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 RR).

Screening Levels

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 care.
  • 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

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 danger.

for More Information

For more information about PASRR, see the Long-Term Care provider reference module.