident Review (PASRR)
Who is subject to PASRR Screening?
The PASRR screening is required for any individual who is being considered for admission into a
Medicaid Certified Nursing Facility regardless of pay source. Medicaid beneficiaries being considered for admission into
Adult Care Home must also have an appropriate PASRR screening in place for that level of care.
Nursing Facilities PASRR
As of January 1989 and as a result of the Omnibus Budget Reconciliation
Act (OBRA) of 1987 (P.L. 100-203). This section of OBRA was enacted to assure that individuals with serious
mental illness (SMI), mental retardation (MR), and/or conditions related to mental retardation (RC) entering or
residing in Medicaid-certified nursing facilities receive appropriate placement and services.
The PASRR program for Nursing Facilities is a federal statutory requirement (see 42 CFR
483 Subpart C) that mandates the review of every individual who applies to or resides in a Medicaid-certified
facility, regardless of the source of payment for nursing facility services.
Note: Hospital swing beds, Community Alternatives Program services, and nursing facilities that are not Medicaid certified are exempt from Level I and Level II PASRR screens. A small number of nursing facilities in North Carolina have a distinct part that participates in the Medicaid program as a nursing facility and another distinct part that participates in the Medicare program as a skilled nursing facility. Persons seeking admission to the separate Medicare-only part of the Facility, as a distinct part, and as long as that part is not Medicaid certified, are also exempt from the Level I and Level II processes.
An individual who is transferred from any of these placements into a Medicaid-certified nursing facility bed (or Medicaid-certified part of a nursing facility) must have a Level I and, if applicable, a Level II screen before that transfer can occur.
A Level I identification screening must be performed before anyone, regardless of payment source, can be admitted to any Medicaid certified nursing facility. When the Level I screening indicates the possibility of MI, MR, or RC, a Level II face to face in-depth evaluation must be performed to assess for nursing facility placement and for potential specialized care needs of the individual. PASRR screenings must also be provided for previously-admitted individuals who have demonstrated a MI, MR, and/or RC change in condition.
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Adult Care Home PASRR
PASRR Screenings are required prior to the admission of Medicaid beneficiaries to Adult Care Homes.
The North Carolina PASRR Medicaid Level I screening form must be completed by an independent screener who is a healthcare professional.
This provision is in accordance with NC DHHS DMA Clinical Policy 3L.
Any authorized community member who is not a legal representative of the individual being screened, and is not
employed or paid by, or affiliated with a licensed ACH can complete the ACH PASRR Level I.
Adult Care Homes themselves cannot complete the Level I PASRR Screen. At the request of the Adult Care Homes, in
order to expedite processing of the screenings, The N.C. Department of Health and Human Services (NCDHHS) has agreed
to use a paper process in addition to the Web-based screening process to ensure that the Level I screenings are
completed expeditiously. As a rule, the online tool will be utilized. However, in the event individuals have
difficulty finding a provider who will use the online process, the paper process described below may be utilized.
For example, as the person who knows an individual's medical history best, it is anticipated that primary care
physicians will be requested to complete the PASRR. A physician's office may complete a paper form if desired and
then the electronic submission of the form can occur at the Adult Care Home as long as a copy of the paper form with
physician signature is uploaded along with the Web-based submission (see "Getting Started Paper Process" below for
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Level I Screens
Federal law (42 CFR 483.128) mandates that states provide
a Level I screen for all applicants to Medicaid-certified
nursing facilities to identify residents with serious mental illness (SMI), mental retardation (MR), or a related
condition (RC). For residents with no evidence or diagnosis of SMI, MR, or RC, the initial Level I screen remains
unless there is a significant change in status.
Level II Screens
Any applicant to a Medicaid-certified nursing facility whose Level I screen indicates the possible presence of SMI,
or RC must undergo a Level II screen. Level II screens are federally mandated (42 CFR 483.128) to be performed
on-site and prior to admission to the nursing facility. Read
Level II Screen Postponements
Federal regulations (42 CFR 483.130) allow short-term
nursing facility admissions for some applicants with SMI, MR,
or RC. These time-limited approvals are authorized during the Level I screen process when any of the following four
circumstances are applicable:
a. Convalescent care (30-day approval): applies to admissions to nursing facilities directly from acute care
Note: Federal regulations (42 CFR 483.106) state that an
individual must need 30 days or less of nursing
facility care for the hospitalization condition for this approval to be granted. The attending physician
provide certification that the nursing facility stay is not expected to exceed 30 days.
b. Emergency (7-day approval): applies when the individual needs emergency protective service placement
c. Delirium (7-day approval): applies to individuals suspected of having SMI, MR, or RC but whose delirium
prevents accurate completion of the Level I and/or Level II processes
d. Respite (7-day approval): applies to individuals whose in-home caregivers need temporary respite
The last character in PASRR numbers differ based on the type of admission requested. Please follow this link to find a table which identifies the Adult Care Home PASSR Numbers, and the Skilled Nursing Facility PASSR numbers. When admitting an individual to your facility, please ensure they have a PASRR number that is appropriate for their condition and level of care.
Residents who exhibit a significant change in mental health or mental retardation needs must be re-screened through
Level I as a status change. A change in status can occur for residents with newly discovered diagnoses or symptoms
of SMI, MR, and RC, as well as for residents known to have SMI, MR or RC but whose treatment needs for those
change significantly. Read More...
If residence in the facility is expected to extend beyond the end date shown on the initial Level I screen, further
approval and evaluation, as authorized by 42 CFR 483.130(e), must be obtained before the authorized period
admitting facility is responsible for initiating further assessment through an updated Level I evaluation
within 5 calendar days of the individual's date of admission for 7-day approvals,
within 25 calendar days for 30-day approvals, and
within 50 calendar days for 60-day approvals.
Note: If the individual is Medicaid eligible and is approved for continued stay through the
updated Level I/II
process, Medicaid's fiscal agent must be contacted for payment to continue.
All evaluation results must be kept in the resident's medical record to allow availability to the facility's care
planning team and to federal and state auditors (see Section 7.5 for additional information on documentation).