Before someone can be admitted to a Medicaid-certified nursing facility in the United States, a screening has to happen first. Families usually meet this process during a hospital discharge, when it arrives as an unexplained delay and a form nobody has time to describe. This page explains what the screening is, who runs it, and what it means for the person being admitted.

What PAS and PASRR mean

PASRR stands for Preadmission Screening and Resident Review. It comes from the Nursing Home Reform Act of 1987, and it applies to every Medicaid-certified nursing facility regardless of who is paying the bill, Medicaid, Medicare, or private funds.

Some states call their process PAS (Preadmission Screening) or use a state-specific name. The underlying federal requirement is the same.

The purpose is narrower than most families assume. PASRR is not a general assessment of whether someone needs nursing home care. It exists to identify two specific groups, people with serious mental illness and people with intellectual or developmental disabilities, and make sure they are not placed in a nursing facility when a different setting would serve them better, and that if they are admitted, they receive the specialized services they need.

Level I and Level II

Level I screening

A short screen completed for everyone seeking admission. It asks whether there is any indication of serious mental illness or an intellectual or developmental disability. Most people screen negative at this stage, the form is filed, and admission proceeds. Level I is usually completed by hospital discharge staff, the nursing facility, or a physician, and it typically takes a day or less.

Level II evaluation

Triggered when Level I flags a possible condition. A Level II is a full evaluation by a qualified professional independent of the facility. It determines three things: whether the person has the condition, whether nursing facility care is appropriate for them, and what specialized services they need if admitted.

Level II takes longer, commonly several business days, and the federal framework contemplates a limited window for completion. This is the step that creates the discharge delay families notice.

Exemptions and shortcuts

Federal rules allow for faster tracks in specific situations, and states implement them differently:

  • Hospital exempted discharge. A short stay (commonly up to 30 days) after a hospital admission, when the person is expected to return home. Note the word expected, if the stay extends, a full evaluation is usually required.
  • Provisional admission in an emergency, with the evaluation completed afterward.
  • Categorical determinations, where a state has pre-approved certain diagnoses or circumstances for a faster decision.

If a delay is holding up a discharge, it is reasonable to ask the hospital social worker directly whether an exemption applies and whether it has been requested.

Who performs the screening

Level I is usually completed by the referring hospital or the admitting facility. Level II must be performed by an entity independent of the nursing facility, typically the state mental health or developmental disabilities authority, or a contractor acting for them. The nursing facility cannot evaluate itself into an admission.

Documents commonly required

Exact requirements vary by state, but the following come up almost everywhere:

  • A physician’s order or certification that nursing facility care is needed
  • A current history and physical, usually dated within the last 30 days
  • A medication list
  • Recent hospital records, including the discharge summary if there was a stay
  • Psychiatric history and records, if a Level II has been triggered
  • Insurance and Medicaid information
  • Advance directives, power of attorney, or guardianship papers, if they exist

What happens after the determination

The outcome is a written determination that says whether nursing facility placement is appropriate and what specialized services, if any, are required. The facility must provide or arrange those services. If the determination says nursing facility placement is not appropriate, the state is expected to help identify an alternative setting.

Determinations can be appealed. Every state has an appeals process, and the determination notice should explain it. If you disagree with a finding, the long-term care ombudsman is a free place to start, and legal aid programs for older adults handle these cases.

Resident Review: the part that continues after admission

The “RR” in PASRR covers people already living in a facility. If someone’s condition changes significantly, a new psychiatric diagnosis, for instance, a review may be required even though they were admitted years ago.

Alternatives worth asking about

If the goal is avoiding a nursing facility, ask the hospital discharge planner or your Area Agency on Aging specifically about these:

  • Medicaid home and community-based services (HCBS) waivers, which fund care at home for people who would otherwise qualify for a nursing facility
  • PACE (Program of All-Inclusive Care for the Elderly), available in many areas for people 55 and over who meet nursing-home level of care
  • Short-term skilled rehabilitation at home through a home health agency
  • Assisted living, which in some states is partially covered by a Medicaid waiver

PASRR is a federal requirement implemented state by state, and the details, timelines, forms, exemption categories, differ. Confirm specifics with your state Medicaid agency or the hospital social worker handling the discharge.