PASRR Screening Virginia Nursing Home: What Families Need to Know Before Admission

What PASRR Screening Means for Virginia Nursing Home Admission

Before your parent can be admitted to any Medicaid-certified nursing facility in Virginia, federal law requires a Pre-Admission Screening and Resident Review — PASRR. This applies regardless of how the stay is being paid for: Medicare, Medicaid, private pay, or a combination.

PASRR exists to identify individuals with serious mental illness, intellectual disabilities, or related conditions who might be better served in a community setting than a nursing home. It has two levels, and understanding the difference matters because a missed or delayed screening can stall an already time-pressured hospital-to-nursing-home transfer.

Level I is the initial filter. The hospital discharge planner, nursing facility, or attending physician completes a standardized form identifying whether the patient has a known history of mental illness (other than dementia), intellectual disability, or a developmental disability. For most elderly patients being admitted primarily for physical care needs, Level I clears quickly — the screening confirms no further evaluation is required.

Level II is triggered when the Level I screen flags a relevant condition. A specialized team evaluates whether the nursing facility can meet the patient's psychiatric or developmental needs, or whether an alternative placement (such as a community mental health program) would be more appropriate. Level II takes longer and involves clinical specialists beyond the hospital's standard discharge team.

How PASRR Differs from the LTSS Screening

Families often confuse PASRR with Virginia's Long-Term Services and Supports screening, but they serve different purposes and run on parallel tracks.

The LTSS screening determines whether your parent meets the functional criteria — nursing facility level of care — required for Medicaid to pay for a custodial bed or CCC Plus waiver services. It evaluates physical dependency in activities of daily living and must be entered into the state's eMLS portal with an "Accepted Authorized" status before Medicaid reimbursement begins.

PASRR, by contrast, is a federal civil rights protection. It does not determine whether your parent qualifies for Medicaid. It determines whether a nursing home is the right clinical setting for someone with certain mental health or developmental conditions. Every applicant needs the Level I screen; a Level II evaluation is required only when Level I indicates it. An LTSS screening may also be required for a Medicaid-funded nursing-home admission, and the two processes use different teams and systems.

The practical risk: if your parent is being transferred from a hospital to a nursing home and the PASRR Level I has not been completed, the facility can refuse the transfer — not because of any clinical concern, but because admitting without a valid PASRR exposes the facility to federal penalties. Ask the hospital discharge planner to confirm the PASRR status and, if Medicaid funding is sought, the LTSS screening status.

Who Conducts the Screening and When to Push for It

In a hospital setting, the discharge planning team typically handles the Level I PASRR screen as part of the transfer paperwork. For admissions from the community (someone entering a nursing home directly from home or assisted living), the admitting facility's staff initiates it.

The timing pressure is real. When your parent is being discharged from an acute hospital stay and needs a nursing home bed, every day of delay costs the family — either in continued hospital charges or in the risk of being discharged to an unsafe setting. If the discharge planner has not mentioned PASRR by the time they start discussing placement options, ask directly: "Has the PASRR Level I been completed for the facilities you're recommending?"

Level I is the initial screen. If the discharge team is citing PASRR as a reason for delay, ask whether a Level II evaluation was triggered or whether the delay is administrative.

What Happens After the Screening

If Level I clears (the most common outcome for elderly patients admitted for physical care needs), the nursing facility can proceed with admission once the LTSS screening and any Medicaid documentation are also in place.

If Level II is triggered, the timeline extends. The specialized evaluation considers whether the nursing facility can provide or arrange for the necessary psychiatric or habilitative services. If evaluators determine that a nursing home is not the appropriate setting, the PASRR process identifies recommended alternative placements or services; ask the discharge team how those recommendations will be implemented.

Families facing a Level II delay should contact the local Area Agency on Aging or the Virginia Long-Term Care Ombudsman for advocacy support. A Level II determination should not leave your parent stranded in a hospital bed with no placement plan.

Planning Around PASRR During Hospital Discharge

The best way to avoid PASRR-related delays is preparation before your parent is hospitalized. If your parent has any history of psychiatric treatment, intellectual disability services, or behavioral health medications, bring that documentation to the hospital admission. A clear clinical picture makes the Level I determination faster and reduces the chance of an unnecessary Level II referral.

If you are coordinating a hospital-to-nursing-home transfer and want a complete framework for managing the discharge timeline — including the PASRR, LTSS, and Medicare appeal processes simultaneously — the Virginia Hospital-to-Home Transition Guide walks through each screening step with the forms, contacts, and deadlines your family needs.

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