Referring entities include anyone or any organization that refers a person to a Medicaid-certified nursing facility. Examples include self-referral, family members or caregivers, hospitals, physicians, legally authorized representatives, assisted living facilities, or other nursing facilities (when moving from one to another). Information on the Preadmission and Resident Review Admission process for these referring entities follows.
Referring Entity PASRR Responsibilities General Overview
- Complete the PL1 Screening Form (PL1) for everyone being recommended for admission into a Medicaid-certified nursing facility.
- Send negative, Expedited Admission and Exempted Hospital Discharge PL1's to nursing facility with the person upon hospital discharge.
- Fax preadmission positive PL1's to appropriate local authority.
PASRR Admission Processes
There are four different PASRR admission processes: Exempted Hospital Discharge, Expedited Admission, Preadmission, and Negative PASRR Eligibility. To decide which admission process to follow, the referring entity must first determine if there is a suspicion of PASRR eligibility, or if the person might have mental illness, or an intellectual and developmental disability. If there is a suspicion of positive PASRR eligibility, then one of the first three processes can be followed. If there is no suspicion of positive PASRR eligibility, then the negative PASRR Eligibility process is followed. Here are some details on the 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 an intellectual disability, developmental disability, 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. The person is not suspected of having an intellectual disorder, developmental disability, and/or mental illness.
The PASRR forms page provides forms and information for the initial PASRR process.
PASRR Referring Entity Training
This training gives the PASRR referring entities the information, tools and resources they need to successfully complete the PL1. Take the training in the HHS Learning Portal.
- Texas Administrative Code, Title 40, Part 1, Chapter 17
- Texas Administrative Code, Title 40, Part 1, Chapter 19, Subchapter BB
- PASRR Code of Federal Regulations: 42 CFR 483 Subpart C (beginning at 483.100)
Medical Acute Care Hospital FAQs
I have never heard of the changes in the PASRR process and I need immediate assistance.
From 2009 to the present, HHSC, DSHS and TMHP have worked collaboratively in an interagency work group with external stakeholders, including the Texas Hospital Association. The PASRR program is under the purview of HHSC.
Who needs the PL1?
Every person seeking admission into a Medicaid-certified nursing facility, regardless of funding source requires the PL1 Screening form to be eligible for admission.
Do veterans need the PL1?
Yes, every person being referred for nursing facility care must have the PL1 form entered into the long-term care portal to be eligible for admission to the nursing facility, regardless of funding source.
Who is responsible for completing the PL1?
The PL1 is always to be completed by the referring entity. The referring entity is the first entity that recommends or refers the person for nursing facility placement. In most cases, the referring entity will be the hospital. The referring entity can also be family, law enforcement, a physician's office, or other community care agency.
Who do I fax the PL1 form to?
- Expedited Admissions, Exempted Hospital Discharges and negative PL1's are sent directly to the nursing facility with the person in the transfer packet.
- If the person is preadmission positive (person is suspected of having mental illness, intellectual disability, or developmental disability and is not expedited or exempted) the referring entity completes a paper copy of the PL1 form and faxes the form to the local authority.
Where can I find a copy of the form?
Go to https://www.tmhp.com/resources/forms?name=&field_programs_target_id=51, select 'Long-Term Care,' then click on ‘Forms,’ and click on 'PASRR Level I Screening Form.'
Can the nursing facility come to the hospital to do the PL1?
The nursing facility should not complete the PL1 as this is the responsibility of the referring entity. The nursing facility completing the PL1 creates a conflict of interest for individual choice in residential placement. Nursing facility participation in completion of the PL1 at hospitals is a violation of the PASRR processes and can be subject to non-compliance sanctions.
What do we do if a nursing facility won't take a resident who doesn't need a PL1?
Complete the PL1 as Texas Administrative Code and federal regulations require referring entities to comply with this process.