Out of State Nursing Facility Admissions

This process provides guidance to entities who refer a person living outside of Texas to a nursing facility within Texas.

When a person moves from another state and is admitted to a Texas Medicaid-certified nursing facility (NF), the referring entity (RE) in the other state must complete the Texas PASRR Level 1 Screening Form (PL1) [PDF].

An RE is a person or entity that refers or recommends NF placement for a person. Examples of REs include a state agency, a NF, hospital discharge planners, physicians’ offices, home health agencies, hospice agencies, psychiatric hospitals, law enforcement agencies, assisted living facilities, group homes, and family members or other community healthcare providers.


The PASRR Level 1 Screening Form (PL1) [PDF] is designed to identify people who are suspected of having a mental illness (MI), an intellectual disability (ID), or a developmental disability (DD) diagnosis, also referred to as related conditions (RC).

The PL1 must be completed prior to admission for every person seeking admission to a Texas Medicaid-certified NF, regardless of the person’s funding source.

If documentation entered on the PL1 indicates a suspicion of MI, ID, or DD/RC, one of Texas’ local intellectual and developmental disability authorities, local mental health authorities, or local behavioral health authorities will complete a PASRR Evaluation (PE).

(Note: If the PL1 indicates a suspicion of MI, ID or DD/RC and the person also has a primary diagnosis of dementia, the PL1 will still be positive and a PE will still be completed.)

If the RE determines the answer is “No” to all three questions within Section C, PASRR Screen, then the PL1 screening status is considered negative for suspicion of an MI, ID or DD. The RE sends the PL1 to the admitting NF with the person. The NF enters the negative PL1 into the Texas Medicaid & Healthcare Partnership Long-Term Care Online portal (LTCOP) upon the person’s admission. The PASRR process ends for the person after admission.

The PASRR Evaluation (PE) is designed to confirm or deny the suspicion of MI, ID or DD/RC and ensure the person is placed in the most integrated residential setting to receive the specialized services needed to improve and maintain the person’s level of functioning.


  1. The RE downloads and completes the Texas PASRR Level I Screening Form (PL1) [PDF]. For instructions on how to complete the PL1, read the Detailed Item by Item Guide for completing the PL1 Screening Form (PDF)
  2. Section F on the PL1 form must be completed as an “Expedited Admission” with a category of “convalescent care.” This type of admission will allow the person to enter the NF without delay and the category will alert the local authority to conduct the PE as quickly as possible.
  3. The RE must send the completed PL1 to the Texas NF with the person. The NF will then submit the PL1 on the LTCOP during the admission process. If the PL1 indicates a suspicion of MI, ID, or DD, the LTCOP will send an electronic notification to the appropriate entity to complete the PE.

Email the PASRR Unit with any questions about the information on this page.