Nursing Facility FAQs for PASRR

Questions about PL1s

Who completes the PASRR Level 1 (PL1) Screening Form when a resident transfers from one nursing facility to another?
Because the discharging nursing facility is acting as the referring entity, they print a blank PL1, complete it, and send it to the receiving nursing facility with the transferring resident.

The receiving nursing facility then enters the PL1 into the LTC Portal and completes Section F, field F0200 using —1 Convalescent Care— as the admission category.

Does a new PL1 need to be completed when a resident returns from a hospitalization?

  • If a resident is hospitalized for acute inpatient care for more than 30 days AND returns to the same nursing facility, a new PL1 must be submitted.
  • If a resident is hospitalized for acute inpatient care for less than 30 days AND returns to the same nursing facility, a new PL1 is not needed.
  • If a resident is hospitalized for acute inpatient care, regardless of the length of time, AND is going to a new nursing facility, a new PL1 is submitted.

A resident was brought to our nursing facility by her family over the weekend and no staff were on shift to start the PASRR process. What happens now? Will this have a financial impact?
For negative PL1s, qualified nursing facility staff (RN, LVN, MDS coordinator or admissions coordinator) can help the family complete the PL1.

For people suspected of having mental illness, an intellectual disability or a developmental disability, the nursing facility should contact the local authority (LA) immediately to complete the PL1 and PASRR Evaluation (PE), as necessary.

There is a possibility of sanctions during regulatory certification surveys for continued non-compliance with the PASRR process.

A resident is being admitted to our nursing facility for respite next month. Should we submit the PL1 now?
No. The PL1 cannot be submitted before the person is physically present in the nursing facility.

Where does the referring entity find a physician certification that the person is staying at the nursing facility for 30 days or less?
This can be found in the physician's orders or other medical records. PASRR rules state the physician must certify the person will require less than 30 days of nursing facility care. It may be documented as short-term rehabilitation. Please clarify with the physician or referring entity if you are unsure.

A physician's office referred a patient to our nursing facility for a clinical drug trial. Do we need to complete a PL1?
No. If the person is suspected of having mental illness, an intellectual disability or a developmental disability, they are considered a Preadmission type and the physician's office must complete the PL1 before the person is admitted to your nursing facility.

  • If the PL1 is positive, the physician's office should fax it to the local authority. Within 7 days, the local authority will complete the PASRR evaluation and enter it into the LTC online portal.
  • If the PL1 is negative, the physician’s office sends it to the nursing facility with the person. The nursing facility admits the person and submits the negative PL1 on the LTC online portal.

Please direct the physician's office to the Texas Department of State Health Services PASRR website for information on referring entity responsibilities.

Do people who have Alzheimer's require a PL1 Screening Form?
Every person seeking admission to a nursing facility must have a PL1.

Do people with a primary diagnosis of dementia require a PL1 Screening Form?
Every person seeking admission to a nursing facility must have a PL1.

Where do nursing facilities fax the PL1 Screening Form?
Typically, the nursing facility would not fax the PL1 to the LA because the referring entity is responsible for completing the PL1 and faxing it to the LA.

There is only one scenario in which a NF might fax a PL1 to the LA: If a person presents to the nursing facility from the community — and has indication of mental illness, an intellectual disability or a developmental disability (Positive Preadmission) — the nursing facility may help the referring entity complete the PL1 and fax it to the LA to expedite the admission.

The NF must not admit the person nor submit the PL1 on the LTC portal for Positive Preadmissions.

When should the PL1 be entered?
The PL1 should be entered immediately upon admission, not before. The PL1 can never be submitted onto the LTC online Portal before the person is physically present in the nursing facility. Initial and subsequent portal, such as the MDS, will be held in pending status awaiting submission of the PL1.

Who at the nursing facility can complete the PL1?
When the referring entity is a family member, and they ask the nursing facility for help completing the PL1, qualified staff (RN, LVN, MDS coordinator or admissions coordinator) may assist the family member with the family member present.

Is it OK for the facility to explain to a physician's office how to fill out the PL1?

If the individual is coming from home, who would be responsible to do the PL1?
The referring entity will be the family members and the PL1 should be completed by them with the assistance, as needed, by qualified nursing facility staff.

What happens if a referring entity refuses to complete the PL1 Screening Form?
The nursing facility must not accept an admission from a hospital without a PL1. The nursing facility should contact the referring entity to let them know that they cannot admit a person without the PL1. If the refusing referring entity is a hospital, please email the hospital name, name of the staff person you spoke with, what attempts were made to get the PL1 from the hospital, and a direct telephone number (not a general hospital line) to: PASRR Support.

What does the RE do if they don’t know the date of the last annual physical examination to enter on the PL1?
If the hospital discharge paperwork is available, consult dates provided. Contact the referring entity to determine the date or consult with family. A general estimate is acceptable. For example, if the family states last summer, use a date from that year, or the date of the last annual physical examination.

Where does the physician sign the PL1?
There is no place for a physician signature, rather it is an electronic certification that the information the referring entity provides is "true and accurate." This applies to either the PL1 or in documentation provided to complete the PL1.

Questions about PASRR Evaluation

What responsibilities does the nursing facility have if the local authority does not show up to complete the PASRR evaluation?
None. The nursing facility does not need to take any action if an LA does not show up. The LTC portal will generate reports to the HHSC PASRR Unit. State office staff will provide timely follow-up for completion of the PE.

Where will the positive preadmission person go while their PASRR evaluation is being completed?
If the person is coming from the community, he or she will remain in his or her current placement pending completion of the PASRR Preadmission process. If the nursing facility thinks the person is in danger or at risk, please contact the local police department or adult protective services.

What qualifies a person to be PASRR positive for mental illness?
Mental Illness(MI): According to 42 CFR 483.102(b), a disorder qualifies as a mental illness for PASRR purposes if satisfies three major criteria:

  1. It appears as a major mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Revised (DSM-III-R), published in 1987.
  2. It has resulted in functional impairments in major life activities in the last 3-6 months, including interpersonal functioning, concentration, and adaptation to change; and
  3. The individual has a recent history of treatment, which means at least one of the following:
    1. Inpatient hospitalization more than once within the last 2 years; or
    2. An episode of "significant disruption" to normal life activities within the last two years, requiring supportive services or the involvement of law enforcement due to mental illness.

A primary diagnosis of dementia or Alzheimer—s is not a qualifying PASRR MI eligibility.

Intellectual Disability (ID): Intellectual disability is a disability characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18.

Developmental Disability (DD) (also referred to as related conditions): People with a developmental disability/related conditions are people who have a severe, chronic disability that meets all of the following conditions:

  1. It is attributable to—
    1. Cerebral palsy or epilepsy; or
    2. Any other condition, other than mental illness, found to be closely related to mental retardation because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons, and requires treatment or services similar to those required for these persons.
  2. It is manifested before the person reaches age 22.
  3. It is likely to continue indefinitely.
  4. It results in substantial functional limitations in three or more of the following areas of major life activity:
    1. Self-care.
    2. Understanding and use of language.
    3. Learning.
    4. Mobility.
    5. Self-direction.
    6. Capacity for independent living.

Other Questions/Contact Questions

Where can I find fax numbers for the local authorities?
Contact Program Staff

Where can I find my local authority?
Contact PASRR Program staff.

We are a new nursing facility. How do we get access to the portal?