Montana PASRR Screening

What PASRR Is and Why It Exists

PASRR — Preadmission Screening and Resident Review — is a federally mandated process that screens anyone being admitted to a Medicaid-certified nursing facility for serious mental illness (SMI) or intellectual disability (ID). The goal is to prevent inappropriate institutionalization: making sure that people whose primary needs are psychiatric or developmental are getting specialized treatment rather than being warehoused in a nursing home that isn't equipped to serve them.

In Montana, the PASRR Level I screen (Form SLTC-145) is completed for every nursing facility admission — whether the person is coming from a hospital discharge, a home setting, or another facility. The hospital discharge planner, nursing facility admissions coordinator, or referring physician typically initiates the screening.

How the Two Levels Work

Level I is a brief screening questionnaire that identifies whether the person has a known diagnosis of serious mental illness, intellectual disability, or a related condition. Most people pass Level I quickly — if there's no SMI or ID diagnosis, the screen clears and the admission proceeds. The Level I form is administered by the Senior and Long-Term Care Division (SLTC) and takes only a few minutes to complete.

Level II is triggered when the Level I screen identifies a potential SMI or ID condition. Level II is a comprehensive clinical evaluation conducted by a specialized team to determine whether the person genuinely needs nursing facility services, whether they need specialized services for their mental health or intellectual disability condition, and whether the nursing facility can provide or arrange those services. Level II evaluations take longer and can delay or redirect the admission.

For eldercare families, the Level II trigger most commonly hits when a parent has a co-occurring dementia diagnosis alongside depression, bipolar disorder, or another psychiatric condition. The screening doesn't prevent nursing home admission — it ensures that appropriate mental health services are included in the care plan and that a community-based alternative isn't more suitable.

Why PASRR Matters for Home Care Families

If your goal is to keep your parent at home rather than placing them in a nursing facility, PASRR is relevant in two ways:

As a diversion opportunity. When a Level II screen determines that a person's needs can be met in a community setting with appropriate services, the screening team may recommend HCBS (Home and Community-Based Services) as an alternative to nursing facility placement. That recommendation does not replace the separate Mountain-Pacific clinical assessment and Office of Public Assistance financial eligibility process for the Big Sky Waiver or Community First Choice Services.

As a hospital discharge complication. When a parent is being discharged from the hospital and the discharge planner is pushing for nursing facility placement, PASRR Level II can affect the admission timeline. While it is pending, families can ask about arranging home care services, request a Mountain-Pacific Quality Health assessment for HCBS eligibility, and apply for presumptive eligibility under Senate Bill 72 — potentially avoiding the nursing home admission entirely.

The risk is the opposite scenario: a hospital discharge team that treats PASRR as a formality, rushes the Level I screen, and moves the parent to a nursing facility before the family has time to explore alternatives. Families who know PASRR exists can ask the discharge planner directly whether a Level II screen was indicated and what the outcome was.

The Montana Process

Montana's PASRR process is administered through the Senior and Long-Term Care Division, which coordinates with DPHHS behavioral-health and developmental-disabilities staff when Level II evaluations are needed. Key contacts:

• Level I screens are initiated by the referring facility or provider and submitted to SLTC
• Level II evaluations are assigned to qualified mental health professionals contracted by the state
• Results are documented and shared with the admitting facility, the referring provider, and the family

The SLTC-145 (Level I Screen) form is available through the Medicaid provider portal at medicaidprovider.mt.gov. Families don't complete this form themselves — but understanding what it screens for puts you in a stronger position to advocate for appropriate placement and push back if a nursing facility admission doesn't match your parent's actual needs.

The Montana Home Care Navigation Guide covers the complete nursing facility diversion pathway, including how PASRR findings connect to HCBS eligibility, the hospital discharge advocacy steps, and the presumptive eligibility process that allows temporary home care to start while permanent program enrollment is pending.

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