DLN Individual PASRR Level 1 Screening Section A Submitter Information (NF/LA only) A0100 2025

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  1. Click ‘Get Form’ to open the DLN Individual PASRR Level 1 Screening Section A Submitter Information form in the editor.
  2. Begin by filling out your submitter information in Section A. Enter your name, title, and contract number in fields A0100, A0800, and A0400 respectively.
  3. Provide your contact details including street address (A0200A), city (A0200B), state (A0200C), and ZIP code (A0200D). Ensure accuracy for effective communication.
  4. Complete the referring entity information by entering the name, address, and phone number of the screener in fields A1000A to A1000F.
  5. Review all entries for completeness and accuracy before submitting. Utilize our platform’s features to save your progress or share it with colleagues for review.

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After your surgery is scheduled, the next step is to complete an interview with Pre-admission Testing (PAT). PAT helps to ensure that you are in your best possible condition before surgery or a procedure. This can mean that you may need further evaluation or testing.
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.
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.
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).
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 brief, the PASRR process requires that all applicants to Medicaid-certified nursing facilities be given a preliminary assessment to determine whether they might have SMI or ID. This is called a Level I screen. Those individuals who test positive at Level I are then evaluated in depth, called Level II PASRR.

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