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Revision 22-1; Effective Nov. 28, 2022
This section provides an overview of the PE form and its purpose in the PASRR process. Refer to Appendix I, Resources for detailed information on completing a PE, and steps for submitting a PE into the LTC online portal.
2410 Purpose, PASRR Status and Staff Qualifications
Revision 25-1; Effective Nov. 12, 2025
If the PASRR level I (PL1) shows a suspicion of MI, ID or DD, the local authority completes the PASRR level II evaluation (PE) to confirm if the person is positive for MI, ID or DD. When completing the PE, use medical records, interviews with the person and LAR, school records and any available statewide historical records.
If a PL1 indicates negative suspicion for a PASRR condition, a PE may also be performed on request from HHSC or an NF. The PE is administered to identify:
- if a person has an MI, ID or DD;
- if a person’s total needs can be met in appropriate community settings;
- a person’s need for specialized services; and
- for preadmissions, if a person meets medical necessity and can be admitted to the NF.
When the PE confirms a person has an MI, ID or DD, the PASRR determination for the person is PASRR positive.
2410.1 PASRR Negative
Revision 25-1; Effective Nov. 12, 2025
When the PE does not confirm a person has an MI, ID or DD, the PASRR determination for the person is PASRR negative.
Note: If the person is PASRR negative based on the PE, the Long-Term Care (LTC) online portal generates a letter to the person and their LAR, if an LAR is documented on the PE. The local authority sends a PASRR negative letter, which includes information about the fair hearing process.
2410.2 Staff Qualifications
Revision 25-1; Effective Nov. 12, 2025
The qualifications for staff completing a PE are in 26 Texas Administrative Code (TAC) Chapter 303, Section 303.303, Qualifications and Requirements for Staff Person Conducting a PE or Resident Review.
2420 LTC Online Portal Notification
Revision 22-1; Effective Nov. 28, 2022
The LIDDA, LMHA or LBHA receives an automatic alert notification in the LTC online portal generated by a NF’s submission of a positive PL1 into the LTC online portal for an expedited admission or an exempted hospital discharge.
The LIDDA, LMHA or LBHA will not receive an automatic alert notification if the LIDDA, LMHA or LBHA submitted the positive PL1 for preadmission into the LTC online portal. The RE provides a copy of the PL1 to the LIDDA, LMHA or LBHA. This serves as the alert to the LIDDA, LMHA or LBHA to conduct the PE.
2420.1 Timing of Alert is Based on Admission Type
Revision 22-1; Effective Nov. 28, 2022
The type of admission from the PL1 determines when an alert will be sent to the LIDDA, LMHA or LBHA to conduct a PE. The timings for alerts are explained in the Long-Term Care (LTC) Preadmission Screening and Resident Review (PASRR) User Guide (PDF).
The LIDDA, LMHA or LBHA must:
- check the LTC online portal daily for PE alerts;
- have a single, identified fax line to receive PL1 forms from REs; and
- check the fax line daily to ensure all requests to conduct a PE are acted on promptly.
2420.2 Change of Ownership Extensions
Revision 25-1; Effective Nov. 12, 2025
A change of ownership (CHOW) occurs when another facility, entity or corporation purchases an NF. A new contract number is assigned when a CHOW takes place. Once the new contract number is assigned, the NF being purchased must enter a new PL1 for every resident in the NF within 90 calendar days after the new contract number’s effective date.
Depending on the NF’s census and the number of PASRR positive residents, the LIDDA, LMHA or LBHA may receive multiple alerts to complete PEs. The LIDDA, LMHA or LBHA may request an extension to the seven-day time frame to complete all the PEs for that NF. The LIDDA, LMHA or LBHA must contact the HHSC PASRR Unit at PASRR.Support@hhs.texas.gov to request an extension.
2420.3 Information Gathered by a LIDDA Following an Alert to Conduct a PE
Revision 25-1; Effective Nov. 12, 2025
A LIDDA that receives an alert in the LTC online portal to conduct a PE or resident review must determine if the person has:
- a prior PE*;
- transferred from another NF, this information is on the PL1**; and
- full Medicaid benefits through being eligible for***:
- Supplemental Security Income; or
- Medicaid benefits if institutionalized.
*Information on if the person has a prior PE is available by checking in the LTC online portal. A LIDDA can view a prior PE within the LIDDA’s local service area and PEs completed by other LIDDAs.
Note: The LIDDA staff who completes PEs must use an LTC online portal login unique to them. The staff given PE Evaluator permission can see any form types for a specific person across local service areas. This must be the only permission assigned to this login.
**If the PL1 shows that the person transferred from another NF in Texas, the receiving LIDDA will contact the transferring LIDDA and request relevant records of the person, including previous PEs, assessments and service plans be sent to the receiving LIDDA.
***Information about if a person has full Medicaid benefits is available through discussions with the NF’s business office.
2420.4 Using Information Gathered by a LIDDA Following an Alert to Conduct a PE
Revision 22-1; Effective Nov. 28, 2022
If the person has Medicaid benefits* and is 21 or older, the LIDDA must be prepared to assign a habilitation coordinator if the person has a positive PE. *Refer to Section 4910, Medicaid Eligibility Guidelines for information about eligible Medicaid types.
If one LIDDA receives a request for records from another LIDDA that received an alert to conduct a PE, then the LIDDA receiving the request must send all available requested records within two business days after the request was made.
A LIDDA that received an alert to conduct a PE must ensure the staff conducting the PE is provided all relevant records sent by other LIDDAs.
2430 Completing and Submitting the PE
Revision 25-1; Effective Nov. 12, 2025
The LIDDA is responsible for completing a PE for a person whose PL1 indicates the person is suspected of having ID or DD.
The LMHA or LBHA is responsible for completing a PE for a person whose PL1 indicates the person is suspected of having an MI.
Both the LIDDA and LMHA or LBHA are responsible for completing their respective part of a PE for people suspected of having a dual diagnosis of ID or DD and MI.
Note: While an LMHA and LBHA generally have the same responsibilities as a LIDDA for completing and submitting a PE, this handbook provides instructions and procedures for LIDDAs to implement PASRR requirements. From here forward, the handbook will not reference LMHA, LBHA or MI from here unless it is within the context of a person with dual diagnoses, which means ID or DD and MI.
The LIDDA uses the following to complete the PE:
- documentation reviews,
- interviews with:
- the person,
- family,
- others who know or have known the person, and
- NF staff.
The LIDDA has the following responsibilities when completing a PE:
- Conduct a state-wide historical record review per 2430.3, Documentation Review for PE Completion.
- Contact the RE or NF to make sure the person is still in the location submitted on the PL1 and is available and alert before traveling to the location to complete the PE.
- Travel to the NF to conduct the PE for exempted hospital discharge admissions and expedited admissions or, for preadmissions, to the location of the person in the community to conduct the PE, and carry proper identification provided by the LIDDA.
- Bring a release of confidential information to obtain the person’s or LAR’s consent to obtain more information as needed from collateral contacts.
- Meet in person* with the person within 72 hours after notification from the LTC online portal or receiving a copy of the PL1 from the RE.
- Notify HHS Complaint and Incident Intake at 800-458-9858 immediately if they are prevented from seeing a person or reviewing the person’s medical record.
- Use the medical information or documents in the person’s NF record to confirm if the person has a diagnosis for ID or DD. The LIDDA should seek assistance and clarification of documentation from available medical staff as needed and record only what is documented in the medical record. The LIDDA must document on the PE the information and documentation used to complete the evaluation.
- Submit the PE into the LTC online portal within seven calendar days after notification.
The PE can be completed on paper or electronically. The LIDDA ultimately must submit the information collected on the LTC online portal within the seven-day time frame.
*In extenuating circumstances, the LIDDA may obtain consent to conduct the PE via audio-visual communication. For more information, refer to 1210 Extenuating Circumstances.
2430.1 Interpreter Services
Revision 22-1; Effective Nov. 28, 2022
The person or LAR should be given the opportunity for interpreter services. The LIDDA must arrange or work in cooperation with the RE, NF and person or LAR for interpreter services as needed.
2430.2 Person or LAR Refuses to Participate in PE
Revision 22-1; Effective Nov. 28, 2022
If a person or LAR refuses participation in the PE, the LIDDA should request assistance from NF staff that have the greatest knowledge and rapport with the person or LAR in explaining the process . If the person or LAR continues to refuse to participate, the LIDDA completes the PE solely from chart review and documents the person’s or LAR’s refusal in a comment field located within Section F1000 of the PE.
2430.3 Documentation Review for PE Completion
Revision 25-1; Effective Nov. 12, 2025
When investigating a person’s history for a PE, the LIDDA should search all applicable service records, including those available in online databases such as the Client Assignment and Registration (CARE) system, Clinical Management for Behavioral Health Services, and, if available, LTC online portal and Service Authorization System Online for evidence of previous diagnostic testing or services received in previous settings.
Investigating these systems can provide the LIDDA with insight on where to look for records and may yield valuable information about previous placement in settings, including:
- Home and Community-based Services (HCS);
- Community Living Assistance and Support Services (CLASS);
- Deaf Blind with Multiple Disabilities (DBMD);
- Texas Home Living (TxHmL);
- STAR+PLUS Home and Community Based Services, sometimes referred to as STAR+PLUS Waiver;
- Intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID);
- state supported living center (SSLC);
- state hospital;
- Department of Family and Protective Services (DFPS) programs and residential operations;
- criminal justice facilities; and
- private psychiatric hospitals.
Documentation gathering and record review should include:
- school records;
- diagnostic records;
- medical records;
- previous PEs, service plans, and assessments; and
- all relevant records from other LIDDAs, LMHAs or LBHAs.
2430.4 Presenting Information About Community Services as Part of the PE
Revision 25-1; Effective Nov. 12, 2025
Person’s PE is Negative for ID or DD
For a person whose PE is negative for ID or DD, the staff conducting the PE must provide and explain to the person and LAR Appendix II, Long Term Services and Supports, in the LIDDA Handbook. Note: This process is instead of presenting the full community living options (CLO) required for someone who is PASRR positive.
If the person wants to pursue community living after receiving information about long-term services and supports, the PE staff must arrange for the person to be referred to the regional Aging and Disability Resource Center (ADRC). The PE staff also must arrange for the person to be referred to the family-based alternatives contractor if appropriate.
Person’s PE is Positive for ID or DD
For a person whose diagnosis of ID or DD is confirmed, the LIDDA staff conducting the PE must present CLO per 5810.3, CLO Materials Provided to Individual or LAR, and 5820, Documenting CLO. The staff must document the CLO discussion on Form 1054, Community Living Options.
CLO must be presented in a manner that allows the person and their LAR to fully understand the options available. Therefore, CLO duration may vary but should last as long as needed to completely and meaningfully present all available community options.
| If the person wants to pursue community living at the end of the CLO presentation and: | ||
|---|---|---|
| the person’s admission type is preadmission, and the person is eligible for a targeted NF HCS diversion slot as described in 3210, Criteria for Diverting from NF Admission, then … | instead of admitting to the NF … | the PE staff:
|
| the person is eligible for habilitation coordination per 4100, Eligibility for Habilitation Coordination Funded by Medicaid, and the person has selected a community program, then … | before the IDT meeting … | the PE staff makes sure the assigned habilitation coordinator:
|
| the person is eligible for habilitation coordination per 4100 but the person has not selected a community program, then … | before the IDT meeting … | the PE staff makes sure the assigned habilitation coordinator:
|
| the person is not eligible for habilitation coordination because the person is 20 or younger, then … | immediately following submission of the PE … | the PE staff will arrange for the person to be referred to the family-based alternatives contractor, EveryChild Inc. |
| the person is not eligible for habilitation coordination because the person is not a Medicaid recipient, then … | immediately following submission of the PE … | the PE staff will arrange for the person to be referred:
|
| If the person is unsure about, or doesn’t want to pursue, community living at the end of the CLO presentation and: | ||
|---|---|---|
| the person is eligible for habilitation coordination per 4100, then … | before the IDT meeting … | the PE staff makes sure the assigned habilitation coordinator receives a copy of the completed CLO. |
| the person is not eligible for habilitation coordination because the person is 20 or younger, then … | immediately following completion of the CLO … | the PE staff informs the person and LAR that they may contact EveryChild Inc. if they want to pursue community living in the future. |
| the person is not eligible for habilitation coordination because the person is not a Medicaid recipient, then … | immediately following completion of the CLO … | the PE staff informs the person and LAR that they may contact the following entities if they want to pursue community living in the future:
|
2430.5 PE for Resident Review
Revision 25-1; Effective Nov. 12, 2025
When a resident with ID or DD who has been living in an NF experiences a significant change in condition, the NF submits an updated Minimum Data Set (MDS) assessment referred to as a Significant Change in Status Assessment (SCSA) into the LTC online portal. When an SCSA is submitted, the LTC online portal issues an alert to the LIDDA to conduct a resident review within seven calendar days after receiving the alert.
Before conducting the resident review, the LIDDA must contact the NF to determine if the change affects the resident’s PASRR eligibility or specialized services. A significant change in condition may require new, different or fewer specialized services than the resident had been receiving. If the change does not meet the definition of a significant change in condition, the LIDDA is not required to conduct a resident review. The LIDDA must determine if a resident review is required based on the information provided by the NF.
If the LIDDA determines the change is not significant and does not conduct a resident review, the LIDDA must document the justification for its decision by adding a note to the history section of the current PE and in a progress note in the person’s record.
The LIDDA uses the same form used to conduct a PE and submit the resident review the same way as the PE on the LTC online portal. The resident review is conducted to:
- assess the resident's need for continued care in an NF;
- assess the resident's need for specialized services as the need may have changed because of the significant change in condition; and
- identify alternate placement options.
The NF must convene the IDT meeting within 14 calendar days after the LTC online portal generates an automated notification to the LIDDA to conduct a resident review. The LIDDA should coordinate with the NF to schedule the initial IDT and SPT meeting and must document attempts to facilitate timely meetings if the NF convenes the initial IDT meeting after more than 14 calendar days.
2430.6 When a DID is Required to Adequately Complete the PE
Revision 25-1; Effective Nov. 12, 2025
If, during a PE, a LIDDA suspects a person of having ID or DD but is unable to confirm the diagnosis because of lack of records or access to family history, the LIDDA must ensure compliance with the following procedure.
The LIDDA must make sure staff conducting the PE:
- completes a referral in section F1000 of the PE:
- in F1000A, by marking 18 for Other;
- in F1000B, by entering a statement that the person or resident is being referred for a determination of intellectual disability (DID);
- in F1000C, by entering the phone number of the LIDDA staff completing the PE or resident review;
- in F1000D, by entering the date of referral for the DID; and
- by marking the PE or resident review negative to indicate the person’s or resident’s diagnosis cannot be confirmed, for example, in Section B, fields B0100 and B0200, enter No; and
- does not send the person or LAR a notice of denial of eligibility for specialized services and an opportunity for a fair hearing.
The LIDDA must, within 45 calendar days after the date of referral entered in Section F, field F1000D, make sure a DID is conducted for the person per rules governing diagnostic assessment, refer to 26 TAC Chapter 304.
The LIDDA must submit a copy of the written DID report to the PASRR unit by the Secure File Transfer Protocol file folder named PASRR Reporting within 30 calendar days after the DID is conducted.
If the DID report indicates the person does not have ID or DD, the LIDDA must:
- enter a note on the previously completed negative PE by clicking on the add note button on the yellow Form Action bar of the PE and state that the person does not have ID or DD per the result of the DID; and
- send the person or LAR a:
- denial of specialized services because the person does not have a diagnosis of ID or DD per CFR Section 483.102(b)(1); and
- an opportunity for a fair hearing.
If the DID report indicates the person has ID or DD, then within seven calendar days after the DID report is completed, the LIDDA must complete a new PE for the person and mark it positive to indicate the person has ID or DD.
2430.7 PE Submission
Revision 25-1; Effective Nov. 12, 2025
The LIDDA must:
- enter the data recorded from the PE into the LTC online portal within seven days of notification.
- retain a copy of the PE in the person’s record.
2430.8 Specialized Services Recommendation Mapping
Revision 25-1; Effective Nov. 12, 2025
When the LIDDA staff enters the PE in the LTC online portal and checks boxes to indicate areas of support the person may need in Section B, Specialized Services Determination/Recommendations, of the PE, the LTC online portal automatically populates the associated specialized services in B0500 Recommended Services Provided/Coordinated by the Local Authority and B0600 Recommended Services Provided/Coordinated by the Nursing Facility.
These auto-populated specialized services help make sure the LIDDA includes all specialized services recommended for the person and are displayed in the Recommended Specialized Services section. For a complete list of the specialized services mapping, refer to the Long-Term Care (LTC) Preadmission Screening and Resident Review (PASRR) User Guide (PDF).
The entity that completes the PE must complete Form 1014, Pre-Admission Screening and Resident Review (PASRR) Evaluation Summary Report. Only one form should be completed per person. For a person whose PE is positive for ID or DD, a LIDDA must complete Form 1014 following the completion of a PE. Form 1014 is used to summarize the recommended specialized services for a person who is eligible for specialized services. For a person who has a dual diagnosis, ID or DD and MI, the LIDDA should take the lead on completing Form 1014. Detailed step-by-step instructions on how to complete the form are available with the form link above.
2430.9 Fair Hearing Related to Negative PE
Revision 25-1; Effective Nov. 12, 2025
A person whose PE is negative is not eligible for PASRR specialized services, which are funded through Medicaid. A negative PE does not affect the person's eligibility for nursing facility services.
Within three business days after entering the data from the PE or resident review in the LTC online portal, a LIDDA must notify the person or their LAR about the negative PASRR determination using Form 2360, Negative PASRR Evaluation Letter. This form informs the person or their LAR of their PASRR determination and their right to request a fair hearing.
When HHSC receives a fair hearing request for a negative PE, HHSC contacts the LIDDA and requests supporting documentation. The LIDDA must submit all requested material or information related to the negative PE by the date established by HHSC. The LIDDA must also attend the fair hearing in person or by phone to defend the PE determination.
2430.10 PE Retention Period
Revision 25-1; Effective Nov. 12, 2025
HHSC currently requires a LIDDA to keep all handwritten PE documentation in the person’s record indefinitely. The electronic version of the PE is retained in the LTC online portal system.
2430.11 Preadmissions Involving Two LIDDAs
Revision 25-1; Effective Nov. 12, 2025
When a person in one LIDDA’s service area plans to move to an NF in a different LIDDA’s service area, follow this process.
The transferring LIDDA:
- receives a positive PL1 completed by the RE;
- submits the PL1 into the LTC online portal within one business day of receipt;
- completes and submits the PE per rule and policy;
- confirms that medical necessity (MN) is approved in the LTC online portal;
- notifies the admitting NF that it can proceed with the admission; and
- sends copies of the submitted PL1 and PE to the receiving LIDDA and notifies the receiving LIDDA within two business days that the person has been admitted to an NF in the receiving LIDDA’s service area.
After receiving the PL1 and PE from the transferring LIDDA, the receiving LIDDA:
- submits a new PL1 within one business day of receipt, changing only the date of assessment (A0600) and signature date (A1200B) to the current date; and
- completes and submits a new PE per rule and policy, including conducting CLO.
After the NF certifies in the LTC online portal that it can meet the needs of the person and MN has been met again, the receiving LIDDA and admitting NF will have access to view the PL1 and PE in the LTC online portal.
During this process, the LIDDAs and NFs must maintain communication about the status of the person’s move. A person or LAR may change their mind and select an alternate placement or a different NF. All parties involved should be aware of where the person is living.