For a state to have its Medicaid plan approved by the Centers for Medicare and Medicaid Services (CMS), it must maintain a Preadmission Screening and Resident Review (PASRR) program that complies with the relevant federal laws and regulations. 

Everyone who may admit to a Medicaid certified nursing facility (NF), regardless of funding, must be "screened" for evidence of serious mental illness (MI) and/or intellectual disability, developmental disabilities, or related conditions (collectively abbreviated as "ID"). 

A NF must not admit an applicant who has MI and/or ID unless the appropriate state agency has determined whether:

  1. The individual meets the level of care that a NF provides
  2. Whether individuals who meet NF level of care also need specialized services, rehabilitative services, or community placement supports.

The intent of PASRR is to ensure that all NF applicants are thoroughly evaluated, that they are placed in nursing facilities only when appropriate, diverted when possible, that they receive all necessary services while in a NF, including any supports that might assist them in transitioning to a lower level of care. 

There are two levels of the PASRR process: Level I and Level II. The Level I screen is to determine whether an individual might have MI and/or ID, also known as PASRR conditions. If an individual has a positive finding for possible PASRR condition at Level I, the subsequent Level II evaluation will: 

  1. Confirm or disconfirm the results of the Level I screen, and 
  2. For individuals who have MI or ID, determine where they may be placed - whether in a NF or in the community, and  
  3. Identify the services they require to optimize the potential for recovery, facilitate return to lower level of care when consistent with needs and choices, and enhance quality of life. 

Iowa's PASRR website provides: How to register for an account on the Iowa PASRR system, Announcements, A PASRR Tip of the Month, Provider and Supervisor Tools, and many resources which are available to the public. PASRR related webinars are available on a frequent basis and face-to-face full day training events are offered in multiple Iowa locations annually.  Registration links are available for all upcoming free training events on the website, which are posted under “announcements.”   


Lila P.M. Starr, PASRR Program Manager  |  515-281-5318