PASRR Forms and Instructions

Note: The forms links are to blank PDF forms. All information recorded on paper forms must be data entered into the TMHP LTC Online portal.

Companion Guide for Completing the Authorization Request for PASRR Nursing Facility Specialized Services (PDF) — This guide is to be used in conjunction with the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Preadmission Screening and Resident Review User Guide which is available for downloading at tmhp.com to navigate the authorization request for PASRR Nursing Facility Specialized Services Form on the TMHP Long-Term Care Online Portal.

Approved Diagnostic Codes

Approved Diagnostic Codes for People with Related Conditions list (PDF) — The list is subject to change; use the link to access the most up-to-date list of approved diagnoses when completing the TMHP forms. The following diagnostic codes are found in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), 2019, and are recognized by the Health and Human Services Commission as conditions which might qualify a person as having a related condition as described in federal and state law.

PASRR Admission Flow Charts

Note: The flow chart details the process and requirements for each PASRR admission type.