PRe-Admission screening and resident review (PASrR)
Congress created the Pre-Admission Screening and Resident Review
(PASRR) program under the Omnibus Budget Reconciliation Act
(OBRA) of 1987 to address concerns that many people with
serious mental illness or mental retardation were inappropriately
placed in nursing facilities (NFs).
The PASRR process is a requirement in all Indiana Health
Coverage Programs (IHCP)-certified NFs. All residents of an
IHCP-certified NF are subject to the PASRR process regardless of
known diagnoses or methods of payment (IHCP or non-IHCP). Screening
occurs prior to admission or when there is a significant change in
the physical or mental condition of a resident (resident review or
The Level I Identification Screen, Form 450B, Section IV, is
completed to identify residents who may have a mental illness (MI),
mental retardation/developmental disability (MR/DD), mental
illness/mental retardation/developmental disability (MI/MR/DD), or
related conditions. If the Level I screen indicates the individual
might have a serious mental illness or other diagnosis/condition
listed above, a Level II screening is required. The NF is
responsible for referring the resident to the appropriate agency,
such as a community mental health center (CMHC) or Diagnostic and
Evaluation (D&E) team, within 21 days. Residents who have or
are suspected of having both mental illness and mental
retardation/developmental disability must be referred to the
D&E team for evaluation.
The Level II assessment typically involves an in-depth clinical
evaluation by a trained mental health professional to verify
whether or not an individual has a serious mental illness. The
Level II assessment must be completed within an annual average of
seven to nine days from the date of referral. If the Level II
screen is positive for serious mental illness, a two-pronged
determination is made as to whether or not the individual requires
(a) specialized mental health services and (b) nursing facility
services (specific to the facility where application is made). The
same process is followed for residents with mental
retardation/developmental disability or dually diagnosed with MI
and MR/DD; D&E teams complete these in-depth evaluations.
Certain individuals are exempted from the PASRR process.
Exempted Hospital Discharge
This exemption is limited to stays of up to 30 days. It is
allowed only when all the following circumstances exist:
- The resident has been hospitalized for acute inpatient
- The resident requires NF services for the condition for which
care was received in the hospital.
- The attending physician certifies before admission to the
facility that the resident is expected to require fewer than 30
days of NF services.
Respite care concerns individuals admitted to an NF from home
for short-term respite care. To qualify for respite care, on
admission, there must be an expressed intention of leaving the NF
by the expiration of the approved respite time period.
Adult Protective Services
An Adult Protective Services (APS) admission is designated as a
maximum stay of seven days. This admission must be authorized
jointly by an APS investigator and the PAS agency prior to the
admission, and must be the placement of last resort. The individual
must be in need of intensive emergency intervention or in imminent
for More Information
For more information about PASRR, please see Chapter 14
of the IHCP Provider Manual.