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.
- PASRR Level I Screening (PL1) form — This form is completed for every person seeking admission to a Texas Medicaid nursing facility, regardless of their funding source.
- Detailed Item by Item Guide for completing the PL1 Screening Form and IDT Form (Local IDD Authorities [LIDDAs] and Nursing Facilities) [PDF] — This document contains complete step-by-step instructions for local authorities and nursing facilities on when and how to submit the PL1 AND IDT.
- Detailed Item by Item Guide for completing the PL1 Screening Form (Referring Entities) [PDF] — This document provides complete step-by-step instructions for referring entities on when and how to submit the PL1.
- PASRR Evaluation form (PE) — This form is completed to confirm the suspicion that an individual has a mental illness, an intellectual disability or a developmental disability (also known as related conditions)
- Detailed Item by Item Guide for Completing the PASRR Evaluation (PDF) —This document provides step-by-step instructions on when and how to submit the PE.
- Expedited Admission Categories — This table is a list of the 7 categories of admission that do not require the PE to be completed before admission. If an individual is admitted under 1 of the 7 listed categories, the PE is conducted by the LIDDA after admission.
- PASRR Specialized Services (PSS) Form — This form is to be printed and completed at the service planning team (SPT) meetings to document the specialized services agreed upon. The information captured on this form must then be entered into the LTC Online Portal by the LIDDA within 5 business days.
- Detailed Item by Item Guide for Completing the PSS Form (PDF) —This document provides complete step-by-step instructions for completing the PSS Form.
- Detailed Item by Item Guide for Completing the Authorization Request for PASRR NFSS Form (PDF) – This document contains complete step-by-step instructions for completing the Authorization Request for PASRR Nursing Facility Specialized Services (NFSS) form in the TMHP Long-term Care Online Portal.
PASRR Admission Flow Charts
Note: The flow chart details the process and requirements for each PASRR admission type.