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PASRR LEVEL I APPLICATION 2026

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  1. Click ‘Get Form’ to open the PASRR LEVEL I APPLICATION in the editor.
  2. Begin by entering the applicant's name and sex. Ensure that all personal information, including date of birth and social security number, is accurately filled out.
  3. In the section regarding the physician’s recommendation, confirm that a DMA-6 form has been certified by the physician. If not, do not proceed with the application.
  4. Indicate the current location of the applicant by selecting from options such as 'Home', 'Acute hospital', or 'Residential Nursing Facility'.
  5. Check all applicable boxes under 'Nursing Facility Services' to indicate any diagnoses or conditions relevant to the applicant's mental health status.
  6. Complete any additional comments or notes in the provided space to clarify specific circumstances related to the applicant’s condition.
  7. Finally, ensure that both the physician's signature and date are included before submitting your application for processing.

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Skilled nursing facilities typically offer three levels of care - Level 1: Basic Care, Level 2: Skilled Care, and Level 3: Specialized Care. The appropriate level of care is determined based on the individuals care needs, medical conditions, and the level of assistance required for activities of daily living (ADLs).
Access the PASRR Online System. Select the Log In button. Enter your email and password. A code will be sent to your cellphone. Enter the code and select Verify. Once logged on, select the PASRR icon. Please follow the instructions in the MS Azure Registration Manual for more information.
A: The Aging Well network will complete the PASRR Level II evaluation if the individual is in the community or hospital or if the individual was already admitted to the NF and needs to have Medical Assistance turned on.
A preadmission review (PAR) is a review required by some health insurance plans prior to an insured being admitted to a hospital for a nonemergency procedure.
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).

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In the case of an RR, the NF initiates the process by submitting a Level I Screening as an RR in the PASRR system. A Level 1 Screening is used to identify if an individual has, or is suspected of having, a PASRR condition, i.e., SMI, ID/DD, or RC.
The PASRR Level I Screening is a preliminary assessment completed for all individuals prior to admission to a Medicaid-certified Nursing Facility in order to determine whether an individual might have a mental illness or intellectual disability.

pasrr level 1 form pdf

104 CMR, 29.04 - Application for DMH Services

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PASRR Forms and Instructions

PASRR Level I Screening Form (PDF) This form is completed for every person seeking admission to a Texas Medicaid nursing facility, regardless of their

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