PASRR Before a Nursing Home Admission: What Families Should Know

The short answer

PASRR—Preadmission Screening and Resident Review—is a federal framework for screening or reviewing individuals with mental illness or intellectual disability who apply to or reside in Medicaid-certified nursing facilities. Medicaid.gov explains that the process begins with a preliminary Level I screen; when a further evaluation is indicated, a Level II review can address whether nursing-facility services are needed, whether the setting is appropriate, and what services may be needed. PASRR is not a diagnosis, does not guarantee admission, does not determine whether Medicare or Medicaid coverage applies, and is not a substitute for emergency care.

What PASRR is—and what it is not

PASRR is intended to help avoid inappropriate nursing-facility placement and to support consideration of appropriate setting and services for people covered by the framework. Federal PASRR regulations span 42 CFR §§ 483.100–483.138. The applicability rule addresses screening or reviewing covered people in Medicaid-certified nursing facilities regardless of payment source; the screening, determination, and evaluation provisions address what the state process considers for the individual.[1] [2] [3] [4]

The process does not answer every transition question at once. It does not determine whether hospital-level treatment is still needed, whether a particular facility has a bed, whether that facility will accept a referral, or whether Medicare, Medicaid, private pay, or insurance will cover a stay. Keeping those questions separate helps families ask for a clearer plan.

Separate the decisions families often hear at once

Question	Who usually addresses it	Why it matters
Is hospital-level treatment still needed?	Treating hospital team	A placement process does not substitute for treatment of an active medical emergency.
What care and supervision needs are documented?	Treating clinicians, therapists, and receiving provider	The receiving provider must decide whether it can safely meet documented needs.
Does PASRR screening or further review apply?	State-defined PASRR process and participating providers	The process can inform the appropriate setting and service considerations for a covered individual.
Is there an appropriate bed and an accepting facility?	Receiving facility	Screening, clinical fit, availability, and acceptance are separate steps.
What payment path applies?	Payer, state Medicaid program, facility, and qualified advisers	Medicare coverage, Medicaid eligibility, private pay, and insurance have separate rules.

Level I and Level II in plain language

Level I: the initial screen

Medicaid.gov describes Level I as a preliminary screen for possible serious mental illness or intellectual disability. It is not the same as a complete psychiatric evaluation, and it does not itself determine that a nursing facility is inappropriate. Ask the hospital or receiving facility whether a screen has been started, who handles the state process, and which current records the process needs.

Level II: a more detailed review when required

When further review is required, the federal determination criteria call for evaluation of the person's physical status, mental status, and functional assessment in deciding whether nursing-facility services are needed and which setting is appropriate. State authorities and state procedures govern how that review is carried out. Do not assume that a diagnosis, a hospital referral, or a family preference alone answers the placement question.[3] [4]

Why PASRR can appear during a hospital-to-nursing-facility transition

Hospital discharge planning should identify people likely to experience adverse health consequences without adequate planning, evaluate likely post-hospital services, consider the availability of and access to those services, and discuss the evaluation with the patient or representative.[5] If a nursing-facility referral is under review, clinical documentation, provider acceptance, availability, payer questions, and the PASRR process can be moving at the same time.

Ask for a clear status update

What care and supervision needs are documented today?
Which facilities are reviewing the referral, and what information is still needed?
Has a PASRR screen been completed, and is a further review required?
Which coverage or payment questions remain open?
What services or settings are being evaluated if nursing-facility admission is not available or appropriate?

Do not confuse PASRR with Medicare skilled-nursing coverage

PASRR and Original Medicare skilled-nursing facility coverage are different concepts. Medicare coverage for skilled nursing facility care is limited and has its own requirements, including qualifying inpatient status, a need for daily skilled services, timely entry, and care in a Medicare-certified facility. Observation time generally does not count toward the usual qualifying inpatient-stay requirement, and Medicare Advantage plans can have different rules.[6] Long-term nursing-facility residence, Medicaid eligibility, and facility acceptance remain separate questions.

A records checklist for a clearer referral and screening conversation

Information to organize	Why it may be requested
Current hospital summary and treating-team contact	Helps the receiving provider understand the current illness and plan.
Medication list and recent changes	Supports a safer handoff and care-plan review.
Therapy, mobility, transfer, swallowing, and supervision notes	Describes functional and support needs.
Relevant history requested by the state screening process	May be relevant to the individual screening and service-planning review.
Insurance and Medicaid-application information	Helps keep clinical acceptance and payment questions separate.
Authorized-representative documentation, if applicable	Helps the team identify the appropriate contact under applicable law.

If a family does not have a document, it is better to say so and ask who can provide it than to guess or alter records.

Questions to ask the nursing facility

Is this facility Medicaid-certified, Medicare-certified, or both?
Can the facility evaluate the documented nursing, rehabilitation, behavioral, mobility, and supervision needs?
Is PASRR required in this situation, and what is the current status?
Does the facility need additional records before making an admission decision?
Who will explain the admission agreement, services, and charges in writing?
If the facility cannot accept the referral, can it identify the care need, document, or capacity issue that prevented acceptance?

If the family is under immediate discharge pressure

For an immediate medical or safety emergency, call 911 or follow the treating team's emergency instructions. For a pending hospital discharge, ask for a discharge-planning meeting and describe the concrete care gap, such as no available transfer support, inability to manage medications without supervision, or need for a more secure setting. Federal discharge-planning standards do not guarantee admission to a particular facility or eliminate state-specific assessment and payer requirements.[5]

Related decision guides

Emergency Nursing Home Placement →Unsafe Return-Home Discharge Guidance →What Is a Skilled Nursing Facility? →Paying for Care While Waiting for Medicaid →When a Resident's Return to the Prior Nursing Home Is Uncertain →

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Frequently asked questions

Is PASRR required for every nursing home admission?

PASRR applies under the federal framework to screening or reviewing individuals with mental illness or intellectual disability who apply to or reside in Medicaid-certified nursing facilities, regardless of payment source. State procedures and exceptions can vary, so ask the facility or hospital which process applies to the referral.

Does PASRR mean my parent has been denied admission?

No. PASRR is a screening and review framework, not a facility admission decision. Facility acceptance, bed availability, clinical fit, and payment arrangements are separate questions.

Does PASRR apply if Medicaid is not paying yet?

The federal PASRR framework applies to the screening or reviewing of covered individuals in Medicaid-certified nursing facilities regardless of payment source. Confirm the individual state process and the facility's certification status for the specific referral.

Does a PASRR review decide whether my parent needs a nursing home?

A PASRR determination can address whether nursing-facility services are needed and the appropriate setting for an individual covered by the framework. It does not replace the treating team's clinical assessment, the facility's admission decision, or payer and contract questions.

Can the hospital wait until PASRR is complete before discharge?

Hospital discharge planning and PASRR are separate processes. Ask the hospital to explain the current discharge plan, identified post-hospital needs, available services, and how PASRR relates to the referral. An article cannot determine the correct timing for an individual patient.

Is PASRR the same as Medicare coverage for rehab?

No. PASRR is a nursing-facility screening and review framework. Original Medicare skilled nursing facility coverage has separate conditions related to qualifying hospital status, skilled-care need, certified-facility care, and other coverage requirements.