The Wisconsin Department of Health Services (DHS) will release several system enhancements for the Preadmission Screen and Resident Review (PASRR) automated process in December 2024. DHS will release system enhancements that have a reimbursement impact in January 2025.

PASRR Level I screen

All nursing facility admissions require PASRR Level I screens regardless of payer source. Nursing facilities must complete a PASRR Level I screen in the following situations:

• Preadmission
  Individuals seeking admission to a nursing facility must have a Level I screen completed before admission. Wisconsin Medicaid pays for Level I screens for all individuals newly admitted to a facility regardless of funding source.
• Resident Review
  Resident Review applies to:
  • Individuals already admitted to a nursing facility.
  • Residents who receive specialized services or specialized psychiatric rehabilitation services, which requires a new Level II screen every two years.
• Change of Condition
  Change of Condition applies when:
  • A resident has already completed a Level II screen but their mental health condition has changed.
  • A resident is newly diagnosed and has never completed a Level II screen.
• Interfacility Transfer
  A new Level I screen is required with interfacility transfer to associate the Level I screen with a new Nursing Home Level of Care (NH LOC) request. Note: Transferring nursing facilities are still responsible for ensuring all PASRR documents accompany transferring residents.

Fee-for-service nursing home reimbursement

Nursing facilities must submit a NH LOC request for a Medicaid fee-for-service member. The request must include a PASRR Level I screen. Effective January 2025, NH LOC requests will be automatically denied if nursing facilities do not submit a PASRR Level I screen within 30 days of the request. This will result in denied nursing home claims.

Short-term exemptions (STE) and staying long

Short-term exemptions (STEs) are allowed only in certain circumstances. Facilities are exempt from completing a Level II screen referral for a mental illness or intellectual and developmental disability when one or both condition(s) are suspected. STEs are only allowed in the following circumstances:

• Hospital Discharge Exemption – 30 day maximum
  An individual is entering a nursing facility from a hospital to recover from a medical problem for 30 days or less.
• Emergency Placement – 7 day maximum
  An individual is entering a nursing facility for seven days or less and appears likely to suffer irreparable physical or medical decline, injury, or death if not immediately placed.
• Respite Care – 7 days per stay maximum: 30 days per year maximum
  An individual is entering a nursing facility to provide planned respite to an in-home caregiver and expects to return home afterward.

STE reimbursement impact

If an individual will stay beyond the STE period, the nursing facility must update the individual’s existing Level I screen in the PASRR Level I Wizard. They must choose “Yes” for the question “Is the person staying longer than the permitted exemption period?” and upload the requested clinical documentation.

Effective January 2025, nursing home claims for dates after the STE period will not be reimbursed if “staying long” is not indicated in the Level I wizard before the last day of the STE period. To resume reimbursement, nursing facilities must:

1. Go to the PASRR Level I Wizard in the ForwardHealth Portal and indicate the resident is staying long.
2. Submit a new NH LOC request in the ForwardHealth Portal.

Note that nursing facilities do not need to create a new Level I to be associated with the NH LOC request as it is good for 90 days.