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Pre-admission Screening and Resident Review (PASRR Level II-MI)

In 1987, Congress developed the Preadmission Screening and Resident Review (PASRR) program to assure that people with serious mental illness who apply for admission to a Medicaid-certified nursing and boarding care facility (NFs) receive

  • care in the most integrated setting and
  • mental health services that they need

Integrated Setting: Medicaid regulation prohibits Medicaid certified nursing facilities (NFs) from admitting any person with a serious mental illness (SMI) unless the state mental health authority (SMHA) or state Medicaid agency has determined that the nursing facility is the most integrated setting for the person. The screening process is designed to assure that the person is not admitted to a nursing facility unless no other community setting is a better fit for that person.

Services: The Code of Federal Regulations for PASRR requires specialized services be provided if needed and if the person to receive the services agrees. For the purposes of Level II MI in Minnesota, a specialized service is any service that supports or assists the person in managing symptoms of mental illness. These services can range from clinical services such as therapy to rehabilitative services such as Assertive Community Treatment (ACT) or simpler interventions like reminding the person to take medications on time. Since nursing facilities in Minnesota do not officially provide mental health services, provision of Medicaid-funded mental health services while the person is at the NF is not considered duplication of services. Most Medicaid funded mental health services can be provided to the person while they are in residence at an NF. The services can be provided on-site or at another location depending on the person’s situation. Many mental health services such as Assertive Community Treatment and Adult Rehabilitative Mental Health Services routinely meet with the person wherever they are.

PASRR Process

Preadmission screening and Resident Review (PASRR) involves a two-step process that is referred to as PASRR Level I and PASRR Level II.


The Level I screener determines if the person requesting admission to the NF may have a mental illness or a developmental disability. The Level I screener also determines whether the person meets nursing facility level of care. If the person may have either a mental illness or a developmental disability, they are referred for a Level II assessment. The Level II assessment is different for people who have a developmental disability and people who have a mental illness. For more information about Level I and Level II for Developmental Disability, please contact


Bulletin #24-25-01​ 
PASRR Level II Mental Health Tool

The Level II MI assessment determines three things:

Current Providers

In Minnesota, the State Mental Health Authority (SMHA is the Minnesota Department of Human Services, Behavioral Health Division. The SMHA has delegated responsibilities for Level II MI to the county or tribal human service agency as the local mental health authority (LMHA). The county or tribal area where person is physically located at the time of the Level I screening is the County or Tribe that has responsibility to conduct the Level II MI. This may not be the county of financial responsibility. 

More information?

PASRR Policy Lead, 651-431-2225 or

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