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Iowa Preadmission Screening and Resident Review (PASRR)

Frequently Asked Questions (FAQs)

Click here to review a comprehensive list of Iowa PASRR Frequently Asked Questions (FAQs) - SEARCHABLE DOCUMENT


See below for ten featured FAQs for the second quarter of 2026.

It depends on whether the change is likely to constitute a significant change in status. For an individual already in the PASRR population:

  • If PASRR has already identified psychotropic medication management as a specialized service for the individual, and a change in the psychotropic medication dosage is part of a normal titration of medication by a qualified practitioner (psychiatrist, psychiatric ARNP) or a gradual dose reduction (GDR) authorized by a qualified practitioner, there has not been a change in status and no new Level I is required.
  • If there is a very significant change in dosage—either increase or decrease— indicating altered symptomology that may cause a need to add additional services or modify a prior PASRR outcome, then such a change would need to be reported as a status change (new Level I).


For a person not already determined to be in the PASRR population (Level I outcome previously):

  • Significant changes in dosage of an existing psychotropic medication or the need to start/add a new psychotropic medication may be an indication of the worsening of a previously mild or situational/very stable mental health condition, and this may be an indication of the need for consideration of new/additional services and a new Level I screen is appropriate. With all questions relating to the possibility of a Status Change, the broadest answer is, “When in doubt, submit a status change/new Level I screen.”

A categorical or exemption can be requested only in cases where the individual is expected to require fewer than 30 days in an NF for an Exempted Hospital Discharge. (EHD) or fewer than 60 days in a NF for a Convalescent Categorical and only to treat the condition that caused the person to be in the hospital in the first place.

If the hospital believes this is a person who may need active behavioral health treatment to have the best possible recovery and to optimize the potential for return to the community, please do not request the EHD or convalescent categorical and allow the full Level II to take place.

NOTE: EHDs and other categorical outcomes are given only for persons who appear to be in PASRR population, so the accepting NF must understand this person to have a Level II condition and must recognize that they are accepting this person without knowing what services the PASRR will identify, in the event that they do not discharge from the NF prior to the expiration of the categorical/exempted outcome

A Case Activity Report, also known as a CAR form, is a form used by facilities of many types, to submit admission/transfer/discharge, level of care, and pay source related information, for individuals that they serve. For many years prior to 2016, nursing facilities submitted paper CAR forms to seek payment for all individuals in the facility, and put handwritten information onto those forms, which were then mailed by snail mail, faxed, or emailed to Income Maintenance staff at HHS/Medicaid. As of February 1, 2016, all Iowa nursing facilities have been required to use PathTracker+, found within the Iowa PASRR Database, to submit all admission, discharge, or transfer notices. 

If you are admitting, transferring, or discharging a person, updating a payor source, changing a Level of Care (LOC), or admitting someone on hospice, by entering information into PathTracker+, you are making entries that will create a Case Activity Report. You will not see the actual CAR form, but it will appear in the queue of an HHS Income Maintenance worker who determines facility eligibility and issues payments to facilities, within 48 hours of your entries into PathTracker+.

To complete or create a Case Activity Report, a member of your facility staff who has access as a “PathTracker+” submitter, will log into the Iowa PASRR Database and locate the Census queue for your facility. Find the individual and click the “edit” icon (teal colored pencil icon/button) in the far-right corner. This will permit changes/updates to prior information. Make the necessary changes to the admission notice and when you enter the information, a new CAR form will be generated. 

 The transferring facility should submit a discharge notice into PathTracker+ as part of the transfer process. If they have not, you should reach out to the other facility and ask them to submit a discharge/transfer notice immediately, reflecting the actual date of discharge. If they refuse or you experience other issues that you are unable to resolve, reach out to the Iowa PASRR Help Desk for assistance. You may only submit your admission notice after the other facility submits the discharge/transfer notice. The individual won’t show up in your facility census and you won’t have access to the PASRR history/records until the person has been admitted to your facility

You cannot use the Iowa PASRR database to electronically review any PASRR for any individual who has not yet been admitted to your facility. This would be a serious HIPAA breach. You must review the PASRR outcome by asking the referring entity to send it to you by mail, fax, email, or other means, so that you can review it. It will not be available to you electronically until you have accepted the person and submitted an admission notice via PathTracker+.

Note: A nursing facility should never accept any individual for admission without first seeing the PASRR outcome as failure to confirm that all pre-admission PASRR activity has been completed prior to admission will create a compliance problem for the facility up to and including the potential for non-payment of any days admitted without a finalized PASRR LI or LII outcome in place. 

A ServiceMatters review is triggered for every individual who has a Level II PASRR with one or more specialized services identified in the Summary of Findings and 50% of those Level II outcomes where no specialized services are identified. Much more detail about when and how that happens is available in the ServiceMatters training webinar, other webinars that cover PASRR compliance, and many/most of the face-to-face full day training events as well.

Note: It is important for nursing facilities to understand that PASRR compliant care planning and service delivery is required for every individual who has a Level II outcome, whether specialized services have been identified, whether a ServiceMatters review has been triggered or not. The elements required for PASRR compliant care planning are the same that DIAL expects, as part of licensing, for all care plans for all NF residents, whether they are in the PASRR population or not. 

You must have permissions set up to serve in the role of “ServiceMatters Respondent,” within the Iowa PASRR database. Check with your agency/facility Access Coordinator to verify that they have approved you for the role of ServiceMatters Respondent.

If you have permissions, click the teal colored “claim” icon/button in the farright column that you’ll see in the facility census. If you continue to have issues, contact IA PASRR Help Desk (833.907.2777 or IowaPASRR@maximus.com).  

The state requires that the NF care plan for community placement supports to optimize the potential for any individual to discharge under the following 3 conditions:

  1. A short-term approval of NF level of care is rendered by PASRR.
  2. The answer to section Q0500 of the MDS is yes, or 
  3. If the individual has indicated a desire for consideration of return to a lower level of care in the community, at any point. The NF should estimate, based on the individual’s current presentation/service needs, what would be needed to support the individual in the community and forecast a possible future discharge date. 

As each discussion of possible discharge occurs, the target date and the potential service needs can be revised. The care plan is a working document and can be adjusted at any time based on the individual’s needs. You might also educate your staff and residents about the obligation of every facility to understand the rights of individuals with disabilities, the mandate of the Olmstead Decision as it relates to the Americans with Disabilities Act, and the goal to always aim to optimize every resident’s potential for recovery, highest possible quality of life, and their potential for transition to a lower level of care if/when desired and possible. 

You can manually enter the name and address of the sending facility or location in the discharge notice in PathTracker+. 

No. The NF must make entries into PathTracker, which will generate a CAR form that goes to Iowa HHS/Medicaid Income Maintenance staff for 100% of your residents. This has been required since February 1, 2016, and the NF must use PathTracker+ to submit these forms electronically. NO PAPER CAR forms are to be submitted by NFs and Income Maintenance staff at Iowa HHS/Medicaid are expected to reject any paper CAR forms that they receive from nursing facilities.