Preadmission and Level of Care Screenings FAQs

The preadmission review process applies to most individuals seeking access to Medicaid-funded, long-term care. The purpose is to ensure that individuals receive the care they need in the most appropriate, least restrictive setting. A preadmission review includes two major components: preadmission screening (PAS) and level of care (LOC). One or both parts can be required.

PAS – Is the process for screening individuals for indications of serious mental illness and/or developmental disabilities. It is required for all admissions to Medicaid-certified Nursing Facilities (NFs), regardless of the payment source. This is a federal mandate. All PAS requirements must be met before a level of care determination can be made for an individual seeking Medicaid as their primary payment source.

LOC – Is a designation of an individual’s functional and nursing needs pursuant to the requirements and criteria in the Ohio Administrative Code (OAC) rules.

  • Level of care determination is required for individuals seeking Medicaid payment in a Medicaid-certified NF; Medicaid waiver program; individuals enrolled in the Residential State Supplement (RSS); or Program of All-Inclusive Care for the Elderly (PACE) program.
  • An intermediate or skilled level of care is required for Medicaid vendor payment in an NF. It is also one of the eligibility requirements for PASSPORT home care, Assisted Living Waiver, and PACE enrollment.
  • A protective or intermediate level of care is required for RSS.
  • A level of care that does not allow an individual to access the type of facility or care they are seeking is considered to be adverse and they have the right to appeal the determination.


Ohio Department of Medicaid Preadmission Forms
ODM 07000 Hospital Exemption From Preadmission Screening Notification
ODM 03622 Preadmission Screening and Resident Review Identification Screen
ODM 03697 Level of Care Assessment
ODM 09401 Facility Communication

Ohio Administrative Code Preadmission Screening Rules
Resident Review: 
Level of Care Rules 


Q: When is PAS required?

A: A PAS/ID is required for all new admissions to Medicaid-certified nursing facilities from hospitals or community settings. A new PAS is not needed for individuals being readmitted following a hospital stay or transferring between NFs, with or without an intervening hospital stay. An individual who is discharged from a NF during a hospital stay is not considered a new admission if they return to that NF or are admitted to another NF directly from the hospital. All PAS/ID must be completed in the Healthcare Electronic Notification System (HENS).

Q: How long is a PAS/ID valid?

A: The PAS/ID is valid if the individual remains in a nursing facility or hospital. If the individual returns to the community, (except for a LOA with a balance of leave days), the PAS becomes invalid.

Q: Does a NF resident ever need a new PAS/ID?

A: PAS/ID is for a new admission, so a NF resident would not need a new PAS/ID but may need a Resident Review (RR/ID).

Q: When does a NF resident need an RR/ID?

A: There are several situations when a NF resident would require an RR/ID, including:

  • Expired convalescent stay – resident is not discharged by day 29 of the convalescent stay
  • Significant change in condition – resident who did not previously have indications of serious mental illness (SMI) and/or developmental disability (DD) or only had indications of one, now has indications of one or both
  • Significant change in condition – resident previously identified as having SMI and/or DD has a change that may impact treatment or placement options
  • Expired timeline for respite stay – resident approved by OH Dept of Mental Health and Addiction Services (ODMHAS) and/or OH Dept of DD (ODODD) for a 14-day respite admission stays beyond day 14
  • Expired timeline for emergency admission – resident approved by ODMHAS and/or ODODD for a 7-day emergency admission stays beyond day 7
  • Psychiatric admission - when a NF resident admits to a psychiatric unit/hospital must be completed within 24 hours of readmission to the same NF or admission to a new NF
  • Extension request for a specified period approval

Q: Who does the RR/ID?

A: The NF completes the RR/ID and it is determined whether or not the resident has indications of SMI and/or DD. If the resident does not have indications, the screen goes in the medical record with the other PASRR paperwork. If the resident does have indications, the screen, along with any supporting documentation, is sent to Ascend (fax 1-877-431-9568, phone 1-833-917-2777 or 1-877-431-1388) and/or ODODD (fax 614-995-4877, phone 614-728-9509) via HENS.

Q: What is a hospital exemption/ODM 07000?

A: A hospital exemption, previously known as a convalescent stay, is a new admission to a NF from a hospital of an individual who entered the hospital from the community and is not anticipated to require long term placement in the NF. The criteria are: 1) it is a direct admission to the NF following an in-patient hospital stay, not an admission from the emergency room or observation bed; 2) the individual requires a NF level of services for the condition that was treated in the hospital; 3) the individual’s physician has certified that the stay is anticipated to be for less than 30 days and has signed and dated the 7000 form no later than the date of discharge; 4) not in a psychiatric unit; and 5) has not had an adverse determination within the past 60 days. If all of these criteria are not met, the individual does not have a valid convalescent stay and needs to undergo PAS. All ODM 07000 must be completed electronically in the HENS system.

Q: When is a Level of Care (LOC) needed?

A: A LOC is needed in the following situations: 1) Medicaid is the primary payer for a new admission to a NF, 2) an individual is changing vendor payment from another payer source to Medicaid, 3) an individual transfers to a new NF and Medicaid will be the payer for the new NF, or 4) an individual who had a LOC returns from a hospital stay and does not have a balance of leave days. Any individual enrolled in a MyCare Ohio plan or who is on hospice does not require a LOC.

Q: How can I submit a request?

A: All 07000, PAS/ID and RR/ID must be completed in HENS, administered by OH Dept of Aging (ODA). LOC requests can be faxed to WRAAA Preadmission Review dept 24 hours a day, seven days a week via fax number 216-621-5994. LOC requests can also be submitted to WRAAA via email to:   

Q: When will my request be processed?

A: Staff is available to process requests Monday through Friday from 8 a.m. to 5 p.m. Requests from hospitals, emergency requests, and NF requests for new admissions will be processed within one business day. NF LOC requests for payer change and transfer to a different NF will be processed within five calendar days.

Q: Where are the review results sent when the request is completed?

A: The request is returned to the submitter via fax or encrypted email. Please be sure that an accurate fax number or email address is included with your request.

Q: Where should PASRR paperwork be stored?

A: All PASRR paperwork should be maintained in the resident’s current medical record at the NF. If a resident transfers to another NF, the paperwork should be forwarded to the new NF as part of the legal record.

Q: What if I need a LOC when the agency is closed?

A: As of 6/30/23, the State of Ohio is no longer providing extended weekend coverage for Levels of Care (LOC). Please keep in mind that per OAC rules a LOC is not needed prior to admission into a Nursing Facility (NF). A request can be submitted by the NF for a LOC back to the date of admission. As always, NFs should be ensuring that the person they are accepting is appropriate for NF admission and has met the PASRR requirements as LOC cannot predate PASRR. LOC requests can still be emailed or faxed to the WRAAA PAR department on the weekends or a holiday. Any LOC requests received on the weekends/holidays will be processed in accordance with OAC timeframes per OAC 5160-3-14.