More Than You Ever Wanted to Know About PASRRs (Preadmission Screening and Resident Review)


I have noticed a lot of searches for “PASRR”.  So I have decided to offer several resources I have found helpful in PASRR compliance.  First, let me say that although PASRRs are a federal requirement, there is not a federally mandated form.  Therefore, states vary greatly in format.


I will post a tool I created to make sense of the federal mandate and South Carolina law.  DISCLAIMER:   This tool has not been reviewed by ANY governmental agency and is subject to change without notice.  This is MY interpretation to the best of my ability from the research I have done.  So, ……


PASRR Screening and Implementation


Below are additional resources:




Title 42 Public Health.PASRR


Pre-Admission Screening and Resident Review (PASRR) and the Nursing Home Survey Process

CMS Memorandum September 28, 2007

PASRR and survey guidance transmittal


Note the reference in the Memorandum Survey:  “Rebroadcast of PASRR satellite, “Mental Illness in Nursing Homes” will air ….”

This is still available for viewing and is well worth the time:


Screening for Mental Illness in Nursing Facility Applicants:  Understanding Federal Requirements

DHHS Understanding the PASRR Process


PASRR Screening for Mental Illness in Nursing Facility Applicants and Residents

“The current report outlines the findings from the second phase of the study, which involved a national survey of the relevant agencies in all 50 States and the District of Columbia to determine how they have organized and administered Federal requirements under PASRR. The second phase of the study also included case studies of four States, which were selected to include each of the entities that conduct Level II screens: private mental health agencies, community mental health centers, individual mental health practitioners, and referring agencies or State agencies. In each State, a total of six nursing homes were selected, with three located in an urban county and three located in a rural county. In each of those 24 nursing facilities, the administrators were interviewed about the PASRR process, and the medical records for the nursing facility residents were reviewed. In two of the four States, clinical interviews were conducted with a total of approximately 50 nursing facility residents.”

PASRR Screening for Mental Illness in Nursing Facility Applicants and Residents


Alabama Department of Mental Health and Mental Retardation
Omnibus Budge Reconciliation Act (OBRA)
Preadmission Screening Resident Review (PASRR)  Instruction Manual
May 2009

Alabama Department of Mental Health and Mental Retardation Omnibus Budge Reconciliation Act (OBRA) Preadmission Screening Resident Review (PASRR) Instruction Manual May 2009


SC Medicaid Bulletin (March 2001)

SC Medicaid Bulletin 2001 Preadmission Screening and Resident Review



Mini Mental Status Exam and PASARR Level I Screen

Update:  7/23/10:  Additional information regarding PASRR Compliance added 7/22/10 under “More Than You Ever Wanted to Know About PASRRs”

Mini Mental Status Examination Requirement Clarification for South Carolina

I have noticed that hospitals have not been sending the MMSE to the admitting SNFs, creating extra work for the Social Service personnel! Thanks to Magdalene, at Magnolia Manor Inman, she sent me the following information received from Susie Boykin, SC DHHS:

MMSE are no longer required on every resident with a dx of Dementia. Only if the resident has indicators of mental illness, but is exempt from the Level II process as the Dementia is primary. The MMSE is required for residents with dx of Dementia and exhibiting behavior problems.

Updating and/or Correcting SC PASARR Level I Screens

The PASARR process has not been utilized to its full potential. Its purpose is pervasively misunderstood. I would venture to say it is viewed as merely a form which needs completing in order to discharge the patient from acute care to a skilled nursing facility. Unfortunately, the burden is then placed on the facility to ensure residents with mental illness and/or mental retardation are appropriately placed in the facility as well as assessed by the appropriate State Authority to determine if specialized services are needed. This is federally mandated to occur prior to admission.

Working in long term care, I would guess 2 of 10 PASARR Level I screens are correctly completed. In the past I have corrected incomplete and/or incorrect PASARR Level I Screens and dated and initialed the changes. However, I have now received clarification. The following is also from Susie Boykin, SC DHHS:

The Level I’s completed by the hospital should be sent to the CLTC for review. If there are necessary changes on the Level I, the NH could complete another Level I on admission if the NH has a MOA (Memorandum of Agreement) to complete Level I’s. If the NH completes a Level I, the form should be sent to CLTC for review. (The manual also states anyone completing the Level I should be trained by CLTC).