Preadmission Screening and Resident Review (PASRR)

​Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing facilities for long term care. 

PASRR requires that Medicaid-certified nursing facilities:

  1. Evaluate all applicants for serious mental illness (SMI) and/or intellectual disability (ID)
  2. Offer all applicants the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings)
  3. Provide all applicants the services they need in those settings
  • PASRR is an important tool to use in rebalancing services away from institutions and towards supporting people in their homes, and to comply with the Supreme Court decision, Olmstead vs L.C. (1999)​.
  • PASRR can also advance person-centered care planning by assuring that psychological, psychiatric, functional, and other health care needs are considered along with personal goals and preferences in planning long-term care.

The PASRR process requires that all applicants to Medicaid-certified nursing facilities (NFs) be given a preliminary assessment to determine whether they might have SMI or ID. This is called a “Level I Screen."  Those individuals who test positive at Level I are referred to the local health department (LHD), where they receive an in-depth Level II PASRR evaluation. The LHD forwards the results of this evaluation to the Developmental Disabilities Administration (DDA-state ID authority) or the Behavioral Health Administration* (BHA-state SMI authority) as appropriate.  The State authority in turn reviews the evaluation findings and issues a determination of need, determination of appropriate setting, and a set of recommendations for services to inform the individual's plan of care.

PASRR Requirements

The hospital, NF, or other entity referring an individual for NF placement must complete the Level I screening prior to that individual being admitted to the NF. If a Level II evaluation is required, this must also be completed and approval for NF placement granted before the individual may be admitted. If DDA or BHA determine that a NF is not an appropriate placement for an individual who is subject to Level II evaluation/determination, the individual may not be admitted. A NF's failure to comply with these requirements may result in sanctions including:

  1. Denial or recovery of Medicaid payments.
  2. Revocation of the NF's Maryland Medicaid provider status; and/or
  3. Revocation of the NF's federal Medicaid certification. 
  • On February 14, 2020 the Centers for Medicare & Medicaid Services (CMS) published a Notice of Proposed Rule Making and Fact Sheet related to PASRR.
  • Effective August 16, 2021, the Department has terminated the Temporary Non-Enforcement of PASRR Requirements that had been in effective since April 1, 2020.  


Maryland Medicaid Transmittals

*The Department currently contracts with Optum, the Administrative Services Organization (ASO) that manages authorization, payment and utilization review functions related to behavioral health for the Department. Optum performs PASRR determinations for BHA.