Medicaid-certified nursing facilities are required to comply with Preadmission and Resident Review. PASRR is a federally mandated review process, requiring all people seeking Medicaid-certified nursing facilities admissions to be screened for mental illness or intellectual and developmental disability regardless of funding source or age.
In addition, people deemed to be PASRR eligible for an intellectual and developmental disability (IDD) by a PASRR Evaluation are eligible for habilitative services that Medicaid-certified nursing facilities are required to provide. Nursing Facility PASRR Specialized Services for people with IDD include but are not limited to: durable medical equipment; habilitative therapies; and assessments. To learn more, see the Texas Administrative Code, Title 26, Part 1, Chapter 554, Subchapter BB.
The PASRR forms page provides forms and information for the initial PASRR process.
PASRR Admission Processes
There are four types of PASRR admission processes:
- Exempted hospital discharge happens when a physician at an acute care hospital (a medical acute care hospital, not a psychiatric hospital) has determined the person might need a nursing facility stay of 30 days or less for rehabilitation purposes.
- Expedited admission is for those discharged from a medical acute care hospital or a nursing facility transfer. There are seven expedited admission categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite and coma. For definitions of each category, visit the forms page.
- Preadmission happens when a person is coming from the community (psychiatric hospital, home, group home, jail, assisted living, etc.). This includes anywhere other than a medical acute care hospital or another nursing facility. The person, coming from the community with a PASRR Level 1 that indicates suspicion of IDD, and/or mental illness must also have a completed PASRR Evaluation submitted before they can be admitted to a nursing facility. This process must be followed to ensure people coming from a community setting can receive education about other placement alternatives before nursing facility admission.
- Negative indicates the person has a negative PL1 screening, and is not suspected of having an intellectual disability, developmental disability and/or mental illness.
To learn more on all PASRR admission processes, visit the Texas Medicaid & Healthcare Partnership’s Provider Education Training Materials webpage. This webpage includes a variety of user guides for PASRR, which also include workflow processes. Before you use these guides for the first time, you will need to click on “accept” to accept the user agreement from TMHP. To learn how to refer a person living outside of Texas to a nursing facility within Texas, visit the Out of State Nursing Facilities Admission webpage.
- Detailed Item by Item Guide for Completing the Authorization Request for PASRR Nursing Facility Specialized Services (PDF)
- Texas Medicare & Healthcare Partnership Provider Education Training Materials
- Texas Administrative Code, Title 26, Part 1, Chapter 303
- Texas Administrative Code, Title 26, Part 1, Chapter 554, Subchapter BB
- PASRR Code of Federal Regulations – 42 Code of Federal Regulations 483 Subpart C (483.100)
PASRR Webinars and Online Trainings
The following information and resources can help nursing facility staff recognize their responsibilities and learn how to navigate each step of the PASRR process.
Nursing facility staff involved in the PASRR process need to understand what it is, their role and responsibilities, and how to navigate each step of the process. Trainings and education are an integral part of that process.
PASRR Technical Assistance
HHS provides a series of PASRR update webinars and informational calls for nursing facilities. These hourlong sessions are designed to address the common questions and concerns identified by nursing facilities or HHS.
Mental Health PASRR and Form 1012
Access the Form 1012 webinar training for nursing facilities hosted via SimpleLTC.
- PASRR 101 Training
- PASRR Rules Training
- PASRR Referring Entity Training
- PASRR Level 1 Training
- PASRR Evaluation Form Training
- Requesting Specialized Services through the TMHP Portal Training
Nursing Facility Administrators: HHS has approved the courses on the HHS Learning Portal’s PASRR Training Page for Nursing Facility Administrator continuing education credit, but they do not contain information about the minimum standards for compliance with regulatory requirements for nursing facilities. To access HHSC Regulatory Services training on the minimum standards, visit apps.hhs.texas.gov/training/cbt/PASRR/.
- Long-Term Care Regulatory Regional Contact Numbers
- Nursing Facility PASRR Responsibility Checklist (Word)
- Texas HHS Office of the Ombudsman
- Texas Medicaid & Healthcare Partnership
- Quality Monitoring Program, Texas HHS
Questions about PL1s
Who completes the PASRR 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 Long-Term Care 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.
What happens when a resident is brought to a nursing facility and no staff are on shift to start the PASRR Process?
Will this have a financial impact?
For negative PL1s, qualified nursing facility staff (registered nurses, licensed vocational nurses, minimum data set 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 immediately to complete the PL1 and PASRR Evaluation, as necessary.
There is a possibility of sanctions during regulatory certification surveys for continued non-compliance with the redesigned 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.
Do nursing facilities have to do a PL1 for all residents admitted before the PASRR redesign implementation on May 24, 2013?
No. Before implementation, the Long-Term Care Portal created a PL1 for every Texas nursing facility resident using the most recently submitted minimum data set assessment data and/or legacy PASRR evaluations. The local authorities will complete PASRR evaluations for all residents with a positive PL1. This will be handled in the portal with no required action from 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 can be documented as short-term rehabilitation. 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 seven days, the local authority will complete the PASRR evaluation and enter it into the Long-Term Care 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 Long-Term Care portal.
Direct the physician's office to the PASRR Referring Entities page 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 local authority because the referring entity is responsible for completing the PL1 and faxing it to the local authority.
There is only one scenario in which a nursing facility might fax a PL1 to the local authority: 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 can help the referring entity complete the PL1 and fax it to the local authority to expedite the admission.
The nursing facility must not admit the person nor submit the PL1 on the Long-Term Care 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 Long-Term Care Portal before the person is physically present in the nursing facility. Initial and subsequent portal, such as the minimum data set, 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) can 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 person 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 inform them they cannot admit without the PL1. If the refusing referring entity is a hospital, 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 phone number (not a general hospital line) to: PASRR.Support@hhsc.state.tx.us.
What does the resident assistant 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 May 1, 2014, for the date of the last annual physical examination.
Where does the physician sign the PL1?
There is no place for a physical signature, rather it is an electronic certification that 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 a local authority does not show up. The Long-Term Care portal will generate reports to HHSC. State office staff will provide timely follow-up for completion of the PASRR Evaluation.
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 processes. If the nursing facility thinks the person is in danger or at risk, contact the local police department or adult protective services.
What diagnoses qualify for PASRR eligibility?
Mental Illness: According to 42 Code of Federal Regulations 483.102(b), a disorder qualifies as a mental illness for PASRR purposes if it satisfies three major criteria:
- It appears as a major mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Revised (DSM-III-R), published in 1987.
- It has resulted in functional impairments in major life activities in the past three to six months, including interpersonal functioning, concentration and adaptation to change; and
- The person has a recent history of treatment, which means at least one of the following:
- Inpatient hospitalization more than once within the past two years; or
- An episode of "significant disruption" to normal life activities within the past two years, requiring supportive services or the involvement of law enforcement because of mental illness.
A primary diagnosis of dementia or Alzheimer’s is not a qualifying PASRR mental illness eligibility.
Intellectual Disability: Intellectual disability is 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 (also referred to as related conditions): People who have a severe, chronic disability that meets all the following conditions:
- It is attributable to—
- Cerebral palsy or epilepsy; or
- Any other condition, other than mental illness, found to be closely related to intellectual disabilities because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of mentally disabled people, and requires treatment or services similar to those required for these people.
- It is manifested before the person reaches 22 years old.
- It is likely to continue indefinitely.
- It results in substantial functional limitations in three or more of the following areas of major life activity:
- Understanding and use of language.
- 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?
Use the link above.
We are a new nursing facility. How do we get access to the portal?