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.

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), Intellectual or Developmental Disabilities (IDD), and/or related conditions(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 (42 CFR 483 Subpart C) that mandates the review of every individual who applies to or resides in a Medicaid-certified nursing facility, regardless of the source of payment for nursing facility services.

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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, IDD, 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,IDD, and/or RC change in condition.

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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), Intellectual or Developmental Disabilities(IDD), or a related condition (RC). For residents with no evidence or diagnosis of SMI, IDD, or RC, the initial Level I screen remains valid unless there is a significant change in status. Read More...

Level II Screens

Any applicant to a Medicaid-certified nursing facility whose Level I screen indicates the possible presence of SMI, IDD, 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 More...

Level II Screen Postponements

Federal regulations (42 CFR 483.130) allow short-term nursing facility admissions for some applicants with SMI, IDD, 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 hospitals 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 must 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, IDD, or RC but whose delirium state 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

PASRR Assessment Numbers

PASRR numbers differ based on the type of admission requested. Please follow this link to find a table which identifies the Skilled Nursing Facility PASRR numbers.

Status Changes

Residents who exhibit a significant change in mental health or Intellectual or Developmental Disabilities 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, IDD, and RC, as well as for residents known to have SMI, IDD or RC but whose treatment needs for those conditions change significantly.   Read More...

Continued Stays

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 ends. The 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).

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