Resources for Pre-Admission
Screening and Resident Review

PASRR is required anytime someone is being admitted into a Medicaid-certified nursing facility or upon significant change in condition. PASRR is also required at the end of a time-limited approval if a person is expected to remain in the nursing home for longer than the approved time period.

PASRR is a federal requirement mandated by the Social Security Act and is intended to ensure that Medicaid-certified nursing facility applicants and residents with serious mental illness, intellectual disabilities, or related conditions, are identified and evaluated for the need for nursing facility level of services, and if indicated, recommendations for specialized services.

A decline or improvement in the resident’s physical or mental status that is anticipated to require intervention with respect to SMI, IDD, and/or RC.

A Resident Review for significant change is required if a person with SMI, IDD, and/or RC experiences a significant change in their physical or mental condition, whether a decline or improvement, with respect to the SMI/IDD/RC. This means the significant change impacts more than one area of the resident’s health status and will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions.

The following examples are provided in CMS’ RAI Manual MDS 3.0 RAI Manual v1.18.11 October 2023 (cms.gov) for guidance on significant change:

• A resident with SMI, IDD, and/or RC who demonstrates increased behavioral, psychiatric, or mood-related symptoms, and symptoms have not responded to ongoing treatment
• A resident who experiences an improved medical condition—such that the resident’s plan of care or placement recommendations may require modification
• A resident whose significant change is physical, but with behavioral, psychiatric, or mood-related symptoms, or cognitive abilities, that may influence adjustment to an altered pattern of daily living receive written notification accompanied by notification of appeal rights through the fair hearing process.

A PASRR Level II evaluation is required when there is a suspicion or diagnosis of serious mental illness (SMI), intellectual disability (ID), or related condition (RC) or when there is a significant change in condition.  

PASRR Level II evaluations will be completed onsite by an Acentra Health employee who holds a masters degree (or doctorate) in a healthcare field and is licensed in the state of North Carolina. Qualifications include LCSWs, LCMHCs, clinical psychologists, and masters level RNs.

An Acentra Health PASRR Evaluator will initiate scheduling with the facility of residence, such as the nursing facility or hospital.

A PASRR Level II evaluation will take place where the individual is located and will take approximately 45 minutes.

The person being evaluated along with any legal representatives, family, or supports.

The NC PASRR Help Desk can be reached at 919-813-5603 or toll free at 888-245-0179 for any Level I screening or NC MUST system questions.

North Carolina Medicaid Uniform Screening Tool (NC MUST) is the self-service, internet-based application used to manage the NC Pre-admission Screening and Resident Review (PASRR) Program.

For any scheduling questions or direct questions about the Level II evaluation process, you can call Acentra Health at 919-568-1717 or 833-522-5429 (toll free) or email the general helpdesk at NCPASRRLIIevaluations@acentra.com. 

The Division of Mental Health, Developmental Disabilities and Substance Use Services can be reached at 984-236-5290 for any Level II outcome, determination, or notification questions.

All Level II evaluation outcomes are made available to the screeners via NCMUST. The applicant/ resident and/or legal guardian will also receive written notification accompanied by notification of appeal rights through the fair hearing process.

The Level I screening must be completed prior to admission. If the individual is determined to require a Level II evaluation, the Level II evaluation must be completed before the applicant may be admitted. Within 7 days prior to the admission, the admitting nursing facility should submit the Level I in NC MUST and attach the supporting documentation from the out of state referral source. This includes:

• Level I and if applicable Level II from the referring state
• H&P, level of care documentation, relevant treatment notes, including psych notes if applicable
• Power of attorney (POA) if applicable

The NC Medicaid PASRR Level I Lead Nurse will review all of the above documentation and if approved, provide an NC PASRR number. If a Level II is required but was not included, the Lead Nurse will notify the NC nursing facility that a Level II is required by the individual’s state of residence. Once received and reviewed, the PASRR Lead Nurse will forward to DMH/DD/SAS for review and if approved, an NC PASRR number will be issued.

In circumstances where Acentra Health is completing because NC is the state of residence, Acentra Health will complete an evaluation via telehealth.

Yes. As part of the PASRR Level II process, a complete referral packet is required prior to the evaluation. Required documents include:

• Current History and Physical
• FL2 (with current medication list)
• Relevant treatment notes, such as nursing, medical, and psych notes (if appliable)
• Guardianship/POA (if applicable)

• New!  07.18.2024 PASRR Provider Training PowerPoint Presentation
• New! 07.18.2024 PASRR Provider Training FAQ
• North Carolina PASRR - Joint Training, December 6, 2023
• Acentra Health Program Overview and PASRR Stakeholder Engagement, September 2023
• Acentra Health Program Overview, August 2023

• New! Acentra Health and DHB PASRR Provider Training - July 18, 2024
• North Carolina PASRR - Joint Training, December 6, 2023 (65 minutes)

Prior to Acentra Health scheduling and completing a face-to-face Level II evaluation, the following documents will need to be provided in NC MUST:

• NC Medicaid Long Term Care FL2 Form
• History and Physical (H&P)
• Medication List (MAR)
• Relevant Treatment Notes (including psych notes if applicable)

Acentra Health's Level II Evaluators will request completion of the following document during the onsite evaluation.  This can be completed by any staff person who witnesses the occurrence of the assessment.

• Acentra Health PASRR Visit Verification Form