A Level 1 Screening involves completion of an evaluation to determine if an individual has, or is suspected of having, a PASRR condition, i.e., serious mental illness (SMI), intellectual disability (ID), developmental disability (DD), or related condition (RC).
Providers are immediately notified of the Level 1 Screening results, positive or negative, in the PASRR Online System. If the Level 1 Screening result is negative for possible SMI, ID/DD, or RC, the PASRR is complete.
If the Level 1 Screening is positive for an individual having, or is suspected of having, a PASRR condition, i.e., SMI, ID/DD, or RC, then a Level 2 Evaluation will be performed to help determine the most appropriate placement of an individual, considering the least restrictive setting, and whether specialized services are needed.
What is a significant change of condition?
There is no federal guideline specific to PASRR that defines "significant change in condition." CMS recommends that you refer to the latest version of the minimum data set (MDS) to make a decision on whether the individual has had a "significant change in condition."
According to the MDS manual, a "significant change" is a decline or improvement in an individual's status that:
- Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, is not "self-limiting" (for declines only);
- Impacts more than one area of the individual's health status; and
- Requires interdisciplinary review and/or revision of the care plan.
If a resident has experienced a significant change of condition, the NF must initiate the RR process by submitting a Level I Screening, regardless of the date of the last PASRR, and note in the resident’s medical record that a significant change of condition has occurred. If the resident’s Level 1 Screening result is positive for SMI, ID/DD, or RC, then a Level 2 Evaluation must be completed by an approved state contractor, and a Determination made by the appropriate MI or ID state authority.
Is PASRR required for everyone being admitted to a NF?
Yes. A Level 1 Screening, a Level 2 Evaluation (if needed), and Determination must be completed for any individual discharging from a hospital to a NF, or for any individual being directly admitted from the community to a NF, regardless of the individual’s age or payor source.
If the individual is admitted to the NF on the weekend and no one is available to complete the Level 1 Screening, will the NF be penalized if it completes the PASRR the following week?
Yes. The NF will lose Medi-Cal reimbursement for each day the individual is in the NF without a completed PASRR.
If it takes three to four (or seven to nine) days to complete the PASRR process, won't it significantly delay a patient discharging from the hospital?
Federal regulations allow seven to nine days for the completion of a PASRR. A hospital should start the PASRR process with a Level 1 Screening at admission, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation, if needed, and Determination prior to discharge.
Who is responsible for payment if a patient is ready to discharge on day three and is waiting for the PASRR process to be completed?
Hospitals will receive Medi-Cal Acute Administrative Days (AAD) while waiting for NF placement. This reimbursement is only for justifiable administrative days while waiting for PASRR completion, assuming the delay is not on the hospital’s part and the reasons for the delay are well documented.
This applies to Medi-Cal members only and would follow current Medi-Cal AAD policy.
DHCS does not have authority over payment by other insurance providers. Please contact other insurance providers directly for related payment policies while waiting for the PASRR process to complete.
A hospital should start the PASRR process with a Level 1 Screening upon admission of the individual, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation (if needed) and Determination prior to discharge.
What is the evaluation system by which DHCS is ensuring that the Level 1 Screening is completed accurately?
The PASRR Online System has logic built into the Level 1 Screening that will determine the outcome. Therefore, it is essential that the screening is completed correctly with accurate information provided by facility staff.
Who can complete Level 1 Screenings?
Who can complete Level 1 Screenings?
It is the facility's responsibility to designate qualified staff that can complete Level 1 Screenings.
The facility staff must have:
- Knowledge of medical terminology.
- Knowledge related to the medical/behavioral history and current status of the individual.
- Met the individual or individual’s family/conservator and be directly involved in the individual’s care.
What disciplines are typically used by hospitals to complete Level 1 Screenings?
Hospitals use disciplines such as social workers, discharge planning staff, and registered nurses to complete Level 1 Screenings.
Does a physician need to sign the Level 1 Screening?
No. A physician's signature is not required on the Level 1 Screening.
Can you please show us what the Level 1 Screening looks like?
PASRRs are already done upon admission to our subacute Distinct Part (DP) NF, does anything change for this process?
If PASRRs are currently completed after an admission to an DP/NF, then, the new process requires that the PASRR be completed at the hospital prior to an individual discharging to the DP/NF.
Can a staff member who works in a hospital with a DP/NF, be an approver for both the hospital and the NF?
Yes. The staff member can be an approver for both the hospital and the NF.
When are hospitals required to complete Level 1 Screenings?
Does PASRR requirements apply to both NF levels of care, i.e., skilled nursing and long-term care?
Yes. The PASRR process must be completed prior to an individual being discharged to a Medicaid Certified skilled nursing or long-term care facility.
Is a Level 1 Screening only required if an individual is coming from the community?
No. A Level 1 Screening is required for any individual that is discharging from a hospital to a NF. A Level 1 Screening is also required when the individual is being admitted to a NF directly from the community, and for current NF residents, readmissions or inter-facility transfers when there is a significant change in the resident’s physical or mental condition.
Is a Level 1 Screening required for ICF-DD admissions?
No. A PASRR Level 1 Screening is not required when discharging to an ICF-DD.
Is a PASRR required for “swing beds”?
No. A PASRR is not required for swing bed NF services. A facility can “swing” its beds and provide either acute hospital or skilled nursing level of care, as needed. These services are covered by Medicare only in certain hospitals and critical access hospitals when the facility has entered a “swing-bed” agreement with the Centers for Medicare & Medicaid Services.
Is a Level 1 Screening required for all patients discharging to a long-term care hospital?
No. A Level 1 Screening is only required if the individual is discharging to a NF, i.e., a Level 1 Screening is not required when discharging to a long-term care hospital.
If the member requires a subacute level of care, will a PASRR be required?
Yes. A PASRR will be required unless the subacute facility has a Medicare-approved swing bed arrangement.
Note: Most PASRR Level 1 Screenings on subacute level of care patients are going to be negative, because of overriding medical conditions.
Is a hospital required to complete a PASRR for a member discharging to an IMD?
A PASRR is required only when an individual is discharging to an IMD that is also a Special Treatment Program/Medicaid Certified Skilled Nursing Facility.
Does a patient discharging to a NF under hospice need a Level 1 Screening?
Yes. A PASRR is required if an individual is discharging from the hospital to a NF, or when an individual from the community is being admitted to a NF.
Our patients typically transfer to and from Children’s Hospitals. Is a PASRR required?
No. A PASRR is not required for hospital-to-hospital transfers.
Are Critical Access Hospital (CAHs) subject to the PASRR process?
Yes. If the CAH is discharging an individual to a NF, the CAH is required to complete a Level 1 Screening, and if needed, arrange for a Level 2 Evaluation to be performed by the state approved contractor to help ensure individuals discharging from CAHs receive services in the most integrated setting.
Is a Level 1 screening required for patients discharging to a long-term care hospital?
No. A PASRR is not required for hospital-to-hospital transfers.
My hospital has a distinct part NF, does it need a separate PASRR account from the NF?
Yes. There should be separate PASRR Online System accounts, i.e., one for the hospital and one for the NF.
Is the PASRR process required if a member is admitted as observation versus inpatient?
If the individual is admitted to the hospital and is discharging to a NF, then the PASRR process must be completed.
If someone initiates a Level 1 Screening then is off work for the next week, how does the process continue in their absence?
Staff who are designated as an Approver or User can take over the process since they have access to the PASRR Online System and can see all activity for their assigned facility.
Is a hospital required to keep a patient until the Level 1 Screening is complete?
Prior to an individual discharging to a NF, the entire PASRR process must be completed. This means the hospital is required to complete a Level 1 Screening, and if needed, arrange for a Level 2 Evaluation to be performed by the state approved contractor to help ensure the individual discharging from the hospital receives services in the most integrated setting.
A hospital should start the PASRR process with a Level 1 Screening upon admission of the individual, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation (if needed) and Determination prior to discharge.
If a member is readmitted from the NF to the hospital, does the hospital need to redo the Level 1 Screening if the individual is already a long-term NF resident?
No. If an individual is readmitted from the NF to a hospital, then returns to a NF, a Level 1 Screening as a PAS is not required. However, if the resident experiences a significant change of condition upon their return, the NF must initiate the RR process by submitting a Level 1 Screening.
If a patient is unable to return to their original NF and is requesting a new NF, is a new PASRR needed?
No. The original NF needs to send the existing PASRR to the new NF. The easiest way to do this is by utilizing the electronic File Exchange feature in the PASRR Online System.
If a patient is discharged to an acute rehabilitation hospital, is a PASRR required?
No. A PASRR is only required when discharging a member to a Medicaid Certified NF.
If an acute rehabilitation hospital discharges a patient to a NF, is a PASRR required?
Yes. A PASRR is required for all individuals discharging from the hospital to a Medicaid Certified NF.
If the Level 1 Screening on admission is negative, and the patient stays at the hospital for 30 days or more, is the Level 1 Screening still good after the 30 days? Or does the hospital need to complete another Level 1 Screening closer to discharge?
As long as the individual does not experience a significant change of condition, the Level 1 Screening is good, regardless of the length of stay.
If a patient’s condition significantly changes, does the hospital or NF need to start a new PASRR or can the original PASRR be edited?
Once a Level 1 Screening is submitted, you cannot make changes. If there is a significant change in an individual’s physical or mental condition, then the hospital must complete a new Level I Screening. Once an individual is admitted to a NF, if there is a significant change in condition, the NF would initiate the RR process by submitting a Level I Screening.
Please define "community". Wouldn't emergency or urgent care doctor's office fit that description?
The community is defined as any location that isn’t a hospital or NF. This includes, but is not limited to, an urgent care clinic, a doctor’s office, home, prison, etc.
Does the hospital Emergency Department (ED) need to complete PASRR for someone going to a NF?
A PASRR is required for anyone being admitted to a NF. Either the ED, the hospital affiliated with the ED, or the NF can complete the PASRR.
If an individual is in the ED, and the Level 1 Screening is positive, is the hospital required to keep the patient in the ED before discharge to a NF?
Yes. The hospital is required to keep the patient prior to discharge to the NF. However, the patient does not need to remain in the ED.
Does DHCS assist a hospital when a patient is transferring to a new NF, but the old NF refuses to send the PASRR to the new NF?
The old NF is required to send the electronic PASRR file to the new NF. If this does not occur, the PASRR team can assist with next steps. Please contact the
PASRR program for assistance.
What if the patient is not discharging from the hospital to a NF?
If the individual is not discharging from the hospital to a NF, then the PASRR process would not be required.
What if the NF refused admission after it accepted the electronic file, and the member is now going to a different NF? Do I need to submit a new PASRR?
No. A new PASRR would not be required. NFs are instructed to accept the electronic File Exchange only after the individual is discharged and received by the NF. If transition plans change, the hospital or NF can cancel the electronic File Exchange. If the NF accepted the electronic File Exchange before the individual arrived, the NF can return the PASRR files to the hospital. The hospital can then send the PASRR files to the accepting NF.
When should the hospital start the Level 1 Screening?
A hospital should start the PASRR process with a Level 1 Screening upon admission of the individual, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation (if needed) and Determination prior to discharge.
Does the electronic File Exchange have to take place before a hospital transfers a member to the NF?
Yes. A hospital is required to initiate the electronic File Exchange before discharging the individual to the NF. Once the individual is discharged and received by the NF, the NF is required to accept the electronic File Exchange.
Will the result of the Level 1 Screening negatively impact the individual being admitted to the NF?
No. The results of the Level 1 Screening should not have a negative impact on the individual being admitted to a NF. In fact, the result of the screening should be used to accurately place the individual in a setting best suited for their needs and identify any additional supports they may need while in the NF.
What if someone has a stable mental health diagnosis, managed by medications, does the PASRR process stigmatize the member?
No. The PASRR process does not stigmatize the member. The purpose of PASRR is to help ensure individuals receive an appropriate level of care and services while placed in a NF.
Do members with a diagnosis of Dementia have a higher rate of positive Level 1 Screenings?
If Dementia is the primary diagnosis, the Level 1 Screening could be positive. DHCS’ contractor will review and likely close the case as Level 2 Categorical Determination.
If we are initiating a screening for a member who had suicidal ideation three weeks prior, but the member's current behavior is stable and the individual does not verbalize suicidal ideation, it is considered resolved? Will I still report the suicidal ideation on the Level I Screening?
Please document the suicidal ideation as resolved on the Level 1 Screening. DHCS’ contractor will review when conducting the evaluation.
What is an Exempted Hospital Discharge (EHD)
The only exemption under which a hospital is not required to fully complete the PASRR process is if the individual discharging to a NF qualifies for an EHD. Under this process, a Level 1 Screening is still required, but the EHD question can be marked “Yes” in the PASRR Online System.
All criteria listed below must apply to meet the 30-Day EHD exemption:
- The individual is directly admitted to the NF from a hospital after receiving acute inpatient care at the hospital; and
- The individual requires NF services for the same condition the individual was receiving care for in the hospital; and
- The attending physician has certified prior to NF admission that the individual’s stay is likely to require less than 30 calendar days of NF services.
Note, if the individual’s stay exceeds the 30 calendar days, then the NF is required to submit a RR Level 1 Screening by the 40th calendar after admission.
Can a member discharged from an ED to a NF qualify for an EHD?
No. A discharge from an ED to a NF does not qualify for an EHD, because the individual did not receive acute inpatient care. One of the criteria for an EHD is the individual must be admitted to the NF directly from a hospital after receiving acute inpatient care.
How do our physicians certify the EHD?
The physician’s certification for the EHD should be documented and saved in the individual’s medical records. Please note: there is no specific form for the physician to complete.
Do I submit the Level 1 Screening if the individual is expected to stay less than 30 days at the NF?
The only exemption under which a hospital is not required to fully complete the PASRR process is if the individual discharging to a NF qualifies for an EHD. Under this process, a Level 1 Screening is still required, but the EHD question can be marked “Yes” in the PASRR Online System.
All criteria listed below must apply to meet the 30-Day EHD exemption:
- The individual is directly admitted to the NF from a hospital after receiving acute inpatient care at the hospital; and
- The individual requires NF services for the same condition the individual was receiving care for in the hospital; and
- The attending physician has certified prior to NF admission that the individual’s stay is likely to require less than 30 calendar days of NF services.
Note, if the individual’s stay exceeds the 30 calendar days, then the NF is required to submit a RR Level 1 Screening by the 40th calendar after admission.
Why does the Level 1 Screening need to be completed by the hospital if the individual is not staying at the NF longer than 30 days?
Pursuant to Title 42, Code of Federal Regulations, sections 483.100-483.138, a PASRR Level 1 Screening is required regardless of an individual’s length of stay in the NF.
When are NFs required to Submit Level 1 Screenings?
When does a NF submit a Level 1 Screening?
NFs are required to submit Level 1 Screenings, when:
- An individual is being admitted directly from the community and not the hospital; and
- There is a need for an RR for current NF residents, readmissions, or inter-facility transfers based on a significant change in the resident’s physical or mental condition. In this scenario, the NF initiates the RR process by submitting a Level I Screening as an RR in the PASRR system.
A member was admitted to our NF from a hospital. A Level 1 Screening was completed, but it indicated the individual’s stay would be less than 30 days. After admission, it has been determined the individual will be staying at the NF for more than 30 days. Do I have to submit a new Level 1 Screening? If so, when do I submit it?
If the individual’s stay exceeds 30 days, the NF will need to submit a new Level 1 Screening as a RR by the 40th calendar day from the date of admission. If the result of the Level 1 Screening is positive, then the NF will need to arrange for a Level 2 Evaluation to be performed by the state approved contractor to help ensure the individual receives services in the most integrated setting.
Do I need to do a PASRR for existing long-term residents?
No. A PASRR is not needed for existing long-term residents. A new Level I Screening as an RR is required only when there is a significant change in a resident’s physical or mental condition. In such a case, a NF must initiate a RR process by completing a new Level 1 Screening, and if needed, arrange for a Level 2 Evaluation to be performed by the state approved contractor to help ensure the individual receives appropriate services in the most integrated setting.
How long does the Level 1 Screening take?
The average time spent completing a Level 1 Screening is approximately 15 minutes.
Does an individual need a PASRR if they are being admitted to a NF from home and if so, who is responsible for it?
Yes. An individual must have a completed PASRR prior to being admitted to a NF from home. In this scenario, the NF is responsible for completing the PASRR prior to an individual’s admission.
If a resident is admitted to a hospital from a NF, does the NF need a PAS Level 1 Screening upon the resident’s return?
No. A new Level 1 Screening is not required unless there is a significant change in a resident’s condition. If there is a significant change in the resident’s condition, then the NF must initiate the RR process by completing a new Level 1 Screening, and, if needed, arrange for a Level 2 Evaluation to be performed by the state approved contractor to help ensure the individual receives services in the most integrated setting.
If a member is admitted from a NF to a hospital, is a PASRR required?
No. A PASRR is not required for individuals who are discharging from the NF to the hospital.
The individual temporarily left the NF; do I need to complete a new PASRR?
If the resident temporarily went somewhere outside of the NF, a new PASRR would not be required unless upon return, there was a significant change in the resident’s physical or mental condition. If this happens, then the NF initiates the RR process by submitting a Level I Screening, and if needed, arrange for a Level 2 Evaluation to be performed by the state approved contractor to help ensure the individual receives services in the most integrated setting.
If an individual will be receiving custodial care at the NF, is a PASRR required?
A PASRR is required for any individual being admitted to a NF.
How do I complete a Level 1 Screening?
How do I complete and submit a new Level 1 Screening?
To complete a Level 1 Screening, please log in to the PASRR Online System and click on New Screening. Then, answer the 19 questions presented and click “submit.”
Can I change the start date on the Level 1 Screening?
No. The start date is automatically assigned by the PASRR Online System and cannot be changed manually.
Can I delete a Level 1 Screening?
Once submitted, the Level 1 Screening cannot be deleted. Once you start a Level 1 Screening and the system assigns it a case identification (CID) number, it will remain “In-Progress” for two weeks until submitted. If the screen is not submitted within two weeks, the system will delete the Level 1 Screening.
Will past Level 1 Screenings be visible to providers if they have been filled out at different facilities?
No. Prior Level 1 Screenings from other facilities are not visible to other providers. Staff can only view the PASRR screenings completed by their facility.
A lot of people are on an antidepressant and/or antianxiety medication but are not necessarily diagnosed with a SMI. Will just being on a psychotropic medication cause a Level 2 Evaluation?
No. Results of the Level 1 Screening are not based solely on the individual’s prescribed psychotropic medication. The results are based on the totality of answers provided in response to the 19 questions included in the Level 1 Screening.
Do I have to list the psychotropic medication in section 12?
Yes. Please list the psychotropic medication in section 12.
Do I have to complete a Level 1 Screening if I know the individual does not have a SMI, ID/DD, or RC?
All individuals require a Level 1 Screening if they are discharging from a hospital to a NF, or if they are being admitted to a NF directly from the community. Current NF residents that experience a significant change in physical or mental condition also require a new Level 1 Screening to initiate the RR process, and if needed, a Level 2 Evaluation and Determination to help ensure the individual receives services in the most integrated setting.
Which admission date should I use?
For hospital admissions, use the admission date for your hospital, not the admission date for the NF to which the individual is discharged. If the individual is being admitted to the NF from the community, then the NF should indicate the admission date to the NF.
Are there any clinical notes or physical therapy evaluations required to be submitted with the PASRR Level 1 Screening?
No. DHCS’ contractor and DDS Regional Centers will access and review the individual’s medical records when they conduct the Level 2 Evaluation.
What does the facility do with the PASRR letters?
The facility is responsible for filing all PASRR letters in the individual’s medical record and distributing them to the:
- Individual
- Individual’s legal representative
- Admitting NF
- Individual’s attending physician
- Any other person involved in the care and treatment of the individual
- DHCS when submitting the treatment authorization request
If a screening is started but a patient’s discharge is delayed, can the screening be saved past the 2 weeks?
No. The screening is closed automatically if not submitted within two weeks of being initiated.
What if the approver is not in-house or is otherwise unavailable to submit the Level 1 Screening to the NF. Can we transfer the member without the PASRR being submitted electronically?
If the Approver is not available, the PASRR can be printed and sent with the member or emailed to the NF. However, ideally, the PASRR should be sent electronically via the file exchange feature in the PASRR Online System as soon as possible.
Can the screening be filled out pre-emptively if I foresee a patient will require placement to a NF?
Yes. The PASRR process can begin as soon as the hospital believes the individual will be discharging to a NF. In fact, a hospital should start the PASRR process with a Level 1 Screening upon admission of the individual, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation (if needed) and Determination prior to discharge.
If a screening is started but a patient’s discharge is delayed, can the screening be saved past the 2 weeks?
No. The screening is closed automatically if not submitted within two weeks of the screening being initiated.
How should a PASRR be documented in ORCHID?
For ORCHID, or any other medical records system, DHCS recommends printing and/or saving the letters and screenings from the PASRR Online System in the individual’s medical records. This may also include the physician’s certification for the EHD, if applicable.
How long does it take to complete the entire PASRR process when a Level 2 Evaluation is required?
A Level 1 Screening (positive or negative) determination is available immediately after you submit the Level 1 Screening using the PASRR Online System.
Federal regulations allow seven to nine days, and the national average is seven to nine days, from the date the Level 1 Screening is submitted by the hospital to complete the Level 2 Evaluation and Determination. However, DHCS’ target for SMI Level 2 Evaluations and Determinations is three to five days.
Per federal regulations, DDS Regional Centers have seven to nine business days to complete an ID/DD or RC Level 2 Evaluation and Determination.
In both instances, the hospital can minimize the risk for delays in NF admissions by starting the PASRR process with a Level 1 Screening upon admission of the individual, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation (if needed) and Determination prior to discharge.
Does the patient have to stay in the hospital until the PASRR screening is complete? Our average length of stay in the hospital is much less than seven to nine days.
Yes. The PASRR process must be fully completed prior to an individual discharging to a NF.
The hospital can minimize the risk for delays in NF admissions by starting the PASRR process with a Level 1 Screening upon admission of the individual, or as soon as there is an indication the individual may be discharging to a NF, as this will support timely completion of a Level 2 Evaluation (if needed) and Determination prior to discharge.
Are NFs required to receive PASRR data electronically?
Yes. NFs are required to receive data electronically using the electronic File Exchange feature in the PASRR Online System. NFs can also receive printed copies of PASRR documents.
How often would I complete an electronic File Exchange?
An electronic File Exchange should occur once a case is closed, and the individual has been admitted to the NF.
Can a NF access the electronic File Exchange prior to member arriving at the NF?
Yes, if the PASRR is complete. However, the NF should not accept the electronic File Exchange until the individual has physically arrived at the NF.
Can you please clarify question 16 on the Level 1 Screening?
Question 16 on the Level 1 Screening is asking to select which data source was provided to justify the responses for Questions 13 through 15.
Can User(s) submit the electronic File Exchange?
Prior to May 1, 2023, only Approvers could submit the electronic File Exchange. However, as of May 1, 2023, DHCS’ modifications to the PASRR Online System will allow Users to also submit the electronic File Exchange.
Do I have to complete an electronic File Exchange for the Level 1 Screening?
It isn’t required, but it is recommended that an electronic File Exchange be used for all PASRR documents.
Do I need to confirm the accepting NF before submitting the electronic File Exchange?
Yes. Confirmation is required before submitting the PASRR documentation. Once you have confirmation from a NF, you can send them the completed PASRR documents using the electronic File Exchange.
Do I need to print PASRR letters and physically give them to the patient or resident?
Yes. Please print all the letters and provide them to the member and/or their conservator.
Do I need to wait for an accepting NF before completing the PASRR?
No. The PASRR can be completed at admission or as soon as there is an indication the individual may be discharging to a NF.
Does the Level 1 Screening letter need to be printed for the NF?
The Level 1 Screening can be printed, or it can be sent using the electronic File Exchange in the PASRR Online System to the NF.
Do positive Level 1 Screenings go directly to DHCS’ contractor and DDS? Also, how does the NF know that it was done?
Yes. Positive screenings are automatically sent to the state approved contractor via the PASRR Online System. The admitting NF will know that the PASRR process is complete after the hospital initiates the electronic File Exchange feature in the PASRR Online System or notifies the accepting NF that the PASRR process is complete.
Is there an age limit for PASRR?
There is no age limit for PASRR.
How should PASRR letters be shared with the NF?
PASRR letters should be shared using the electronic File Exchange within the PASRR Online system. For any reason, if the NF is unable to accept the electronic File Exchange, then PASRR letters can be printed and sent to the NF with the individual or emailed to the NF.
I made a mistake on the Level 1 Screening. How do I fix this?
Data on the Level 1 Screening cannot be edited once the screening has been submitted. Please contact the DHCS IT Service Desk for assistance via email or by phone as follows:
The DHCS IT Service Desk hours are Monday to Friday 7:30 am to 5:30 pm. It is closed on weekends and state holidays. If calling, please leave a detailed message that includes your name, email address, your facility name, phone number, the PASRR CID number, if applicable, and other details on the nature of your call.
If the individual does not have a mental illness or intellectual disability, do I still need to complete the PASRR process?
Yes. All individuals require a Level 1 Screening if they are discharging from a hospital to a NF, or if an individual from the community is being admitted directly to a NF. Current NF residents that experience a significant change in physical or mental condition also require a new Level 1 Screening to determine if a RR should be completed.
If the individual does not trigger positive for SMI, ID/DD or RC on admission, but does in the MDS, should the NF submit another PASRR?
Yes. The NF should submit a new Level 1 Screening to determine if a RR should be completed.
If the Level 1 Screening is negative, can an individual be transferred to a NF?
Yes. A negative Level 1 Screening completes the PASRR process. The Approver at the hospital should transfer the PASRR file electronically to the NF using the PASRR Online System File Exchange.
If the Level 1 Screening triggers a Categorical Review, do I need to wait for the review and Categorical Letter prior to discharging the patient to a NF?
Yes. The PASRR process must be fully completed prior to an individual discharging to a NF.
If a patient is discharging to a non-Medicaid certified nursing facility (private pay only), is the hospital still required to submit a PASRR? Will the non-Medicaid certified nursing facility be required to submit a PASRR?
No. A PASRR is not required if an individual is discharging to a non-Medicaid certified nursing facility, and a non-Medicaid certified nursing facility is not required to complete a PASRR.
Is there a list of the Level 1 Screening questions on the PASRR website?
There are reference materials specific to the Level 1 Screening process on the PASRR website at:
PASRR hospitals discharging to a SNF. Please see the options available under "Training Materials."
If there is no confirmed SMI, but the hospital uses psychotropic medication for agitation, do I still mark “yes” for use of a psychotropic medication?
No. Please only mark “yes” if psychotropic medication is prescribed for mental illness. However, if the agitation is linked to a suspicion of a SMI condition, then the “yes” response is appropriate.
In my Level 1 Screening, the phone number and hospital name are not correct. How do I get it changed?
Please contact the DHCS IT Service Desk for assistance via email or by phone as follows:
The DHCS IT Service Desk hours are Monday to Friday 7:30 am to 5:30 pm. It is closed on weekends and state holidays. If calling, please leave a detailed message that includes your name, email address, your facility name, phone number, the PASRR CID number, if applicable, and other details related to the nature of your call.
Who determines if there is a significant change in condition, doctors only?
Clinical staff at the NF determine if there is a significant change in the resident’s physical or mental condition. If a significant change in condition is confirmed, the NF must initiate the RR process by completing a new Level 1 Screening, and if needed, arrange for a Level 2 Evaluation to be performed by the state approved contractor to help ensure the individual receives services in the most integrated setting.
What if I am sending referrals to more than one NF? Do I need to complete a PASRR for each facility?
No. The PASRR process is completed for the individual, therefore, please use the same PASRR for each NF.
Resolutions on my Level 1 Case List
What do the different resolutions mean on my Level 1 Screening Case List?
A resolution indicates the current status of the Level 1 Screening. The different types of resolutions include:
LI- In Progress: The Level 1 Screening is currently being worked on by you or someone else at your facility. It has not been submitted yet. The case is still open. Please submit the case as soon as possible.
LI - Submitted: The Level 1 Screening was completed and submitted. It is being processed by DHCS. Once processes, please print, distribute, and file the Level 1 Screening and designated letter under the Action column.
LII - Not Required: The Level 1 Screening has been closed and a SMI Level 2 Evaluation is not required. Please print, distribute, and file the Level 1 Screening and the Notice of No Need letter under the Action column.
Determination Available: The case is closed, and the final PASRR Determination letter is available online for printing and distribution under the Action column.
LII - Attempt: A Level 2 Evaluation could not be scheduled due to reasons beyond the DHCS contractor's control (e.g., the individual was discharged or deceased). The PASRR process is complete. Please print, distribute, and file the Level 1 Screening and the Attempt letter under the Action column. If the individual is now available for a Level 2 Evaluation, then submit another Level 1 Screening.
LI - Categorical Review: The case is with DHCS for further review. If the individual cannot benefit from specialized mental health services, a Categorical letter will be available after the review has been completed. Please do not resubmit a new PASRR.
LII - Categorical Review: The case is with DHCS for further review. A Categorical reason applies to the individual, but the facility did not select the Categorical reason on the Level 1 Screening. If the individual cannot benefit from specialized mental health services, a Categorical letter will be available under the Action column after the review has been completed.
LII – Categorical: The LII Categorical letter is now available under the Action column after the review has concluded. The individual cannot benefit from specialized mental health services and does not need a Level 2 SMI evaluation.
LII - Unavailable: The DHCS Contractor traveled to the facility to perform the Level 2 Evaluation, but the individual was not available to participate (e.g., discharged or deceased). The PASRR process is complete. Please print, distribute, and file the Level 1 screenings and the Attempt letter under the Action column. If the individual is now available for a Level 2 Evaluation, and the individual continues to require specialized mental health services, then submit another Level 1 Screening.
