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The federal definition of MI for PASRR is best understood in terms of the four “D's”: A diagnosis or suspicion of a major mental illness such as schizophrenia, bipolar disorder, major depression, or an anxiety disorder such as OCD. An absence of dementia.

Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care.

As part of the Omnibus Budget Reconciliation Act (OBRA) enacted in 1987, Congress developed the Preadmission Screening and Resident Review (PASRR) program to prevent inappropriate admission and retention of people with mental disabilities in nursing facilities.

The Department of Health Care Services (DHCS) is responsible for SMI Level II Evaluations and has contracted with Acentra Health, formerly Kepro, to perform these services for the state of California. PASRR Level II evaluations must be completed by Kepro within 72 hours of completion of the positive Level I screen.

A Level 2 Evaluation is a person-centered evaluation that is completed for anyone identified by the Level 1 Screening as having, or suspected of having, a PASRR condition, i.e., serious mental illness (SMI), intellectual disability (ID), developmental disability (DD), or related condition (RC).