Quick answer
PASRR is an admission and resident-review process for Medicaid-certified nursing facilities, not merely a Medicaid-payment check. Identify the state’s required screening route, obtain any necessary state determination and carry service recommendations into assessment and care planning. New or changed needs can require further referral after admission.
Identify the state route before admission
The CMS Medicaid PASRR overview describes preliminary Level I screening for all applicants to Medicaid-certified nursing facilities and an in-depth Level II evaluation for positive screens. The determination addresses appropriate setting and needed services.
CMS Appendix PP, F644–F646, explains state-designated authority, use of recommendations, exceptions and later notifications. State procedures govern the actual forms and routing. Do not copy an exception from another state's workflow or assume a hospital referral automatically establishes one.
Reconcile three referral packets
A fictional admissions team receives three packets:
| Packet | Initial assumption | Correct routing question |
|---|---|---|
| A: private-pay applicant | PASRR is unnecessary because Medicaid is not paying | Is the destination a Medicaid-certified NF, and has the applicable screen been completed? |
| B: positive Level I | Facility assessment can stand in for Level II | Has the state-designated authority completed the required evaluation and determination, or does a properly verified exception apply? |
| C: claimed short-stay exception | Hospital label is sufficient indefinitely | Does the state's process permit this exception, is its basis documented, and what follow-up is required if the stay changes? |
The team resolves A through the applicable screen, routes B to the state process and verifies C's actual exception criteria and follow-up. It does not make a clinical diagnosis or an individual eligibility determination from this table.
A state determination received after admission does not make an earlier missing step disappear. Preserve the actual chronology and route any deficiency through the authorized response process.
Turn the determination into services
A Level II report is not merely an admission attachment. CMS guidance requires its information to inform assessment, care planning and transitions. Distinguish specialized services assigned to the state from the other services the facility remains responsible for providing.
In a fictional follow-through case, a report recommends a service but the facility's plan contains only “PASRR complete.” The coordinator identifies the recommendation, confirms the responsible state or facility route, arranges the required communication and verifies the resulting service. If access remains unresolved, the record shows the barrier and escalation rather than falsely closing the recommendation when the PDF is uploaded.
The facility's broader behavioral-health obligations remain relevant even where PASRR does not identify specialized services. One program's outcome does not replace the resident's comprehensive assessment.
Keep resident review active
CMS guidance calls for prompt notification to the state-designated mental-health or intellectual-disability authority when an applicable resident experiences a significant change. Newly evident or possible qualifying conditions also require referral for review. Do not wait for a routine dashboard cycle to consider the need for notification.
Qualified staff determine the clinical findings and applicable assessment process. The operational record preserves the change, referral, state response and resulting plan updates. Keep the MDS assessment and PASRR notification as related but separate events.
The completed workflow contains a defensible preadmission route, actual state determination, implemented service recommendations and a later-review trigger. That is the useful full-platform requirement: admission, assessment and service coordination must preserve the state process without reducing it to a payer checkbox.
Questions & answers
Does PASRR apply only when Medicaid pays?
No. CMS describes screening for all applicants to Medicaid-certified nursing facilities. Facility certification and the applicable process matter, not just the resident’s current payer.
Can facility staff complete the Level II determination themselves?
No. Level II evaluation and determination belong to the appropriate state-designated authority. Facility staff route information and incorporate the result.
Does a negative admission screen end all later review duties?
No. Newly evident possible conditions or a significant change can require referral to the state-designated authority under the applicable rules.
Primary sources
Use the cited source and its applicable version when making a facility-specific decision. These guides explain operational evaluation methods; they are not individualized clinical, coding, or legal advice.