PASRR Tennessee: What Families Need to Know About Pre-Admission Screening

If your parent is being admitted to a nursing home in Tennessee, federal law requires a Pre-Admission Screening and Resident Review (PASRR) before placement. This multi-stage screening determines whether a nursing facility is the clinically appropriate setting — or whether your parent's primary needs would be better served in a specialized psychiatric or habilitative program.

PASRR catches families off guard because it adds a mandatory screening step on top of Tennessee's own Pre-Admission Evaluation (PAE) process. Understanding how both interact prevents delays that can leave your parent in limbo between hospital discharge and nursing home admission.

What PASRR Actually Screens For

PASRR is a federal mandate (under OBRA 1987) designed to prevent two specific populations from being inappropriately warehoused in nursing homes:

1. Individuals with serious mental illness (SMI) — including schizophrenia, major depressive disorder, bipolar disorder, and other diagnoses that require active psychiatric treatment
2. Individuals with intellectual or developmental disabilities (IDD) — whose primary needs are habilitative rather than medical

The screening asks: does this person need nursing home-level medical care, or are their primary needs psychiatric or habilitative in nature? If the answer is psychiatric or habilitative, the nursing home is not the right setting — even if the family and hospital want the placement.

The Two-Level PASRR Process

Level I Screening

Every person being considered for nursing home admission in Tennessee gets a Level I screen. This is a brief identification tool — typically a checklist completed by the hospital discharge planner, Area Agency on Aging and Disability (AAAD), or nursing facility intake coordinator.

Level I asks whether the individual has any history of mental illness or intellectual disability. If the answer is no across all categories, the person clears Level I and proceeds directly to nursing home admission (assuming the PAE clinical evaluation also approves nursing facility level of care).

If the answer is yes — the person has a documented mental health diagnosis or intellectual disability — they're referred for a Level II evaluation.

Level II Evaluation

Level II is the detailed clinical determination. In Tennessee, this evaluation is conducted by the state's designated PASRR authority and involves a comprehensive review of:

• The person's psychiatric or IDD diagnosis and treatment history
• Whether they need the level of medical and nursing care that only a nursing facility can provide
• Whether they need specialized services (active psychiatric treatment or habilitative programming) that a nursing facility cannot provide
• Whether they can receive appropriate care in the nursing facility with supplemental specialized services

The Level II evaluation produces one of three determinations:

1. Nursing facility appropriate — the person's primary need is medical/nursing care, and any mental health or IDD needs are secondary. Admission proceeds.
2. Nursing facility appropriate with specialized services — admission proceeds, but the facility must arrange for supplemental psychiatric or habilitative services.
3. Nursing facility not appropriate — the person should be placed in a community mental health or IDD residential program instead.

How PASRR Interacts with Tennessee's PAE

Tennessee has its own clinical screening for TennCare CHOICES eligibility: the Pre-Admission Evaluation (PAE), which uses the state's 26-point acuity scale. A person needs a score of 9 or higher to qualify for nursing facility level of care.

The PAE and PASRR serve different purposes:

• PAE = Does this person need nursing-level care? (state clinical threshold)
• PASRR = Is a nursing home the right setting for this person's primary needs? (federal appropriateness check)

Both must be completed and approved before a Medicaid-funded nursing home admission. A person can pass the PAE (yes, they need skilled nursing care) but fail PASRR Level II (no, their primary issue is untreated schizophrenia, not a medical condition requiring nursing care).

Common Scenarios That Trigger Level II

Your parent may be referred for Level II PASRR if they have:

• A documented diagnosis of major depression, bipolar disorder, or schizophrenia — even if it's well-controlled on medication
• A history of psychiatric hospitalization, even decades ago
• An intellectual disability diagnosis from childhood
• Dementia with significant behavioral symptoms that could be interpreted as psychiatric in nature

The dementia exception: Individuals with a primary diagnosis of dementia (Alzheimer's, vascular dementia, Lewy body) are generally exempt from Level II evaluation if their need for nursing care stems from the dementia itself rather than a co-occurring psychiatric condition. However, if the dementia coexists with a separate, active serious mental illness, Level II is triggered.

Timeline and Potential Delays

Level I screening is typically completed within 24-48 hours as part of the admission paperwork. Level II evaluations take longer — anywhere from 7 to 30 days depending on the complexity of the case and the availability of evaluators.

During this waiting period, the person may remain in the hospital (if they're being discharged from an acute stay) or in their current living situation. The nursing home cannot admit them until Level II clearance is obtained, even if a bed is available and the family is ready.

What You Can Do to Prevent Delays

Gather your parent's complete psychiatric and medical history before the admission process begins. Having records ready — including medication lists, prior psychiatric diagnoses, and treatment summaries — speeds the Level II evaluation significantly. If your parent's mental health history is minimal (a brief episode of depression treated with medication years ago, for example), providing documentation that the condition is resolved and not their primary care need can help expedite clearance.

The Tennessee Care Decision Toolkit maps the full clinical screening timeline — PAE scoring, PASRR coordination, and MCO enrollment — into a 90-day transition workflow so families can anticipate each step rather than being surprised by administrative requirements during a crisis.

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