PASRR - V. Level 1 Screens

Level I Screens

  1. Who Must Be Screened
    1. Persons Seeking Admission to an NF in Maine. ALL individuals who apply for admission to an NF in Maine and who meet the standards for medical need must be screened prior to admission. Screening is required regardless of the source of payment. It is required whether or not mental illness, intellectual disability or other related condition is known or suspected.
    2. Individuals who reside outside Maine and are being admitted to an NF in Maine. All individuals must be screened (Level I). Level I Screens for people who are residing in NFs in another state must be completed by the out-of-state NF. It is the individual's state of residency, which is paying for the person's care at the time of admission, that is responsible for reviewing and processing the PASRR Level I Screen.
  2. Exceptions. Individuals who meet the following conditions are exempt from Level I pre-admission screening:
    1. Individuals who are being readmitted to the same NF. There is no time limit from the time of discharge from the NF to the re-admission. This exception applies to individuals who were discharged to a hospital, for treatment of a medical issue, from the same NF or SNF as the re-admission. The NF is responsible for maintaining a copy of the original Level I Screen. However, an individual with a confirmed or suspected diagnosis, or significant change in mental status or functional limitations, who has been re-admitted from a hospital, may require a Change in Condition review.
    2. Individuals who are transferring from one NF to another, without an intervening hospitalization, within Maine. The transferring NF is required to ensure that the Level I screen and Level II assessment, if applicable, have been completed in the past and that copies of each are provided to the receiving NF. People with a confirmed diagnosis may require a Change in Condition review.
    3. Individuals who had been at an NF, were discharged to a hospital, and are being admitted to a different NF, within Maine. The admitting NF is required to ensure that the Level I screen had been completed previously and may make a referral for a Change in Condition review, if the individual has a confirmed diagnosis or significant change in mental status or functional limitations.
    4. Individuals who are otherwise required to be screened are exempt if they have been admitted to an NF. As hospital 'swing beds' are not nursing home beds in which a person could become a permanent resident, SNF 'swing bed' admissions are exempt from a Level I screening. However, if the person is being discharged from a hospital 'swing bed' to an outside, community NF for either SNF or NF level of care, a Level I Screen is required, since there is now the possibility of the person becoming a permanent resident at the community NF.
    5. Federal Regulations allow for an exemption for individuals being discharged from a hospital, for treatment of the same condition as the hospitalization, and when a discharging hospital physician has documented that the NF stay will be 30 calendar days or less, however, DHHS Maine requires the completion of a Level I Screen on all people being admitted to an NF, even if the expected length of stay is 30 calendar days or less, as a way of following these individuals in case they remain at the facility for permanent placement (at which time a Level II Assessment may be required). If the length of stay exceeds 30 calendar days, the NF must contact Goold Health System to request either an extension or a Level II Assessment.
  3. Process. The following process is used to complete the Level I Screen*.
    1. Persons authorized to screen. The Level I Screen may be completed by hospital discharge planners, licensed social workers, registered professional nurses, psychologists, physicians and professional NF staff.
    2. Submission. The Level I Screen is to be completed and if indicated, submitted to Goold Health System, at the time the request for medical eligibility screening is submitted to Goold Health Systems.
    3. Responsibility. Completion and retention of Level I Screens is the responsibility of the NF to which the individual is seeking admission. Hospital staff may complete the Level I Screen and forward it to the admitting NF (after submission to Goold Health System, if applicable). Discharging NFs must provide admitting NFs with a copy of the Level I screen and any determination letter if applicable, prior to admission.
    4. Determinations. The Level I screening process makes only two determinations:
      1. there is no known or suspected mental illness, intellectual disability or other related condition, or
      2. there is a known or suspected mental illness, intellectual  disability or other related condition.
    5. Referral to Goold Health System. The discharging hospital or NF to which application for admission has been made, is responsible for forwarding Level I Screens that indicate a known or suspected mental illness, intellectual disability, or other related condition, to Goold Health System for review. Level I Screens that indicate a known or suspected mental illness, intellectual disability or other related condition should be FAXED to Goold Health System, attention: PASRR Coordinator.
    6. Written Notice of Level I finding. If the Level I Screen identifies the individual as having, or is suspected of having, a severe mental illness, an intellectual disability, or an other related condition, then Goold Health System will provide written notice, to the individual or resident and/or his/her legal representative, that the individual is suspected of having a mental illness, an intellectual disability, or an other related condition and is being referred for a Level II Assessment (if an alternative determination has not already been made).

Form. Level 1 Screen: (Adobe PDF*)

Initial Assessment Flowchart (Microsoft Word*)