Pre-Admission Review: Resources for Hospital and Nursing Facility Staff

This page provides information on PASRR and LOC processes, step-by-step processes for common scenarios, links to required forms, and updates to rules about nursing facility placement. The Pre-Admission Review Team (Pre-Ad) works with professionals from hospitals and nursing facilities to provide screening and review of required PASRR processes and Levels of Care (LOC) as stipulated in Federal Law and the Ohio Administrative Code. 


If you have any questions or require a deeper explanation of these processes, contact the Pre-Ad team at (513) 345-8622.


Contacting Council on Aging

Contact our Pre-Admission Review team: 

By E-mail: pread@help4seniors.org
By Phone: (513) 345-8622
8:00 a.m.-4:30 p.m., Monday-Friday
By Fax:

For Hospitals and Hospice: (513) 345-8666
For NFs and Other Agencies: (513) 345-8618
For NFs faxing Form 9401: (513) 725-1885

By Mail: Council on Aging of Southwestern Ohio
Attn: Pre-Admission Review
175 Tri-County Parkway
Cincinnati, Ohio 45246

What if I need to contact someone on the weekend or a holiday?

Extended coverage is offered by PASSPORT Administrative Agency 3 in Lima, Ohio. 

  • The fax number is 419-222-8262
  • You can fax your request from 4:30 p.m. on Friday until Saturday at midnight.
  • On holidays, there is a recorded message on 513-345-8622 giving the holiday hours

Information on how to complete and submit the 9401 form

As of 8/1/16, the preadmission group at COA has taken over some of the data entry for the 9401 form for nursing facility residents using Medicaid reimbursement. Here are the things you’ll need to know for completing and submitting the 9401 to COA.

For Medicaid managed care consumers, contact ODM or the consumer’s health plan directly, not COA.
Council on Aging does not process level of care (LOC) requests or 9401s for Medicaid managed care consumers. This is a directive from the Ohio Department of Medicaid. We have been told that the managed care providers are working directly with ODM, so that COA is not involved with the managed care consumers. Any questions regarding this process can be directed to the specific managed care company, i.e. Aetna, Molina, Caresource, Buckeye, etc., or to Ohio Department of Medicaid at NFStay@medicaid.ohio.gov.

COA processes LOC requests and 9401s for “traditional” fee-for-service Medicaid consumers only.
Council on Aging does process LOC requests and 9401’s for fee-for-service Medicaid, sometimes referred to as “traditional” Medicaid or “Ohio” Medicaid. The LOC request process and rules have not changed. Those requests can still be submitted to us with the same documentation. For additional information on the LOC request process, see the preadmission review information on this webpage. Please remember that the LOC request can and should be submitted to us when the Medicaid application is submitted. The LOC request should not be sent months after the Medicaid application is sent. We no longer need to see the Medicaid pending number to process the LOC request. We will check the Ohio Benefits system to make sure that the resident is active or pending Medicaid. We cannot proceed with the request until the resident appears in the Ohio Benefits system.

The 9401 has been revised. Please always use the most recent version.
The most recent version is dated September 2016. The date is shown on the lower left corner of the form. Whenever you use the form, check to make sure it is the most recent.

Fax LOC requests and 9401 form together to COA.
If you are sending a LOC request, please include a copy of the 9401 with the request and fax them together to our NF fax number at 513-345-8618. If you send the 9401 with the request, it’s not necessary to send the 9401 again to the fax number for those forms, which is 513-725-1885.

Where and when to send 9401 to COA:

  1. The 9401 will be sent to preadmission at COA for:
    • admission of an active fee-for-service Medicaid consumer (after they’ve been in the NF for 90 days)
    • o new Medicaid applicant (send with the LOC request)
    • o LOC Exemptions (hospice residents or Medicare A/Medicaid co-pay residents)
  2. The 9401 will be sent to Ohio Department of Medicaid when Section III is completed: Facility Information – Update.
  3. The 9401 will be sent to Job and Family Services when Section IV is completed: Resident Information – Update.

Please be sure to include your facility’s Medicaid Provider Number.
In order for the information to migrate from the Ohio Benefits system to the MITS system, there must be a Medicaid Provider Number included on the 9401. This is the field that the system pulls from to move the information from one system to the other. If you are unsure of that number, you can obtain it by searching on the Ohio Department of Health website. Go to Health Care Provider Real-time Information and look up your facility.

If you are submitting the 9401 to COA for a Level of Care Exemption, please be sure to mark “Yes” on the LOC Exemption box on the 9401.
That is used for residents enrolled with hospice programs or for residents who admitted with Medicare A coverage using Medicaid for co-pay days. At this time, please use the comments section to indicate if the resident is exempted for hospice or for Medicare A/Medicaid co-pay. Keep in mind that if the person is exempted from LOC, you are still required to send a LOC request to COA if the person disenrolls from the hospice program or when they transition to 100% Medicaid and Medicare is terminated. Ohio Department of Medicaid indicates that they will check during an audit to see that LOC requirements were met.

Level of Care Validation Request
It is our understanding that this box may be eliminated with the next revision as there are many questions about how and when to use this. As a result, we suggest not checking this box on the form (leave it blank).

How to submit a completed form:
Sign and date the 9401 and include contact information for the submitter.

  1. To submit to COA, please fax to 513-345-8618 if you are including the 9401 with a LOC request. If sending the 9401 not associated with a LOC request, please fax only the 9401 form to 513-725-1885.
  2. To submit to Ohio Dept of Medicaid, please email to NFStay@medicaid.ohio.gov or fax to 614-466-6742.
  3. To submit to your county Dept of Job and Family Services (Nursing Home Section), please contact your DJFS representative for his or her contact information.

[return to top]


Pre-Admission Screening (PAS/RR)

What is a Pre-Admission Screening (PAS) and who needs one?
Pre-Admission Screening (PAS) is the state-mandated screening for mental illness, mental retardation, developmental disability, and "related conditions." It is part of the Ohio Administrative Code and can be found in 5160-3-15.1 at http://codes.ohio.gov/oac. Everyone seeking admission to an Ohio Nursing Facility (NF) certified by Medicaid, regardless of payment source, is subject to PAS unless they meet the requirements for a Hospital (Convalescent) Exemption. PAS law is based on the federally mandated Social Security Act nursing home reform of 1987. The intent of PAS is to insure that individuals with mental illness, mental retardation, developmental disability, and "related conditions" are appropriate for a NF stay.


How is the effective date of the Pre-Admission Screening (PAS) determined?
A Pre-Admission Screening (PAS) effective date depends on when the request is complete and whether an individual requires a Further Review:

For an individual who does not require a Further Review: the PAS effective date is the day the submitter sends a "complete" and "accurate" PASRR screen and all needed supporting documentation to the PASSPORT Administrative Agency (such as Council on Aging). Remember that it is up to the PAA to decide if the request (a) was actually sent to the PAA, (b) is "complete" and "accurate" and, (c) if all necessary supporting documentation was received.

For an individual requiring a Further Review: the PAS effective date is the date of the "determination" by Ohio Mental Health and Addiction Services and/or Ohio Department of Developmental Disabilities. If the individual needed a Further Review through both OMHAS and DODD, the PAS is effective the date the second state authority made its determination.

When can a Pre-Admission Screening be "back dated?"
Under the revision of Pre-Admission Screening (PAS) rules beginning 12/01/2009, a PAS authorization can be back dated to the date the submitter sent a complete and accurate request to the PASSPORT Administrative Agency for individuals who do not require a Further Review for indications of "Serious Mental Illness" or mental retardation, a developmental disability, or a "related condition." Remember that Council on Aging ultimately has the right to decide (a) if the request was actually sent or not, (b) what date and time the request was sent, (c) if the request is "complete", (d) if the request is "accurate", (e) if the individual requires Further Review or not.

When does a Pre-Admission Screening expire?

  • A Pre-Admission Screening (PAS) is only good for one nursing facility admission and must be used within 180 days of determination. If an individual does not enter the NF within this timeframe, a new PAS is needed.
  • If an individual`s PAS was approved through OMHAS and/or DODD for a respite stay, the individual must enter the NF within 60 days of the determination.
  • If an individual`s PAS was approved through OMHAS and/or DODD for an emergency stay, the individual must enter the NF within 24 hours of the determination.
  • If an individual’s mental health status has changed since the PAS determination, a new PAS is needed.


Are old Pre-Admission Screenings still valid?

  • A Pre-Admission Screening (PAS) is used for one nursing facility admission, and follows the individual if they transfer to a different NF. If an individual returns to the community (other than just out on leave from a nursing facility), they need a new PAS with a Review Results letter to be re-admitted to a NF.
  • A PAS with a Review Results letter authorized prior to 12/01/09 does not have to be re-authorized just because of the rule changes.
  • An individual who had a PAS with a Review Results letter authorized on/after 12/01/09 must use that PAS within certain timeframes. Timeframes refer to expiration guidelines for pre-admission screening.
  • In general a PAS with a Review Results letter remains valid as long as an individual does not return to the community or does not have a "significant change in condition" related to "Serious Mental Illness" or mental retardation, a developmental disability, or a "related condition."
  • An individual who was admitted to a NF prior to 1993 may have something on their chart called the "MI/MR." This is the former version of the PAS determination. It is still valid as long as the individual has not returned to the community or had a "significant change in condition" since the date of the MI/MR.

Is it true that the "short PAS" is only a myth?
Yes. Some individuals incorrectly refer to the Hospital (Convalescent) Exemption from Pre-admission Screening Notification/ JFS 07000 form (7000) as the "short PAS" or the "short PAS form." Keep in mind that this form is not just a different version of the form called the Pre-admission Screening/ Resident Review (PAS/RR) Identification Screen JFS 03622 (3622) that is used to request a Pre-Admission Screening or a Resident Review. The 7000 is a temporary exemption from the Pre-Admission Screening (PAS) process; it is not a PAS determination. This exemption is not considered a short PAS. Individuals must undergo either a PAS process or Convalescent Exemption.

What should a NF do if there was no Pre-Admission screening?

  1. Make sure the individual was not a transfer from another Ohio NF.
  2. Make sure the individual did not go from another Ohio NF to the hospital before coming to the current NF placement.
  3. Make sure the individual was not admitted with a valid hospital convalescent exemption from the PAS process.
  4. Request the PAS as soon as possible. Use the HENS 2.0 to submit for a PAS or fax the following documents to Council on Aging at 513-345-8618. We will issue a PAS Review Results letter:
    • PAS/RR Identification Screen (3622); use a code #1 or #2 in section B
    • History and Physical signed by a MD or Doctor of Osteopathy, dated within the last 180 days
    • A note explaining the individual`s admission date, where the individual was admitted from (if they were admitted from a hospital where they were prior to the hospital stay) along with your name, phone number and fax number

[return to top]


Resident Review

How is a Pre-Admission Screening (PAS) different from a Resident Review (RR)?

  • Both Pre-Admission Screening (PAS) and Resident Review (RR) are screenings for "Serious Mental Illness" or mental retardation, a developmental disability, or a "related condition."
  • Both PAS and RR are initiated by filling out a Pre-admission Screening/ Resident Review (PAS/RR) Identification Screen JFS 03622 form (3622).
  • A PAS is for "new admissions" to Nursing Facilities processed by a PASSPORT Administrative Agency (such as Council on Aging) or the HENS 2.0. When the PAS has been authorized by Council on Aging, or the HENS 2.0, a Review Results letter is issued with an outcome specified on the letter. PAS should be authorized prior to the individual`s NF admission. A "new admission" is defined in the Ohio Administrative Code 5160-3-15 and generally means that the individual came from a setting other than another Ohio Medicaid certified NF either with or without an intervening hospital stay.
  • A Resident Review (RR) is for individuals currently residing in Nursing Facilities who must, by law, be reviewed or re-reviewed for "Serious Mental Illness" and/or mental retardation, developmental disability, or a "related condition." Council on Aging does not process RRs. However Council on Aging must look over the paperwork related to an RR in order to authorize a Level of Care (LOC) to make sure the NF is in compliance with the law. The need for a RR is event-based and is needed for:
    1. Expired Time Limit for Hospital Exemption (for individuals who stay longer than 29 days at a Nursing facility after being admitted as a convalescent stay) code #3 a-c
    2. Expired Time Limit for Emergency Admission (for individuals with "Serious Mental Illness" and/or mental retardation, developmental disability, or a "related condition") code #4 a-c
    3. Expired Time Limit for Respite Admission (for individuals with "Serious Mental Illness" and/or mental retardation, developmental disability, or a "related condition") code #5 a-c
    4. NF Transfer, No Previous PASRR Records (for individuals going from one Ohio Medicaid certified NF to another) code #6
    5. Significant Change in Condition (related to a "Serious Mental Illness" and/or mental retardation, developmental disability, or a "related condition") code #7 

Where can I get direction or information about processing a Resident Review?

  • If you have questions about initiating a Resident Review for an individual with mental illness, you should call the Ohio Mental Health and Addiction Services at 614-466-1063.
  • If you have questions about initiating a Resident Review for an individual with mental retardation, developmental disability, or a "related condition," you should call the Ohio Department of Developmental Disabilities at 800-617-6733.

What should be done when an individual stays longer than their emergency/respite stay approval?
Everyone needs a Pre-Admission Screening Review Results letter or a 7000 form/HENS to be admitted to a NF, even if it is an emergency situation or just a respite stay. The following instructions apply only to an individual with Serious Mental Illness and/or mental retardation/ developmental disability/ "related condition." This individual went through the further review PAS process and has a Review Results letter from Council on Aging (COA) or the HENS 2.0 and was granted a time-limited approval for a 7-day emergency admission or a 14-day respite admission.

  • If the individual needs to stay longer than the 7 or 14 day approval, another PASRR review, called a Resident Review, is needed
  • The NF needs to initiate a Resident Review no later the resident`s 7th day for an Emergency Admission or no later than the resident`s 14th day for a respite admission. If the resident is hospitalized during this time period, days out at the hospital count towards the tally of 7 or 14 days.

How do you initiate a Resident Review for "Expired Time Limit for Emergency Admission" or "Expired Time Limit for Respite Admission?"

Use the HENS 2.0 or

  • Fill out a new PAS/RR ID Identification Screen (3622), using code #4 a, b, or c or code #5 a, b, or c in section B
  • Make sure to sign and date the bottom of page 7 of the screen.
  • Do not send this form to COA for processing. COA will only need to see this information if the NF asks for a LOC authorization.
  • Fax the PASRR ID to KEPRO (844) 285-9764for mental illness or DODD (614) 995-4877 for mental retardation, developmental disability, or a "related condition." Fax to both places if the individual has both mental illness and MR, DD or a "related condition." Keep the fax transmission report or your fax cover sheet to prove the date it was faxed to KEPRO and/or DODD; you will need to show this if you ask for a LOC. Maintain the PASRR screen and any letters you receive about the individual from KEPRO/OMHAS and/or DODD.
  • If you have questions about doing a Resident Review for an individual with mental illness, you should call the Ohio Mental Health and Addiction Services at 614-466-1063.
  • If you have questions about doing a Resident Review for an individual with mental retardation, developmental disability, or a "related condition," you should call the Ohio Department of Developmental Disabilities at 800-617-6733.

If a NF resident gets a new mental illness diagnosis or a new dementia diagnosis, does this count as a "significant change in condition?" Does the Nursing Facility need to fax a new PASRR ID screen to KEPRO?
If you have questions about doing a Resident Review for an individual with mental illness, you should call the Ohio Mental Health and Addiction Services at 614-466-1063.

[return to top]


Further Review


A Further Review (sometimes called a Level II review) is part of the Pre-Admission and Resident Review processes. It is a review that is done for individuals who have indications of "Serious Mental Illness" and/or mental retardation, a developmental disability, or a "related condition." Individuals who need to be reviewed for both conditions are sometimes referred to as needing a "dual further review." The Ohio Mental Health and Addiction Services and/or the Ohio Department of Developmental Disabilities determines if an individual is appropriate to either be admitted to an Ohio Medicaid certified NF or remain in such a NF, and whether or not an individual requires Specialized Services. KEPRO manages the Further Reviews for individuals with mental illness in Ohio, through a contract with the Ohio Mental Health and Addiction Services.

[return to top]


Level of Care (LOC)

What is a LOC and who needs one?

A LOC is "a determination of an individual`s physical, mental and social/emotional status" according to legal guidelines set forth in the Ohio Administrative Code. The authorization of a LOC is necessary for a NF to receive Medicaid reimbursement for an individual`s NF stay. In our area, Council on Aging of Southwestern Ohio has the contract to authorize LOCs.
  • LOCs are needed for individuals residing in Nursing Facilities whose payer source is 100% Medicaid and who are not enrolled in hospice.
  • A LOC may or may not be needed for individuals covered by Medicaid managed care; the managed care company decides if a LOC is needed.
  • A LOC is not needed if an individual only used Medicaid as a co-payer.
  • A LOC is not needed while an individual on Medicaid is enrolled with hospice, but a new LOC is needed when an individual on Medicaid dis-enrolls from hospice.
  • A LOC is not needed for bed-hold days.

How can a Pre-Admission Screening date or a Resident Review impact a LOC date?
According to the Ohio Administrative Code, the effective date of a LOC cannot be prior to the effective date of the Pre-Admission Screening (PAS). "The LOC effective date cannot precede the date the PASRR requirements were met." This means that if an individual was required to go through PAS but failed to do so, their LOC cannot be dated prior to the date the PAS requirements were met. Also according to law, if the NF was not in compliance with the timelines or process of the Resident Review (RR) the dates of the LOC authorization can be impacted.

Medicaid managed care plans: is a LOC needed?
It is up to the Medicaid managed care company to determine if the individual needs a LOC authorization from the PAA (such as Council on Aging).

More information: Medicaid Level of Care Criteria

[return to top]


 

Hospital Exemptions: General Discussion

Effective 4/1/15 submitters must use the web based HENS 2.0 managed by the Ohio Department of Aging to complete Hospital Exemptions. Paper JFS 07000s can only be used after obtaining permission from the PASSPORT Administrative Agency. Permission is only granted for the following reasons:

  1. The HENS system is down
  2. The submitter has no internet access
  3. The submitter has technical difficulties in the HENS system
  4. The individual lacks a Social Security number
  5. The individual is an Ohio resident in an out-of-state hospital seeking a nursing facility admission in Ohio

Effective 9/29/13, individuals who are being discharged from a psychiatric hospital or from the psychiatric unit in a hospital to a nursing facility are no longer exempt from pre-admission screening. You may not use a Hospital Exemption Notification for these individuals. Please complete and submit the PAS-ID screen, form 3622.

What is a Hospital (Convalescent) Exemption from Pre-admission Screening?
A Hospital Exemption temporarily exempts an individual from having to have a Review Results letter or from being screened for mental illness/ mental retardation/ developmental disability/ "related conditions" for the first 29 days the individual is in a NF. A Resident Review must be completed no later than 29 days after admission to the NF, if the individual requires a longer stay.

Who needs a Hospital Exemption?
A Hospital Exemption is used for all individuals, regardless of payment source, who (a) were admitted to an Ohio hospital from the community, assisted living, independent living or out-of-state, and (b) are seeking admission to an Ohio Medicaid-certified NF on/after 2/01/2010, and (c) do not go through the Pre-Admission Screening (PAS) process conducted by a PASSPORT Administrative Agency (PAA) (such as Council on Aging) or the HENS 2.0 because they are not expected to remain in the NF for longer than 29 days.

Should a Hospital Exemption be considered a "short PAS?"
No. A Hospital Exemption is an exemption to the PAS process, and has no validity after 30 days. Individuals remaining in the NF longer than 29 days require additional screening. This process is called the Resident Review.

Can a Hospital Exemption be used for an individual in the emergency room or an observation bed?
No. It can only be used for an individual who is an in-patient (full admission) to a hospital. Individuals who are in the emergency room or an observation bed must have a Pre-Admission Screening (PAS) authorized by a PAA (such as Council on Aging) with a Review Results letter.

Is a Hospital Exemption needed every time an individual is (a) admitted to a hospital, or (b) readmitted to a hospital?
A Hospital Exemption is only needed for individuals who will be "new admissions" to an NF. This means that only individuals who were admitted to the hospital from the community, assisted living, independent living, a facility not certified by Medicaid or from out-of-state need a Hospital Exemption. Individuals coming to the hospital from a Medicaid-certified NF do not need a Hospital Exemption to return to the same NF or to transfer to a different NF.

Can a Hospital Exemption be used for an individual with "Serious Mental Illness" or mental retardation, a developmental disability, or a "related condition?"
A Hospital Exemption can be used for individuals with any of the above conditions. However, these conditions must be documented in section B of the 7000 form or on the second tab of a HENS. Please note that these diagnoses do not in any way delay the individual`s discharge from the hospital if they appear on the 7000 form or HENS. It is necessary to put them on whichever format is used, as the NF must have accurate information about the person`s mental illness or developmental disability diagnoses. If the person has diagnoses of serious mental illness or MR/DD, a Further Review may be needed if the individual progresses to the Resident Review process while at the NF. If a Further Review is needed, the RR is faxed to KEPRO for serious mental illness, and/or to the Ohio Department of Developmental Disabilities for MR/DD.

[return to top]


Hospital Exemption: ODJFS 7000 form

Effective 4/1/15 submitters must use the web based HENS 2.0 managed by the Ohio Department of Aging to complete Hospital Exemptions. Paper JFS 07000s can only be used after obtaining permission from the PASSPORT Administrative Agency. Permission is only granted for the following reasons:

  1. The HENS system is down
  2. The entire hospital facility has no internet access
  3. The individual lacks a Social Security number
  4. The individual is an Ohio resident in an out-of-state hospital seeking a nursing facility admission in Ohio

Effective 9/29/13, individuals who are being discharged from a psychiatric hospital or from the psychiatric unit in a hospital to a nursing facility are no longer exempt from pre-admission screening. You may not use a Hospital Exemption Notification for these individuals. Please complete and submit the PAS-ID screen, form 3622.

Where does the 7000 need to be faxed?
It is mandatory that one copy be faxed to the NF. Another copy needs to be faxed to Council on Aging at 513-345-8666.

When should the hospital fax the 7000 to the NF?
The Ohio Administrative Code does not state when the 7000 should be faxed to the NF. However, the 7000 form states, "The nursing facility accepts the admission only after receipt and review of [the 7000] for 100% accuracy and completion." The MD signature on the 7000 must also be dated on or prior to the date of admission to the NF.

When should the hospital fax the 7000 to the Council on Aging?
The Ohio Administrative Code does not state when the 7000 should be faxed to the PASSPORT Administrative Agency (such as Council on Aging). In general, the 7000 should be faxed to Council on Aging after the individual has decided on an NF. If the hospital discharge planner is requesting a LOC authorization, the 7000 should be faxed with the other paperwork related to a LOC; it is not necessary to know the NF selection.

Does the Continuity of Care form still need to document a Convalescent Stay?
Prior to 12/01/09 the most common way for a Convalescent Stay to be documented was by checking a box or writing in a note on the hospital Continuity of Care (COC) that the "new admission" was to be at the NF for less than 30 days or for a "convalescent" stay and ensuring the MD signed the COC with a live signature. This method of documentation can legally be used for all individuals who were newly admitted to a NF on or prior to 1/31/2010. The old law specified that the convalescent stay had to be documented in writing and signed by an MD or Doctor of Osteopathy no later than the date of the discharge from the hospital.

During the months of 12/2009 and 1/2010, a convalescent stay was accepted using either the 7000 form or the former method of indicating the convalescent stay (typically on the COC).

Individuals who were "new admissions" to a NF on or after 12/01/09 who have a valid 7000 do not require their convalescent exemption to be documented in any other way. This means that individuals with a valid 7000 do not need to have the "less than 30 day stay" or "convalescent stay" box checked on their hospital Continuity of Care form. Hospitals without a box to check on the Continuity of Care also do not need to write in this authorization on the Continuity of Care form.

Individuals who were "new admissions" on or after 2/01/2010 must have their convalescent stay documented using a valid 7000 form. After 11/1/11, the convalescent stay can be documented on a 7000 form or HENS; see discussion of HENS below.

Can a 7000 be used for an individual coming from an out-of-state hospital?
A 7000 can only be used for an individual coming from an out-of-state hospital if that individual normally resides in Ohio. For example if an individual who usually lives in Cincinnati goes on a trip to Michigan, has an accident and winds up in the University of Michigan Hospital, that hospital may use the 7000 for admission to an Ohio NF.

However if an individual normally resides in another state, the out-of-state hospital cannot use a 7000. For example if an individual normally resides in northern Kentucky, is at St. Elizabeth Hospital in Edgewood, Kentucky and wants to come to a Cincinnati NF, St. Elizabeth Hospital cannot use a 7000. The individual must have a Pre-Admission Screening (PAS) authorized through Council on Aging and a Review Results letter. A 7000 can be used for an individual in an Ohio hospital who normally resides out-of-state and is seeking admission to an Ohio Medicaid certified NF.

Is the 7000 related to an individual`s payment status?
No. A 7000 can be used regardless of the payment source for the individual`s NF stay. It is only an initial exemption from the PAS process. It can also be used for individuals enrolled in a Medicaid managed care.

Are 7000s used for re-hospitalizations?
An individual does not need a new 7000 for every hospital admission. A 7000 is not used for an individual admitted to the hospital from an Ohio Medicaid-certified NF returning to the same or going to another NF. A 7000 is only used for individuals coming to an Ohio hospital as a "new admission" from the community, assisted living, independent living, non-Medicaid-certified facilities, or from out-of-state.

Does anything need to be attached to the 7000 when the hospital faxes it to Council on Aging?
The only thing the hospital needs to fax to Council on Aging is the 7000 form itself. A cover sheet, cover fax, history & physical or face sheet are not needed. However, if a LOC authorization is needed, the 7000 should be included along with the other information needed to request a LOC.

How "complete" must a 7000 be?
The guidelines state that the 7000 must be completely filled out. In fact leaving out any information can render the 7000 invalid. Invalid 7000 documentation can jeopardize the NF`s Medicaid payment. We have already seen cases where failing to have a complete 7000 has impacted NF payment. The NF is ultimately responsible for making sure the 7000 was used properly and is "complete."

What makes up a valid paper Hospital Exemption?
Form ODJFS 07000 should be used. The following fields are required: Consumer`s first/last name, DOB, SSN, all questions in section B, the MD/DO`s full name, signature, date and license number. License numbers can be found online. Forms without these fields are invalid, and a PASRR must be completed prior to admission.

When will notifications be submitted by the hospital?
A Hospital Exemption is part of the required PASRR process for admission to a Medicaid-certified nursing facility, regardless of payment source. A HENS notification should be completed before admission to a facility ideally, at the time of confirmation of the transfer to the nursing facility. If an individual is admitted to a facility with no hospital exemption notification, the nursing facility must submit a PASRR 3622 immediately to the PAA (Pre-Admission Review) or use HENS 2.0 to submit for a PAS. The Ohio Administrative Code 5160-3-15.1 (B) (7) states the if the nursing facility accepts a new admission without a PAS or hospital exemption, it is in violation of its Medicaid provider agreement, regardless of payment source for the individual`s nursing facility stay. On page 2 of the Hospital Exemption notification is the statement, "The nursing facility accepts the admission only after receipt and review of this notification form for 100% accuracy and completion."

[return to top]


Hospital Exemption Notification System (HENS)

In 4/2015 HENS 2.0 was launched and currently allows Ohio hospitals and nursing facilities to obtain PAS determinations.  HENS 2.0 also allows nursing facilities to complete Resident Reviews.  User guides and computer based training for HENS 2.0 is available by pressing the “Help” button on the HENS 2.0 website.  To report any issues with the system, users may contact the Ohio Department of Aging helpdesk at ODA_ISD_HelpDesk@age.ohio.gov.

Effective 9/29/13, individuals who are being discharged from a psychiatric hospital or from the psychiatric unit in a hospital to a nursing facility are no longer exempt from pre-admission screening. You may not use a Hospital Exemption Notification for these individuals. Please complete and submit the PAS-ID screen, form 3622.

What is HENS?
HENS stands for Hospital Exemption Notification System. It is a web-based system for submitting JFS Form 7000 electronically. When a hospital completes and submits the form, known as a notification, the NF and PAA (Council on Aging) receive it in the system, and are able to print the notification for records if desired. The system became available 11/1/11.

How does one get access to HENS?
Each hospital and NF in the region is assigned a "HENS administrator" from the staff on-site. It is her or his responsibility to add or remove staff at their site to provide user rights to the HENS system; users only have access to the system that is designated to their hospital or NF. Once a person is added as a user, the HENS system sends 2 e-mails: one contains the User Name, the second contains the Password. Contact the Pre-Admission Review Department at COA at 513-345-8622 to add your Hospital or NF to the HENS system.

What are the benefits of using HENS?
HENS allows a submitted notification to be "sent" electronically to both the receiving NF and the PAA (COA) automatically. The NF can choose to print out the notification at that time or convert it into a text document that can be saved electronically. The notification is automatically downloaded into the PIMS computer system, which is used for PAS, LOC and PASSPORT in the state of Ohio. The hospital no longer needs to rely on facsimile technology, which is more time intensive and prone to error for the hospital and receiving NF. Further, the notification is available on-line.

HENS also ensures that required fields are completed by the submitter. The HENS system will not "allow" a notification to be saved into the system unless the major questions are answered and the MD/DO`s signature is certified as being on file at the hospital. Incomplete fields in specific areas invalidate a Hospital Exemption, so HENS provides a safety net for the NF that accepts the individual by providing a valid temporary exemption to the PASRR process.

HENS notifications that show indications of Serious Mental Illness or Mental Retardation/Developmental Disabilities are automatically forwarded by the system to the Ohio Dept. of Mental Health and Ohio Dept of Developmental Disabilities, respectively. This does not cause a delay to discharge plans. With paper Hospital Exemptions, the PAA faxes notifications with SMI and/or MRDD to the state entities for demographic purposes only; HENS saves the PAA`s resources by doing this automatically, if the SMI or MRDD questions are answered "yes."

Can HENS be used for out-of-state residents discharging to an Ohio NF?
Yes. An out-of-state resident being discharged from an Ohio hospital to an Ohio NF is eligible for a Hospital Exemption.

Does a HENS notification replace the 9 page PASRR form?
No. A HENS or paper form ODJFS 7000 is not the equivalent of a PASRR. It is an exemption for PASRR process for an individual who will be at the NF for less than 30 days. These are not interchangeable.

What sort of documentation needs to accompany a HENS notification?
None. Only the HENS notification is needed.

Does a HENS notification for an individual with Serious Mental Illness or Mental Retardation/Developmental Disabilities require Further Review?
No. There is no delay in discharge for individuals with SMI or MRDD checked on HENS.

The printed HENS notification has no MD or DO signature. How do I know it is valid?
A valid printed HENS notification contains the "signature on file" under the MD/DO`s name; this means that the hospital attested that documentation exists to support an exemption in hospital records.

What should I do if the receiving nursing facility is not registered in HENS?
The hospital user will receive a message that the nursing facility is not in the system. If the hospital completed the entire notification, the HENS can be printed and faxed to the nursing facility as a valid hospital notification form.* PAA (Pre-Admission Review) will receive an e-mail from HENS that a notification was created for a nursing facility that is not registered. We will contact the nursing facility to encourage registration or to assist with any technical difficulties.

If you are completing a paper ODJFS 7000, you must fax it to both the receiving nursing facility and PAA (pre-admission review).

*Please note that if you are sending a HENS notification that has been printed, a valid copy is 2 pages long, and looks exactly like the JFS 7000 form. Printed screen shots are not valid as a hospital exemption because required items are often missing from screen shots.

I`ve submitted a HENS notification and the NF got it - but the PAA cannot find it. What`s wrong?
Each PAA in Ohio can only see the HENS submissions for nursing facilities in their respective areas. Here at PAA 1 (Council on Aging) we will only see submissions to NFs in Butler, Clinton, Clermont, Hamilton and Warren Counties. If the receiving NF is outside those counties and you need to discuss it with the correct PAA, the following link will provide a listing of PAA areas and contact information: www.ohioaging.org

If the PAA is working on a LOC request from a hospital for transfer to an out-of-area nursing facility, the submitter at the hospital may be asked to fax a printed HENS notification with the request. HENS notifications are automatically downloaded into "PASSPORT Information Management System (PIMS)" but there may be a delay in this download. This explains why the notification may not be available at the time of a Hospital to NF LOC request.

Any Hospital working with Weekend Statewide Coverage to obtain a LOC under a hospital exemption should include the printed HENS in the submission, for reasons stated above.

Are HENS trainings offered regularly?
No. However, there are written user guides and video tutorials available for hospital and NF users at the HENS website: www.hens.age.ohio.gov. Log on to HENS 2.0. Click on HELP on the menu bar.  Select a user guide or computer based training. To report any issues with the HENS system, users may contact the Ohio Department of Aging at ODA_ISD_HelpDesk@age.ohio.gov.

[return to top]


Hospital Processes

Community to hospital to Nursing Facility (non-Medicaid)

This individual needs a Hospital (Convalescent) Exemption or a Pre-Admission Screening with a Review Results letter.

  1. Use the HENS 2.0 to complete a Hospital Exemption Notification OR
  2. Use the HENS 2.0 to Complete a Pre-Admission Screening OR
  3. For individuals in a behavioral unit or a behavioral hospital, fax a direct referral to KEPRO OR
  4. Fax the following information to Council on Aging to get a Pre-Admission Screening authorization Review Results letter:
    • Hospital Cover Letter
    • PAS/RR Identification Screen (3622)
    • History and Physical signed by the MD within 180 days
    • Hospital face sheet/ demographics (not required but helpful to Council on Aging)
    • Psychiatric Consultations or other appropriate consultations
  5. Wait for a Review Results letter from Council on Aging BEFORE sending the individual to the NF

Community to hospital to Nursing Facility (Medicaid)
This individual needs a LOC authorization and a 7000/HENS or a Pre-Admission Screening Review Results letter or an approval by OMHAS following a direct referral to KEPRO.

Fax the following information to Council on Aging to get a LOC authorization:

  • Hospital Cover Letter
  • PAS/RR Identification Screen (3622) or Hospital (Convalescent) Exemption form (7000) or complete a HENS or obtain an approval from OMHAS after a direct referral to KEPRO.
  • History and Physical signed by MD or DO
  • Continuity of Care/ Nursing Facility Transfer Document signed by the MD
  • Medication Reconciliation sheet
  • Hospital face sheet/ demographics (not required but helpful to Council on Aging)
  • Psychiatric Consultations (if applicable)


Details about an individual going from the community to a hospital to a Nursing Facility as a convalescent exemption

  • The MD has determined the individual`s expected stay in the NF is less than 30 days
  • The individual is NOT reviewed for mental illness, mental retardation, developmental disabilities, or related conditions
  • The individual must be a full admission to the hospital; they cannot be coming from the emergency room or an observation bed
  • The individual will be a "new admission" to the NF; they must have come to the hospital from the community, assisted living, independent living, out-of-state, or from a facility that is not certified by Ohio Medicaid
  • The individual did NOT come to the hospital directly from an Ohio Medicaid-certified NF
  • The individual must have a Hospital (Convalescent) Exemption (7000) form or HENS completed by the hospital
  • The 7000 must be completely filled out
  • The 7000 must be signed and dated by an MD or a Doctor of Osteopathy
  • The 7000 cannot be signed by a physician`s assistant, a verbal order, a rubber stamp, or an electronic signature
  • If the individual does not have a valid 7000 or HENS, then Pre-Admission Screening is required; Council on Aging needs to issue a Review Results letter for the NF or the submitter may use the HENS 2.0 to get a PAS determination.
  • If the individual does not have a valid 7000 or HENS, the NF`s payment can be jeopardized. If the 7000/HENS is not completed, a Pre-Admission Screening (PAS) must be authorized. The submitter may use the HENS 2.0 to get a PAS determination, or Council on Aging may process the request and issue a Review Results letter. The PAS effective date is the date the submitter sends Council on Aging enough information to make a PAS determination. If the individual needs a Further Review, the PAS date is the date of OMHAS`s and/or DODD`s authorization. A Medicaid LOC cannot be dated prior to the date of the Pre-Admission Screening effective date.
  • Only the discharging hospital can complete the 7000 or HENS
  • The discharging hospital faxes a copy of the 7000 to the NF and a copy to Council on Aging or completes a HENS
  • The NF is responsible for making sure the 7000 is valid or that a HENS was completed
  • The NF is responsible for maintaining the hospital exemption documentation in the resident’s record at the nursing facility according to Ohio Administrative Code 5160-3-15.1 (H) (4).
  • Council on Aging is not required to retain 7000s and cannot provide copies of 7000s if they are lost by the hospital or NF
  • If the individual was admitted to the NF prior to 2/01/10, the following documentation could be used in lieu of the 7000 form: Documentation signed and dated by a physician, no later than the date of the hospital discharge, that the resident will stay at the NF for "less than 30 days" or for a "convalescent stay." This was typically documented on the hospital Continuity of Care form by the individual`s admitting hospital staff. Often a box was available for checking on the Continuity of Care to document a convalescent stay. The Continuity of Care must have matched the admitting hospital stay, Continuity of Cares for re-hospitalizations do not apply.

Nursing Facility to hospital to different Nursing Facility (Medicaid)
This individual`s PAS/RR records follow them to the new NF (NF).

  • A new PAS Review Results letter is not needed.
  • A new Hospital (Convalescent) Exemption (7000) or HENS is not needed.
  • If the first NF does not have PAS/RR records, the second NF needs to do a Resident Review (RR) for "NF Transfer- No Previous PASRR Records" (code #6) using the PAS/RR Identification Screen (3622) or the HENS 2.0 Resident Review.
  • The hospital should ask for a new LOC if the individual will be 100% Medicaid on their day of admission at the second NF.
  • If the individual will be non-Medicaid (for example Medicare) for a while at the second NF the hospital does not request a LOC. The second NF should request a LOC when the individual returns to 100% Medicaid status.
  • The first and second NFs need to follow the law if the individual is in the middle of a Further Review situation: from 5160-3-15.2 (C)

(6) If an individual is to be transferred to another Ohio nursing facility after submission of the RR/ID request but prior to receipt of the RR/ID, RR/ DD and/or RR/SMI determinations:

(a) The sending nursing facility must notify DODD and/or OhioMHAS of the transfer. Such notice must be written and must be provided to DODD and/or OhioMHAS not later than the day the individual is transferred. The sending nursing facility must provide sufficient contact information to enable the completion of the RR process.

(b) At or prior to the time the individual is transferred, the sending nursing facility must also provide the receiving nursing facility with copies of all PASRR related documents pertaining to the individual and written notice of the individual's current status with regard to PASRR.

If known, the notice must include contact information for the RR evaluator assigned by OhioMHAS and/or DODD.

(c) The receiving nursing facility must not accept the individual as a
nursing facility transfer unless it receives this information at or prior to the time the individual is admitted to the receiving nursing facility.

(d) If the transferring individual is medicaid eligible at the time of the transfer, the sending nursing facility must also provide written notice of the transfer and the current PASRR status of the individual to ODM or its designee. Such notice must be provided no later than the date on which the individual is transferred.

(7) A nursing facility that, intentionally or otherwise, accepts any readmission or nursing facility transfer, or retains as a resident any individual in violation of this rule is in violation of its medicaid provider agreement. This is true regardless of the payment source for the individual's nursing facility stay.

Nursing Facility to hospital to different Nursing Facility (non-Medicaid)
The hospital does not need to fax anything to the PAA (such as Council on Aging).

  • The first NF needs to send a copy of the individual`s PAS/RR records to the second NF.
  • If the first NF does not have PAS/RR records to send to the second NF, the second NF needs to initiate a Resident Review for "NF Transfer, No Previous PASRR Records" (code #6) using a PAS/RR Identification Screen (3622) or the HENS 2.0 Resident Review.
  • The first and second NF need to follow the law if the individual is in the middle of a Further Review situation: from 5160-3-15.2 (C)

    (6) If an individual is to be transferred to another Ohio nursing facility after submission of the RR/ID request but prior to receipt of the RR/ID, RR/ DD and/or RR/SMI determinations:

    (a) The sending nursing facility must notify DODD and/or OhioMHAS of the transfer. Such notice must be written and must be provided to DODD and/or OhioMHAS not later than the day the individual is transferred. The sending nursing facility must provide sufficient contact information to enable the completion of the RR process.

    (b) At or prior to the time the individual is transferred, the sending nursing facility must also provide the receiving nursing facility with copies of all PASRR related documents pertaining to the individual and written notice of the individual's current status with regard to PASRR. 

    If known, the notice must include contact information for the RR evaluator assigned by OhioMHAS and/or DODD.

    (c) The receiving nursing facility must not accept the individual as a 
    nursing facility transfer unless it receives this information at or prior to the time the individual is admitted to the receiving nursing facility.

    (d) If the transferring individual is medicaid eligible at the time of the transfer, the sending nursing facility must also provide written notice of the transfer and the current PASRR status of the individual to ODM or its designee. Such notice must be provided no later than the date on which the individual is transferred.

    (7) A nursing facility that, intentionally or otherwise, accepts any readmission or nursing facility transfer, or retains as a resident any individual in violation of this rule is in violation of its medicaid provider agreement. This is true regardless of the payment source for the individual's nursing facility stay.

Process if a current Nursing Facility resident becomes hospitalized

If a NF resident goes out to the hospital and then returns to the same NF:

  • A new Pre-Admission Screening (PAS) is not needed
  • A new 7000 Hospital (Convalescent) Exemption or HENS is not needed
  • A new LOC is not needed unless the individual is covered by Medicaid and has used their bed-hold days for the year
  • If the hospital stay was a psychiatric stay, the NF needs to consider if this was a "significant change in condition" (code #7) that may need a new Resident Review PASRR screening. Call the Ohio Mental Health and Addiction Services at 614-466-1063 if you have questions about this.

If a NF resident is hospitalized and then is admitted to a different NF:

  • A new LOC is needed for the new nursing facility if the payment source is 100% Medicaid. If the individual is skilled under Medicare for awhile at the second NF, the second NF asks for a LOC once the individual is cut from Medicare.
  • A new PAS is not needed. If a PAS was done at the first NF, the first NF is required to forward it to the second NF. If the individual entered the first NF under a convalescent exemption, the first NF should forward the Resident Review PASRR screen to the second NF if it was already completed. If the first NF did not complete a PASRR, then the second NF should initiate a Resident Review PASRR for "NF transfer, No Previous PASRR Records" (code #6) using a PAS/RR Identification Screen (3622) or the HENS 2.0 Resident Review. The first and second NF need to follow the law if the individual is in the middle of a Further Review situation: from 5160-3-15.2 (C)

    (6) If an individual is to be transferred to another Ohio nursing facility after submission of the RR/ID request but prior to receipt of the RR/ID, RR/ DD and/or RR/SMI determinations:

    (a) The sending nursing facility must notify DODD and/or OhioMHAS of the transfer. Such notice must be written and must be provided to DODD and/or OhioMHAS not later than the day the individual is transferred. The sending nursing facility must provide sufficient contact information to enable the completion of the RR process.

    (b) At or prior to the time the individual is transferred, the sending nursing facility must also provide the receiving nursing facility with copies of all PASRR related documents pertaining to the individual and written notice of the individual's current status with regard to PASRR. 

    If known, the notice must include contact information for the RR evaluator assigned by OhioMHAS and/or DODD.

    (c) The receiving nursing facility must not accept the individual as a 
    nursing facility transfer unless it receives this information at or prior to the time the individual is admitted to the receiving nursing facility.

    (d) If the transferring individual is medicaid eligible at the time of the transfer, the sending nursing facility must also provide written notice of the transfer and the current PASRR status of the individual to ODM or its designee. Such notice must be provided no later than the date on which the individual is transferred.

    (7) A nursing facility that, intentionally or otherwise, accepts any readmission or nursing facility transfer, or retains as a resident any individual in violation of this rule is in violation of its medicaid provider agreement. This is true regardless of the payment source for the individual's nursing facility stay.

[return to top]


Out-of-State Processes

Out-of-state hospital to Ohio Nursing Facility 
An Ohio Pre-Admission Screening (PAS) is needed. A PAS from another state cannot be used for an admission to an Ohio Nursing Facility. Council on Aging must process the request and issue a Review Results letter.

  • Only individuals who 1) normally reside in Ohio, 2) are admitted to an out-of-state hospital, 3) want to go to an Ohio NF, and 4) have a valid 7000 form, are exempt from a PAS. For example, if an Ohio resident injures themselves on a ski vacation in Colorado and wants to be admitted to an Ohio NF, the Colorado hospital could either complete an Ohio PAS or a 7000 form.
  • Either the Ohio NF or the out-of-state hospital completes a PASRR screen
  • Fax Council on Aging the PAS/RR Identification Screen (3622), a history and physical from the hospital stay, and contact information for the hospital discharge planner
  • If the individual requires Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," the individual must have an evaluation by the other state`s PASRR evaluator. A copy of this evaluation needs to be faxed to Council on Aging. Council on Aging will forward this evaluation to KEPRO and/or DODD.
  • The NF needs to wait until they receive a Review Results letter from Council on Aging before they admit the individual.
  • If an individual is admitted from out-of-state without a Review Results letter, a NF`s Medicaid reimbursement may be jeopardized. Due to Ohio law, a Medicaid LOC cannot be authorized for a date prior to the PAS Review Results.
  • The out-of-state hospital may request a LOC if the individual`s payment source is to be Ohio Medicaid beginning on their date of admission to the Ohio NF.


Out-of-state community to Ohio Nursing Facility
This individual needs an Ohio Pre-Admission Screening (PAS) authorization processed by Council on Aging or HENS 2.0 with a Review Results letter.

  • It is not sufficient just to fill out a PASRR screen: it must be processed by Council on Aging or in HENS 2.0
  • A 7000 is not valid for this situation.
  • The Ohio NF needs to request an Ohio PAS authorization:

How to request a PAS from Council on Aging:

  1. Complete the Cover Letter for non-Medicaid and Out-of-State NF Admissions
  2. Complete the PAS/RR Identification Screen (3622)
  3. Obtain a History and Physical that includes diagnoses. These documents must be signed and dated by the physician within 180 days.
  4. If the individual needs a Further Review for Serious Mental Illness and/or mental retardation, developmental disability, or "related condition," the individual must have an evaluation by their home state`s local mental health and/or MR/DD evaluator. Council on Aging will forward this evaluation to KEPRO and/or DODD.
  5. Fax the Cover Letter, PASRR Screen, History and Physical, and local evaluation if applicable to 513-345-8618. We will process your requests within 5 days of receiving complete information.
  6. The individual may be admitted once the NF receives the Review Results letter from Council on Aging.

Out-of-state nursing facility to Ohio Nursing Facility
This individual needs an Ohio Pre-Admission Screening (PAS) authorization processed by Council on Aging or HENS 2.0 with a Review Results letter.

  • It is not sufficient just to fill out a PASRR screen: it must be processed by Council on Aging or in HENS 2.0
  • A 7000 is not valid for this situation.
  • The Ohio NF needs to request an Ohio PAS authorization

How to request a PAS from Council on Aging:

  1. Complete the Cover Letter for non-Medicaid and Out-of-State NF Admissions; include contact information about the staff at the out-of-state nursing facility
  2. Complete the PAS/RR Identification Screen (3622)
  3. Obtain a History and Physical that includes diagnoses. These documents must be signed and dated by the physician within 180 days.
  4. If the individual needs a Further Review for Serious Mental Illness and/or mental retardation, developmental disability, or "related condition," the individual must have an evaluation by their home state`s local mental health and/or MR/DD evaluator. Council on Aging will forward this evaluation to KEPRO and/or DODD.
  5. Fax the Cover Letter, PASRR Screen, History and Physical, and local evaluation if applicable to 513-345-8618. We will process your requests within 5 days of receiving complete information.
  6. The individual may be admitted once the NF receives the Review Results letter from Council on Aging.

[return to top]


Hospice Processes

Hospice-enrolled individual going to Nursing Facility (non-Medicaid)
A Pre-Admission Screening processed by Council on Aging with a Review Results letter is required prior to admission to the NF.

A Hospital (Convalescent) Exemption form 7000/HENS (in lieu of a PASRR with a Review Results letter) may be used for an individual who is hospice enrolled, transferring from an in-patient hospital stay to a NF.

The admitting nursing facility may choose to process the PAS using HENS 2.0.

How to request a PAS from Council on Aging:

  1. Complete the PAS/RR Identification Screen (3622).
  2. Obtain a History and Physical that includes diagnoses. This document must be signed and dated by a physician within 180 days.
  3. Fax your request for PAS to 513-345-8666. We must have the name and phone number of a contact individual who can answer any questions we may have. Do not admit the individual until you receive a Review Results letter stating the individual may be admitted to a NF.

Hospice-enrolled individual going to Nursing Facility (Medicaid)
An individual who is enrolled in hospice does not need a LOC while they are with hospice. A LOC is needed if they will be disenrolled from hospice upon admission to the NF and covered by traditional Medicaid.

  • A Pre-Admission Screening processed by Council on Aging or HENS 2.0 with a Review Results letter is required prior to admission to the NF, or
  • A Hospital (Convalescent) Exemption form 7000/HENS (in lieu of a PASRR with a Review Results letter) may be used for an individual who is hospice enrolled, transferring from an in-patient hospital stay to a NF.

How to request a PAS from Council on Aging:

  1. Complete the PAS/RR Identification Screen (3622).
  2. Obtain a History and Physical that includes diagnoses. This document must be signed and dated by a physician within 180 days.
  3. Fax your request for PAS to 513-345-8666. We must have the name and phone number of a contact individual who can answer any questions we may have. Do not admit the individual until you receive a Review Results letter stating the individual may be admitted to a NF

Hospice-enrolled individuals: Pre-Admission Screening and LOC needs

  • A hospice-enrolled individual needs a PASRR screening with a Review Results letter from the PAA (such as Council on Aging) or HENS 2.0 to be admitted to a NF, or
  • A hospice-enrolled individual may also be admitted as a convalescent stay if they meet the criteria and have the proper documentation.
  • A hospice-enrolled individual does not need a LOC authorization while they are enrolled with hospice.
  • An individual who has been disenrolled from hospice needs a new LOC authorization if they are 100% Medicaid

[return to top]


Nursing Facility Processes

Community to Nursing Facility (Medicaid)
This process is used for individuals who currently have traditional Medicaid or will be applying for Medicaid in hopes that it will be paying for their entire NF stay.

This individual needs a face-to-face assessment for a Pre-Admission Screening (PAS) and LOC.

  • A referral is made to Pre-Admission Review at Council on Aging, by calling the team at 513-345-8622.
  • The face-to-face assessment is scheduled.
  • The assessor conducts the face-to-face assessment by interviewing the individual, interviewing other individuals who may be involved with the individual, and having the individual or their legal representative sign paperwork.
  • Pre-Admission Review support staff faxes the 4444 and the Pre-admission Screening/ Resident Review PAS/RR Screen (3622) to NF admissions office. 
  • If the individual needs a Further Review for mental illness and/or MR/DD the support staff also faxes their information to KEPRO and/or the county Developmental Disabilities Services and/or DODD. Once a determination is made by OMHAS and/or DODD, a follow-up 4444 and the results of the Further Review are faxed to the NF.
  • Pre-Admission Review support staff faxes the LOC Assessment (3697) and MD signature form to the individual`s doctor for signature
  • Pre-Admission Review support staff follows-up with the NF to obtain the Medicaid number if necessary
  • Pre-Admission Review support staff enters the LOC authorization into CRIS-E
  • Pre-Admission Review support staff faxes an updated 4444 to the NF that shows a LOC outcome with a LOC effective date
  • At this time all paperwork is completed and NF may bill Medicaid.

Community to Nursing Facility (non-Medicaid)
The individual always needs a Pre-Admission Screening (PAS) processed by Council on Aging or HENS 2.0 with a Review Results letter. This process refers to individuals whose payer source is NOT traditional Medicaid and are going to a Medicaid-certified facility.  Follow this process for members of MyCare Aetna and MyCare Molina.

  • A 7000 form or only filling out a PASRR ID screen is not valid
  • Follow this process for an individual who is covered by Medicare, private insurance, hospice, or is paying out-of-pocket
  • This process does not include an individual who intends to apply for Medicaid and hopes that Medicaid will cover their NF from date of admission; for these individuals follow the "Medicaid" process
  • Remember to allow extra days to accommodate an individual with mental illness, and/or mental retardation, developmental disability, or a "related condition"

How to request a PAS from Council on Aging:

  1. Complete the Cover Letter for non-Medicaid and Out-of-State NF Admissions
  2. Complete the PAS/RR Identification Screen (3622)
  3. Obtain a History and Physical that includes diagnoses. These documents must be signed and dated by the physician within 180 days.
  4. Fax the Cover Letter, PASRR Screen and History and Physical to 513-345-8618. We will process your requests within 5 days if the information is complete.
  5. The individual may be admitted once the NF receives the Review Results letter from Council on Aging.

Nursing Facility to a different Nursing Facility (Medicaid)

The individual will need a new LOC if they have traditional Medicaid and are not hospice-enrolled. Either the sending NF or the receiving NF may request this LOC. The first NF needs to send a copy of the individual`s PASRR records to the second NF.

  • A LOC is requested by sending the following information to Council on Aging:
    1. Information on the Medicaid Level of Care Request Cover Sheet
    2. The MDS (Sections A, I, and G if using Version 3.0), or Level of Care Assessment (3697)
    3. PASRR/ convalescent documentation/ Further Review information if applicable
    4. Physician`s Orders for the month of the transfer
  • It is not necessary for the LOC authorization to be completed before the individual transfers as long as (a) the individual clearly meets the criteria for ILOC or SLOC, (b) the individual`s PASRR records are in order, and (c) the receiving NF agrees to admit the individual prior to the LOC being authorized.
  • The first NF needs to send a copy of the individual`s PASRR records to the second NF. If the first NF has no PASRR records, the second NF needs to initiate a Resident Review for "NF Transfer, No Previous PASRR Records" (code #6) using a PAS/RR Identification Screen (3622) or HENS 2.0.
  • Be careful to follow the law if an individual is in the middle of a Further Review situation: from 5160-3-15.2 (C)

    (6) If an individual is to be transferred to another Ohio nursing facility after submission of the RR/ID request but prior to receipt of the RR/ID, RR/ DD and/or RR/SMI determinations:

    (a) The sending nursing facility must notify DODD and/or OhioMHAS of the transfer. Such notice must be written and must be provided to DODD and/or OhioMHAS not later than the day the individual is transferred. The sending nursing facility must provide sufficient contact information to enable the completion of the RR process.

    (b) At or prior to the time the individual is transferred, the sending nursing facility must also provide the receiving nursing facility with copies of all PASRR related documents pertaining to the individual and written notice of the individual's current status with regard to PASRR. 

    If known, the notice must include contact information for the RR evaluator assigned by OhioMHAS and/or DODD.

    (c) The receiving nursing facility must not accept the individual as a 
    nursing facility transfer unless it receives this information at or prior to the time the individual is admitted to the receiving nursing facility.

    (d) If the transferring individual is medicaid eligible at the time of the transfer, the sending nursing facility must also provide written notice of the transfer and the current PASRR status of the individual to ODM or its designee. Such notice must be provided no later than the date on which the individual is transferred.

    (7) A nursing facility that, intentionally or otherwise, accepts any readmission or nursing facility transfer, or retains as a resident any individual in violation of this rule is in violation of its medicaid provider agreement. This is true regardless of the payment source for the individual's nursing facility stay.


Nursing Facility to different Nursing Facility (non-Medicaid)
The first NF needs to send a copy of the individual`s PASRR records to the second NF.

If the first NF does not have PASRR records to send to the second NF, the second NF needs to initiate a Resident Review for "NF Transfer, No Previous PASRR Records" (code #6) using a PAS/RR Identification Screen (3622) or HENS 2.0.

  • The first and second NF need to follow the law if the individual is in the middle of a Further Review situation: from  5160-3-15.2 (C)

    (6) If an individual is to be transferred to another Ohio nursing facility after submission of the RR/ID request but prior to receipt of the RR/ID, RR/ DD and/or RR/SMI determinations:

    (a) The sending nursing facility must notify DODD and/or OhioMHAS of the transfer. Such notice must be written and must be provided to DODD and/or OhioMHAS not later than the day the individual is transferred. The sending nursing facility must provide sufficient contact information to enable the completion of the RR process.

    (b) At or prior to the time the individual is transferred, the sending nursing facility must also provide the receiving nursing facility with copies of all PASRR related documents pertaining to the individual and written notice of the individual's current status with regard to PASRR. 

    If known, the notice must include contact information for the RR evaluator assigned by OhioMHAS and/or DODD.

    (c) The receiving nursing facility must not accept the individual as a 
    nursing facility transfer unless it receives this information at or prior to the time the individual is admitted to the receiving nursing facility.

    (d) If the transferring individual is medicaid eligible at the time of the transfer, the sending nursing facility must also provide written notice of the transfer and the current PASRR status of the individual to ODM or its designee. Such notice must be provided no later than the date on which the individual is transferred.

    (7) A nursing facility that, intentionally or otherwise, accepts any readmission or nursing facility transfer, or retains as a resident any individual in violation of this rule is in violation of its medicaid provider agreement. This is true regardless of the payment source for the individual's nursing facility stay.

Community to Nursing Facility as an emergency admission

  • Definition of an emergency: Pre-Admission Review has the authority to determine if an admission is an "emergency" or not. Examples include an individual who has a loss of care-giver, an Adult Protective Services worker states the individual has an emergency need for a NF admission, the individual is in a hospital emergency room, or it has been determined that the individual is not safe at home alone.
  • Timelines: Pre-Admission Review has one business day to complete the request once complete and accurate documentation has been received by our office
  • If a Further Review is needed for either non-Medicaid or Medicaid admission, please send supporting documentation about the mental illness or MR/DD diagnosis. Send your request as soon as possible; the request must be approved by Council on Aging via KEPRO/OMHAS and/or DODD for the individual to be admitted. Do not admit the individual until you receive a Review Results letter stating the individual may be admitted to a NF.
Emergency Request non-Medicaid payment (any payment other than traditional Medicaid)

Use HENS 2.0 to receive a PAS determination letter, or 

Process for requesting a PAS from Council on Aging:

      1. Complete the Cover Letter for non-Medicaid and Out-of-State NF Admissions. Clearly state the reason why the request is an emergency.
      2. Complete the PAS/RR Identification Screen (3622).
      3. Obtain a History and Physical that includes diagnoses. This document must be signed and dated by a physician within 180 days.
      4. Fax your request for PAS to 513-345-8618. We must have the name and phone number of a contact individual who can answer any questions we may have. Do not admit the individual until you receive a Review Results letter stating the individual may be admitted to a NF.

Emergency Request Medicaid payment

Process for requesting a PAS and LOC:

      1. Complete the PAS/RR Identification Screen (3622).
      2. Complete the Level of Care Assessment from (3697). The 3697 must be completely filled out (stability, Medicaid number, all diagnoses, medications, ADL/IADL information, physician information, demographics, review of systems).
      3. The physician must sign and date the first page of the 3697.
      4. Fax your request for PAS and LOC to 513-345-8618. We must have the name and phone number of a contact individual who can answer any questions we may have. Do not admit the individual until you receive a Review Results letter stating the individual may be admitted to a NF.

How a Nursing Facility requests a LOC for a current resident
See also: Level of Care

Why is a LOC needed?

  • An intermediate (ILOC) or skilled (SLOC) LOC authorization by the PAA (such as Council on Aging) is needed for an individual to receive traditional Medicaid payment for a Nursing Facility (NF) stay.
  • The LOC authorization is needed for individuals who are not enrolled in hospice and have days at the NF where traditional Medicaid is paying 100%. A LOC is not needed while Medicaid is only a co-payer or for bed-hold days.
  • A LOC authorization is needed for the Department of Job and Family Services to start Medicaid "vendor payment" to the NF

When is a LOC needed?

  • When the resident becomes financially eligible for Medicaid and needs Medicaid to start paying 100% of their NF stay
  • When Medicare "cuts" an individual from coverage, they do not have enough money to pay out-of-pocket, and they qualify for Medicaid
  • When an insurance policy no longer covers the individual`s NF stay, they do not have enough money to pay out-of-pocket, and they qualify for Medicaid
  • When a Medicaid managed care company asks the NF to get a LOC authorization
  • When an individual with Medicaid payment transfers from one Ohio NF to another Ohio NF
  • When an individual came from out-of-state, gets approved for Ohio Medicaid, and needs Ohio Medicaid to pay for their NF stay
  • When an individual on NF Medicaid goes out to the hospital and has run out of "leave days" or "bed hold days"
  • When the hospital did not obtain the LOC prior to the admission of the individual who was 100% Medicaid since their date of admission from the hospital
  • When an individual has an actual gap in their Medicaid eligibility (not just a "glitch"). This often happens when an individual sells their house.
  • When an individual under Medicaid at a NF is disenrolled from hospice. A LOC is not needed while an individual is enrolled in hospice.

When is a LOC not needed?

  • When an individual is not 100% Medicaid
  • When an individual is using Medicaid as a co payer or for bed-hold days only
  • When an individual has a Medicaid managed care and the managed care company says the individual does not need a LOC
  • While an individual on Medicaid is enrolled in hospice

Who determines a LOC?
Council on Aging of Southwestern Ohio Pre-Admission Review staff

How does the NF request a LOC?
The NF faxes the request to (513) 345-8618 or mails the request to:
Council on Aging of Southwestern Ohio
Attn: Pre-Ad
175 Tri-County Parkway
Cincinnati OH 45246

The request should include:

  1. The information found on the Medicaid Level of Care Request Cover Sheet signed by the MD
  2. The MDS with the Assessment Reference Date closest to the LOC effective date (Sections A, I, and G) (if no MDS is available, a 3697 Level of Care Assessment form may be used)
  3. Physician`s Orders for the month of the LOC effective date (do not include telephone orders)
  4. Hospital exemption documentation as well as the PAS/RR Identification Screen for those individuals who were admitted with a convalescent stay from the hospital. If the individual needed Further Review in the Resident Review process, also include proof of the date the PASRR was faxed to KEPRO and/or DODD, and the final determination from OMHAS and/or DODD.

Individual going from one Nursing Facility to another Nursing Facility but lacks PAS/RR records

Background:

    • When an individual transfers from one NF to another NF, their PAS/RR records should follow them to the new NF. This includes individuals who had a hospital stay between the two NF`s.
    • The discharging NF is responsible for sending PAS/RR records to the admitting NF
    • Only the first NF needs to have the convalescent documentation or the 7000 or the HENS

If the admitting NF cannot obtain PAS/RR records from the first NF:

    • The admitting NF can initiate a Resident Review for "NF Transfer, No Previous PASRR Records" (code #6) using a PAS/RR Identification Screen (3622) or HENS 2.0.
    • The admitting NF should initiate this Resident Review "as soon as the (new) NF finds that no PASRR records are available from the previous NF placement."


How to initiate a Resident Review for "NF Transfer, No Previous PASRR Records"

Use HENS 2.0 or

    • Fill out a new PAS/RR Identification Screen (3622), using code #6 in section B
    • If the individual does not have indications of Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," simply maintain the PASRR screen on the resident`s chart. Never discard this information. Do not send this form to Council on Aging for processing. Council on Aging will only need to see this information if the NF asks for a LOC authorization.
    • If the individual does have indications of Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," fax to KEPRO (844) 285-9764for mental illness or Ohio Department of Developmental Disabilities (614) 995-4877 for mental retardation, developmental disability or a "related condition." Fax to both places if the individual has both mental illness and MR, DD or a "related condition." Retain a fax transmission confirmation to prove the date it was faxed. Maintain the PASRR screen and any letters you receive about the individual from KEPRO/OMHAS and/or DODD.
    • If you have questions about doing a Resident Review for an individual with mental illness, you should call the Ohio Mental Health and Addiction Services at 614-466-1063.
    • If you have questions about doing a Resident Review for an individual with mental retardation, developmental disability, or a "related condition," you should call the Ohio Department of Developmental Disabilities at 800-617-6733.

[return to top]


Nursing Facility Documentation

What are the variations of the Review Results letters issued by Council on Aging? What do each of them mean?

There are actually five different versions of Review Results letters issued by Council on Aging. Let`s take a look at what each one looks like and what each one means.

1. A Pre-Admission Screening only:

    • In the LOC review outcome, there is no date in the "Effective Date" blank
    • In the PAS Review section, there is an "X" next to "No indications of…", or "Indications of serious mental illness", or "Indications of mental retardation…"
    • There is not an "X" next to "Not Applicable." Be careful! Many individuals assume that they have a PAS Review Results letter, but when the X is next to "Not Applicable", this means that the letter is NOT a PAS.
    • If the individual needed a Further Review for mental illness and/or mental retardation, developmental disability or a "related condition," documentation from Ohio Department of Mental Illness and/or Ohio Department of developmental disability should also be attached

2. A LOC only:

    • In the LOC review outcome, there is a date in the "Effective Date" blank
    • In the PAS review section, there is an "X" next to "Not Applicable." Be careful! Many individuals assume that they have a PAS Review Results letter, but when the X is next to "Not Applicable", this means that the letter is NOT a PAS.

3. A PAS and a LOC on the same letter:

    • In the LOC review outcome, there is a date in the "Effective Date" blank
    • In the PAS Review section, there is an "X" next to "No indications of…", or "Indications of serious mental illness", or "Indications of mental retardation…"
    • There should not be an "X" next to "Not Applicable." Be careful! Many individuals assume that they have a PAS Review Results letter, but when the X is next to "Not Applicable", this means that the letter is NOT a PAS.
    • If the individual required a Further Review for mental illness and/or mental retardation, developmental disability or a "related condition," documentation from Ohio Department of Mental Illness and/or Ohio Department of Developmental Disabilities should also be attached

4. A COAP 4444 with a PAS outcome only:

    • The first copy of the 4444 that Council on Aging faxes to the NF is a PAS only
    • There is nothing in the "LOC Review Outcome" section of the letter
    • If the individual needed a Further Review, their PAS Review Results happen in two phases.
      • The first phase is shown by a comment at the bottom of the letter stating that the individual may not be admitted to a NF until a determination is made by OMHAS and/or DODD.
      • The second phase is when Pre-Admission support staff faxes the NF documentation from Ohio Mental Health and Addiction Services and/or Ohio Department of Developmental Disabilities showing that the individual may/may not be admitted to a NF.
    • The individual`s Council on Aging documentation has been forwarded to the physician for signature so that the LOC can be authorized

5. A COAP 4444 updated with a LOC added to the PAS

    • After the individual`s physician has signed the documentation from Council on Aging, the individual`s LOC is authorized.
    • In "LOC Review Outcome" an "Effective Date" is added and the box next to the appropriate LOC is checked.
    • The updated 4444 is faxed to the NF.

What a NF resident`s paperwork should look like, based on where the resident was admitted from and the payment source

Community to hospital to Nursing Facility (non-Medicaid):

  • PAS Review Results Letter issued by a PAA (such as Council on Aging) or HENS 2.0. In the PAS Review section of the letter an "X" must be next to an outcome other than "not applicable." If the individual had a Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition" there should also be paperwork attached from the state authority(ies). It is not enough to have just a PAS/RR screen JFS 03622; just having the screen does not show that it was processed through the Council on Aging or HENS 2.0, OR
  • Instead of the PAS Review Results Letter, an individual can have a completed Hospital (Convalescent) Exemption from Pre-admission Screening Notification JFS 07000 or HENS print-out. If the individual was admitted prior to 2/01/2010, instead of a 7000 form, a convalescent stay could have been indicated on the Continuity of Care or Nursing Facility Transfer Document. This document must be from the time period of the admitting hospital stay (not a re-hospitalization). Many hospital forms had a box that was checked by a statement such as "convalescent stay" or "less than 30 day stay." Sometimes a notation was written in such as ">30 day NF stay." The rule stated that documentation had to mention either a "convalescent" stay or specify a stay of less than 30 days in length. It was not enough to say "short term stay." Also an MD or Doctor of Osteopathy (DO) must have signed the documentation no later than the date of the hospital discharge. A telephone order, rubber stamp signature, or a nurse signing for an MD or DO was not acceptable. Additionally individuals from other professions were not allowed to sign convalescent orders. If the individual stayed at the NF longer than 29 days, there should also be a (1) PAS/RR screen filled out by the NF with a code #3 in Section B of that form. If the individual needed Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," there should also be (2) proof that the PAS/RR screen was faxed to Ascend/KEPRO and/or DODD and (3) a final outcome from OMHAS and/or DODD.

Community to behavioral/psychiatric hospital to Nursing Facility (non-Medicaid) direct referrals:

Beginning in November 2014, behavioral units of hospitals were allowed to start faxing information directly to Ascend.  This information did not have to be processed through a PASSPORT Administrative Agency nor did the information need to go through HENS.  For requests processed as a direct referral to Ascend, there is only an outcome letter issued by Ohio Mental Health and Addiction Services.

Beginning August 1, 2015, KEPRO replaced Ascend as the vendor for Level II further review assessments for serious mental illness. 

Community to hospital to Nursing Facility (Medicaid):

  • Review Results Letter issued by a PAA (such as Council on Aging) with a date in the blank next to "LOC review outcome." This shows that a LOC has been authorized, AND
  • Also on the Review Results Letter, in the PAS Review section of the letter an "X" must be next to an outcome other than "not applicable." If the individual had a Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition" there should also be paperwork attached from the state authority(ies). It is not enough to have just a PAS/RR screen JFS 03622; just having the screen does not show that it was processed through the Council on Aging, OR
  • Instead of the PAS Review Results Letter, an individual can have a completed Hospital (Convalescent) Exemption from Pre-admission Screening Notification JFS 07000. If the individual was admitted prior to 2/01/2010, instead of a 7000 form, a convalescent stay was usually indicated on the Continuity of Care or Nursing Facility Transfer Document. This document must be from the time period of the admitting hospital stay (not a re-hospitalization). Many hospital forms had a box that was checked by a statement such as "convalescent stay" or "less than 30 day stay." Sometimes a notation was written in such as ">30 day NF stay." The rule stated that documentation had to mention either a "convalescent" stay or specify a stay of less than 30 days in length. It was not enough to say "short term stay." Also an MD or DO must have signed the documentation no later than the date of the hospital discharge. A telephone order, rubber stamp signature, or a nurse signing for an MD or DO was not acceptable. Additionally individuals from other professions were not allowed to sign convalescent orders. If the individual stayed at the NF longer than 29 days, there should also be a PAS/RR screen filled out by the NF with a code #3 in Section B of that form. If the individual needed Further Review for Serious Mental Illness and/or mental retardation or a "related condition," there should also be (2) proof that the PAS/RR screen was faxed to Ascend/KEPRO and/or DODD and (3) a final outcome from Ascend/KEPRO and/or DODD.

Community to Nursing Facility (non-Medicaid):
Also out-of-state settings other than a hospital to Ohio NF (non-Medicaid):

PAS Review Results Letter issued by a PAA (such as Council on Aging) or HENS 2.0. In the PAS Review section of the letter an "X" must be next to an outcome other than "not applicable." If the individual had a Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition" there should also be paperwork attached from the state authority(ies). It is not enough to have just a PAS/RR screen JFS 03622; just having the screen does not show that it was processed through the Council on Aging or HENS 2.0.

Community to Nursing Facility (Medicaid):
Review Results Letter with hand-written information called the COAP 4444.
An individual may have up to three revisions of this form showing various stages of authorization.

  • The first time a NF receives a copy of this form, it has a box checked in the PAS Review area. Often there is also a PAS/RR screen to go with this. It is not enough to have just a PAS/RR screen JFS 03622; just having the screen does not show that it was processed through the Council on Aging.
  • If the individual required Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition" the first copy of the form would say that the individual should not be admitted to a NF until a determination is made. The second revision would report the results of the determination; these results should be attached.
  • Once the MD has signed off on the assessment paperwork, there is another version of the 4444 with an "Effective Date" and an "X" in the LOC Review Outcome area.

Nursing Facility to a different Nursing Facility (non-Medicaid):
Also Nursing Facility to a hospital to a different Nursing Facility (non-Medicaid):

The individual`s PAS/RR records need to follow that individual to the new NF. The new NF is not required to have the convalescent stay documentation or the 7000 form.

The PAS/RR records could be any of the following:

  • Nothing at all. An individual who was admitted to the first nursing facility as a convalescent exemption may not have any PASRR records at all that were completed by the first nursing facility. This is entirely "legal" if the individual had been at the first NF for less than 30 days. If this is the case, the second or subsequent NFs would need to initiate a Resident Review screening for "NF Transfer, No Previous PASRR Records."
  • A Review Results letter issued by an Ohio PAA (such as Council on Aging) or HENS 2.0 with an "X" in the "PAS review" area next to an outcome other than "not applicable." Tip: if the X is next to "not applicable", this Review Results letter is not a PAS. If the individual needed Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," there should also be information regarding an outcome to go with the PAS/RR Review Results letter.
  • A MI/MR form for an individual who has been in NF`s since prior to 1993
  • A new or an old version of the PAS/RR screen with a code 6 or 7 in Section B, filled out by the second or subsequent NF. If the individual needed Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," there should also be information regarding an outcome to go with the PAS/RR screen. There is no Review Results letter from a PAA (such as Council on Aging) or HENS 2.0 to go with the PAS/RR form in this scenario.
  • A new or old version of the PAS/RR screen with a code 3, 4, 5, 6, or 7 in section B filled out by the first NF. There is no Review Results letter issued by a PAA (such as Council on Aging) or HENS 2.0 to go with this screen. If the individual required Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," there should also be information regarding an outcome to go with the PAS/RR screen. If no determination has yet been made, both NF`s need to make sure they follow the law about this: from 5160-3-15.2 (C)

    (6) If an individual is to be transferred to another Ohio nursing facility after submission of the RR/ID request but prior to receipt of the RR/ID, RR/ DD and/or RR/SMI determinations:

    (a) The sending nursing facility must notify DODD and/or OhioMHAS of the transfer. Such notice must be written and must be provided to DODD and/or OhioMHAS not later than the day the individual is transferred. The sending nursing facility must provide sufficient contact information to enable the completion of the RR process.

    (b) At or prior to the time the individual is transferred, the sending nursing facility must also provide the receiving nursing facility with copies of all PASRR related documents pertaining to the individual and written notice of the individual's current status with regard to PASRR. 

    If known, the notice must include contact information for the RR evaluator assigned by OhioMHAS and/or DODD.

    (c) The receiving nursing facility must not accept the individual as a 
    nursing facility transfer unless it receives this information at or prior to the time the individual is admitted to the receiving nursing facility.

    (d) If the transferring individual is medicaid eligible at the time of the transfer, the sending nursing facility must also provide written notice of the transfer and the current PASRR status of the individual to ODM or its designee. Such notice must be provided no later than the date on which the individual is transferred.

    (7) A nursing facility that, intentionally or otherwise, accepts any readmission or nursing facility transfer, or retains as a resident any individual in violation of this rule is in violation of its medicaid provider agreement. This is true regardless of the payment source for the individual's nursing facility stay.

Nursing Facility to a different Nursing Facility (traditional Medicaid):
Also Nursing Facility to a hospital to a different Nursing Facility (traditional Medicaid):
This individual needs both (1) PAS records if they exist at the first NF, and (2) a new LOC.

A new LOC determination needs to be made for the second NF. This would be shown by a Review Results letter issued by a PAA (such as Council on Aging) with a date in the LOC review outcome area. The LOC date should be the date of the transfer or up to 29 days prior to the date of the transfer.

The individual`s PAS/RR records need to follow them to the new NF, or the new NF needs to initiate a Resident Review for "NF Transfer, No Previous PASRR Records" (code #6). The new NF is not required to have the convalescent stay documentation or the 7000 form.

The PAS/RR records could be any of the following:

  • Nothing at all. An individual who was admitted to the first nursing facility as a convalescent exemption may not have any PASRR records at all that were completed by the first nursing facility. This is entirely "legal" if the individual had been at the first NF for less than 30 days. If this is the case, the second or subsequent NFs would need to initiate a Resident Review screening for "NF Transfer, No Previous PASRR Records."
  • A Review Results letter issued by an Ohio PAA (such as Council on Aging) or HENS 2.0 with an "X" in the "PAS review" area next to an outcome other than "not applicable." Tip: if the X is next to "not applicable", this Review Results letter is not a PAS. If the individual needed Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," there should also be information regarding an outcome to go with the PAS/RR Review Results letter.
  • A MI/MR form for an individual who has been in NF`s since prior to 1993
  • A new or an old version of the PAS/RR screen with a code 6 or 7 in Section B, filled out by the second or subsequent NF. If the individual needed Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," there should also be information regarding an outcome to go with the PAS/RR screen. There is no Review Results letter from a PAA (such as Council on Aging) to go with the PAS/RR form in this scenario.
  • A new or old version of the PAS/RR screen with a code 3, 4, 5, 6, or 7 in section B filled out by the first NF. There is no Review Results letter issued by a PAA (such as Council on Aging) to go with this screen. If the individual needed Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," there should also be information regarding an outcome to go with the PAS/RR screen. If no determination has yet been made, both NF`s need to make sure they follow the law about this: from 5160-3-15.2 (C)

(6) If an individual is to be transferred to another Ohio nursing facility after submission of the RR/ID request but prior to receipt of the RR/ID, RR/ DD and/or RR/SMI determinations:

(a) The sending nursing facility must notify DODD and/or OhioMHAS of the transfer. Such notice must be written and must be provided to DODD and/or OhioMHAS not later than the day the individual is transferred. The sending nursing facility must provide sufficient contact information to enable the completion of the RR process.

(b) At or prior to the time the individual is transferred, the sending nursing facility must also provide the receiving nursing facility with copies of all PASRR related documents pertaining to the individual and written notice of the individual's current status with regard to PASRR. 

If known, the notice must include contact information for the RR evaluator assigned by OhioMHAS and/or DODD.

(c) The receiving nursing facility must not accept the individual as a 
nursing facility transfer unless it receives this information at or prior to the time the individual is admitted to the receiving nursing facility.

(d) If the transferring individual is medicaid eligible at the time of the transfer, the sending nursing facility must also provide written notice of the transfer and the current PASRR status of the individual to ODM or its designee. Such notice must be provided no later than the date on which the individual is transferred.

(7) A nursing facility that, intentionally or otherwise, accepts any readmission or nursing facility transfer, or retains as a resident any individual in violation of this rule is in violation of its medicaid provider agreement. This is true regardless of the payment source for the individual's nursing facility stay.

Out-of-state resident in an out-of state hospital going to an Ohio Nursing Facility (non-Medicaid or currently receiving another state`s Medicaid):
An individual admitted to a NF prior to 2/01/2010 was allowed to have either (a) a convalescent exemption or, (b) an Ohio PASRR with a Review Results letter issued by an Ohio PAA (such as Council on Aging). The convalescent exemption was usually indicated on the Continuity of Care or Nursing Facility Transfer Document. This document must be from the time period of the admitting hospital stay (not a re-hospitalization). Some hospital forms had a box that was checked by a statement such as "convalescent stay" or "less than 30 day stay." Sometimes a notation was written in such as ">30 day NF stay." The rule stated that documentation had to mention either a "convalescent" stay or specify a stay of less than 30 days in length. It was not enough to say "short term stay." Also an MD or DO must have signed the documentation no later than the date of the hospital discharge. A telephone order, rubber stamp signature, or a nurse signing for an MD or DO was not acceptable. Additionally individuals from other professions were not allowed to sign convalescent orders.

An individual admitted to a NF on/after 2/01/2010 must have an Ohio PASRR with a Review Results letter issued by an Ohio PAA (such as Council on Aging). Just having a PASRR screen by itself without a Review Results letter is not enough; there must be a Review Results letter showing it was processed by a PAA (such as Council on Aging). Additionally, a 7000 or HENS form cannot be used for an out-of-state resident coming from an out-of-state hospital, nor are out-of-state residents coming from out-of-state hospitals allowed to be considered a convalescent stay on/after 2/01/2010.

Ohio resident in an out-of-state hospital coming to an Ohio Nursing Facility (Medicaid):

  • Review Results Letter issued by a PAA (such as Council on Aging) with a date in the blank next to "LOC review outcome." This shows that a LOC has been authorized, AND
  • Also on the Review Results Letter, in the PAS Review section of the letter an "X" must be next to an outcome other than "not applicable." If the individual had a Further Review for Serious Mental Illness and/or mental retardation, developmental disability or a "related condition" there should also be paperwork attached from the state authority(ies). It is not enough to have just a PAS/RR screen JFS 03622; just having the screen does not show that it was processed through the Council on Aging, OR
  • Instead of the PAS Review Results Letter documenting a PAS outcome, an individual can have a completed Hospital (Convalescent) Exemption from Pre-admission Screening Notification JFS 07000. If the individual was admitted prior to 2/01/2010, instead of a 7000 form, a convalescent stay could have been indicated on the Continuity of Care or Nursing Facility Transfer Document. This document must be from the time period of the admitting hospital stay (not a re-hospitalization). Many hospital forms had a box that was checked by a statement such as "convalescent stay" or "less than 30 day stay." Sometimes a notation was written in such as ">30 day NF stay." The rule stated that documentation had to mention either a "convalescent" stay or specify a stay of less than 30 days in length. It was not enough to say "short term stay." Also an MD or DO must have signed the documentation no later than the date of the hospital discharge. A telephone order, rubber stamp signature, or a nurse signing for an MD or DO was not acceptable. Additionally individuals from other professions were not allowed to sign convalescent orders.

Other Documentation Information
See also: Form 7000, Nursing Facility Processes, Pre-Admission Screening, Level of Care, Convalescent Exemption NEEDS LINKS

[return to top]

Hospital Exemption

Please note, Hospital Exemption may also be referred to as Convalescent Exemption, Convalescent Stay, or "less than 30 day stay."

Based on the individual`s admission date, what should their documentation look like?

  • For an individual admitted to a NF prior to 12/01/2009, a hospital exemption was usually indicated on the Continuity of Care or Nursing Facility Transfer Document. This document must be from the time period of the admitting hospital stay (not a re-hospitalization). Many hospital forms had a box that was checked by a statement such as "convalescent stay" or "less than 30 day stay." Sometimes a notation was written in such as ">30 day NF stay." The rule stated that documentation had to mention either a "convalescent" stay or specify a stay of less than 30 days in length. It was not enough to say "short term stay." Also an MD or Doctor of Osteopathy must have signed the documentation no later than the date of the hospital discharge. A telephone order, rubber stamp signature, or a nurse signing for an MD or DO was not acceptable. Additionally individuals from other professions were not allowed to sign convalescent orders.
  • For an individual admitted to a NF during 12/2009 and 1/2010, there was a "grace period" in effect. A hospital exemption could have been documented either the former way or the new way, which is:
  • For an individual admitted to a NF on or after 2/01/2010, a Hospital (Convalescent) Exemption from Pre-admission Screening Notification JFS 07000 or HENS is needed. This form must have been completely filled out by the hospital. It is to be kept in the individual`s file at the NF. The form states, "This notification form must be kept in the nursing facility resident`s file. By accepting the admission, the nursing facility confirms that the hospital exemption criteria and all applicable requirements of Ohio Administrative Code rules are met. The nursing facility accepts the admission only after receipt and review of this notification form for 100% accuracy and completion. The nursing facility accepts responsibility for requesting a resident review (if required) prior to the 30th day following admission from the hospital."

What should a NF do when an individual stays longer than their hospital exemption?

Helpful tips:

  • The NF should double-check their paperwork or HENS to make sure the hospital exemption was properly documented.
  • The NF should confirm that the individual was admitted to the NF from an in-patient hospital stay (not from the emergency room or from an observation bed).
  • The NF should confirm that the individual was not admitted after 9/29/13 from a behavioral/psychiatric hospital or unit.
  • The NF should confirm that the individual was in the community or assisted living or independent living prior to the admitting hospital stay.
  • The NF should confirm that the individual was not an out-of-state resident coming from an out-of- state hospital if they were admitted on/after 2/01/2010.
  • The NF should initiate a Resident Review no later than the individual`s 30th day at the NF.

How does a NF initiate a Resident Review for "Expired Time Limit for Hospital Exemption?"

Use HENS 2.0 or

  • Fill out a new PAS/RR Identification Screen (3622), using code #3 a, or 3 b, or 3 c in section B
  • Make sure to sign and date Section I of the screen. The date by your signature is the date you are actually filling out and signing the form; writing any other date is falsification of records. Undated forms are not valid.
  • If the individual does not have indications of Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," simply maintain the PASRR screen on the resident`s chart. Never discard this information. Do not send this form to Council on Aging for processing. Council on Aging will only need to see this information if the NF asks for a LOC authorization.
  • If the individual does have indications of Serious Mental Illness and/or mental retardation, developmental disability or a "related condition," fax to KEPRO (844) 285-9764for mental illness or DODD (614) 995-4877 for MR, DD or a "related condition." Fax to both places if the individual has both mental illness and MR, DD or a "related condition." Keep the fax transmission report or your fax cover sheet to prove the date it was faxed to KEPRO and/or DODD; you will need to show this if you request a LOC. Maintain the PASRR screen and any letters you receive about the individual from KEPRO/OMHAS and DODD.
  • If you have questions about doing a Resident Review for an individual with mental illness, you should call the Ohio Mental Health and Addiction Services at 614-466-1063.
  • If you have questions about doing a Resident Review for an individual with mental retardation, developmental disability, or a "related condition," you should call the Ohio Department of Developmental Disabilities at 800-617-6733.

What should a NF do if the NF thought there was a hospital exemption, but there was not?

Common reasons why Nursing Facilities (NFs) often believe an individual has a hospital exemption but, in fact, they do not, include:

  • The individual went from the community to the hospital to the NF before 12/01/2009 without hospital exemption documentation nor do they have a Review Results letter issued by an Ohio PAA (such as Council on Aging)
  • The individual went from the community to the hospital to the NF between 12/01/2009 and 1/31/2010 without hospital exemption documentation, nor a 7000, nor do they have Review Results letter issued by an Ohio PAA (such as Council on Aging)
  • The individual went from the community to the hospital to the NF on/after 2/01/2010 without a 7000 nor do they have Review Results letter issued by an Ohio PAA (such as Council on Aging)
  • The individual was an out-of-state resident and was admitted from an out-of-state hospital on/after 2/01/2010 and they do not have a Review Results letter issued by an Ohio PAA (such as Council on Aging)
  • The individual went from the emergency room to a NF without a PAS Review Results letter issued by an Ohio PAA (such as Council on Aging) or a PAS Review Results letter issued by HENS 2.0 . A 7000 or a HENS hospital exemption other hospital exemption documentation cannot be used for this scenario.
  • The individual went from a hospital observation bed to a NF without a PAS Review Results letter issued by an Ohio PAA (such as Council on Aging) or a PAS Review Results letter issued by HENS 2.0. A 7000 or a HENS hospital exemption or other hospital exemption documentation cannot be used for this scenario.
  • The individual went from a hospital behavioral/psychiatric unit to a NF after 9/29/13 without a PAS Review Results Letter or an Ohio Mental Health and Addiction Services determination from a direct referral to KEPRO.  A HENS Hospital Exemption cannot be used for this scenario.
  • 7000 found to be incomplete
  • 7000 not signed by MD
  • NF is not able to access the HENS record

What the NF should do if the individual does not have valid hospital exemption documentation:

  1. Make sure the individual was not a transfer from another Ohio NF.
  2. Make sure the individual did not go from another Ohio NF to the hospital before coming to the current NF placement.
  3. Use HENS 2.0 to obtain a PAP authorization, or fax the following documents to Council on Aging at 513-345-8618. We will issue a PAS Review Results letter:
    • PAS/RR Identification Screen (3622); use a code #1 or #2 in section B
    • History and Physical signed by a MD or DO, dated within the last year
    • A note explaining the individual`s admission date, where the individual was admitted from (if they were admitted from a hospital where they were prior to the hospital exemption) along with your name, phone number and fax number

Frequently Asked Questions

Can an individual be admitted from the emergency room or a hospital observation bed and be considered a hospital exemption?
No, the individual must go to the NF from an in-patient hospital stay

Can an individual come from out-of-state and be considered a hospital exemption?

  • Yes, if the individual was admitted prior to 2/01/2010 and the hospital exemption was properly documented, they could have been a hospital exemption.
  • However, on/after 2/01/2010, only an individual who normally resides in Ohio can come from an out-of-state hospital with a 7000 form to be considered a hospital exemption.

What about out-of-state residents?

  • Individuals who normally reside out-of-state and are going from an out-of-state hospital to an Ohio NF cannot be a hospital exemption on/after 2/01/2010.
  • Individuals who normally reside out-of-state and are going from an Ohio hospital to an Ohio NF may be considered a hospital exemption with the correct hospital exemption documentation.

What documentation is needed to show a hospital exemption?

  • For an individual admitted to a NF prior to 12/01/2009, a hospital exemption/convalescent stay was usually indicated on the Continuity of Care or Nursing Facility Transfer Document. This document must be from the time period of the admitting hospital stay (not a re-hospitalization). Many hospital forms had a box that was checked by a statement such as "convalescent stay" or "less than 30 day stay." Sometimes a notation was written in such as ">30 day NF stay." The rule stated that documentation had to mention either a "convalescent" stay or specify a stay of less than 30 days in length. It was not enough to say "short term stay." Also an MD or Doctor of Osteopathy must have signed the documentation no later than the date of the hospital discharge. A telephone order, rubber stamp signature, or a nurse signing for an MD or DO was not acceptable. Additionally individuals from other professions were not allowed to sign convalescent orders.
  • For an individual admitted to a NF between 12/2009 and 1/2010, there was a "grace period" in effect. A hospital exemption could have been documented either the old way or the new way.
  • For an individual admitted to a NF on or after 2/01/2010, a Hospital (Convalescent) Exemption from Pre-admission Screening Notification JFS 07000 or a HENS is needed. This form must have been completely filled out by the hospital. It is to be kept in the individual`s file at the NF. The form states, "This notification form must be kept in the nursing facility resident`s file. By accepting the admission, the nursing facility confirms that the hospital exemption criteria and all applicable requirements of Ohio Administrative Code rules are met. The nursing facility accepts the admission only after receipt and review of this notification form for 100% accuracy and completion. The nursing facility accepts responsibility for requesting a resident review (if required) prior to the 30th day following admission from the hospital."

What if the hospital exemption was not properly documented?
The NF needs to request a PASRR screening Review Results letter from the PAA (such as Council on Aging) or by using HENS 2.0.

Additional Information
See also: Hospital Processes

 

 |  CMS Login
175 Tri County Parkway | Cincinnati, OH 45246 | (513) 721-1025