ALTCS Pre-Admission Screening (PAS) in Arizona: How the 60-Point Test Works

You've gathered five years of financial records, verified your parent's income is under the $2,982 monthly cap, and you're ready to apply for ALTCS. But passing the financial gate is only half the battle. Arizona's long-term care Medicaid program requires a separate medical eligibility determination through the Pre-Admission Screening (PAS) assessment — and your parent must score 60 points or higher to qualify.

Most families walk into this evaluation blind. Understanding how the PAS scoring system works gives you the ability to ensure your parent's true level of need is accurately captured.

What the PAS Assessment Measures

A state nurse or social worker conducts the PAS evaluation, typically at the hospital, nursing facility, or your parent's home. The assessment measures functional limitations — how much help your parent needs with basic daily activities — and medical conditions that affect their ability to live independently.

The PAS tool evaluates two categories that combine into a total score:

Functional score (maximum 166 points): Based on Activities of Daily Living (ADLs) — bathing, dressing, eating, toileting, transferring (moving from bed to chair), and mobility. Each ADL is rated on a scale from 0 (completely independent) to 3 (totally dependent), then multiplied by specific weights to produce the functional subscore.

Medical score (maximum 31.5 points): Based on diagnosed medical conditions, cognitive status, behavioral issues, and the complexity of required treatments (wound care, tube feeding, oxygen therapy, dialysis, etc.).

Your parent needs a combined score of 60 or higher out of the maximum 197.5. The threshold is designed to identify individuals whose care needs are at the level where institutionalization would be necessary without community-based support.

How Dementia and Cognitive Decline Affect the Score

This is the single most important scoring factor most families don't know about: a formal diagnosis of Alzheimer's disease or a related dementia from a neurologist or licensed psychiatrist automatically contributes 20 points toward the medical score.

Twenty points is enormous — it represents roughly 33% of the 60 points needed to qualify. A parent with moderate dementia who also needs help with two or three ADLs can reach the threshold based largely on the cognitive diagnosis alone.

The key word is "formal diagnosis." A primary care physician noting "memory issues" or "mild cognitive impairment" in the chart is not sufficient. You need a documented evaluation by a neurologist or psychiatrist with a specific diagnostic code. If your parent shows signs of cognitive decline but hasn't been formally evaluated, schedule that neurology appointment before the PAS assessment.

The 56–59 Point Safety Net

If your parent's initial PAS score lands between 56 and 59 — close but not over the 60-point threshold — the case is automatically routed for a secondary Physician Review. A reviewing physician examines whether the applicant's medical or functional conditions place them at immediate risk of institutionalization.

If the physician determines that the borderline score understates the actual risk, medical eligibility can still be granted. This safety net exists because the PAS scoring tool, while standardized, can't capture every nuance of a person's care needs.

Families can strengthen a borderline case by:

• Providing detailed documentation from all treating physicians about the progression and severity of conditions
• Keeping a daily care log showing the actual hours of hands-on assistance your parent requires
• Getting statements from home health nurses or therapists who have observed your parent's functional limitations firsthand

Private PAS Assessments

You don't have to wait until the formal ALTCS application to find out whether your parent will meet the medical threshold. Families can request a standalone "Private PAS" assessment to evaluate medical eligibility before making major financial decisions or facility commitments.

A Private PAS gives you two advantages: first, you learn whether your parent's score is strong, borderline, or insufficient before triggering the formal application timeline. Second, if the score is borderline, it gives you time to gather additional medical documentation, schedule specialist evaluations, or address undiagnosed conditions that could push the score above 60.

This is particularly valuable for families considering significant financial moves — establishing a Miller Trust, spending down assets, or signing a private-pay facility contract — that depend on eventual ALTCS approval.

Preparing for the PAS Evaluation

The assessment should capture your parent on a realistic day, not their best day. Some practical steps:

Don't coach your parent to perform above their actual ability. A parent who insists on demonstrating independence during the evaluation — getting dressed without help, walking without their walker — may score lower than their daily reality warrants. The assessor needs to see the level of assistance your parent genuinely requires.

Have documentation ready. Bring a list of all diagnosed conditions, current medications, hospital discharge summaries from the past year, and any specialist reports (especially neurology or psychiatry evaluations). The assessor can only score what's documented or observed.

Be present for the evaluation. The family caregiver's perspective matters. You can describe what daily care actually looks like — how many times your parent needs help transferring, whether they wander at night, how often they forget medications. The assessor may incorporate these observations into the scoring.

Document behavioral issues. If your parent exhibits wandering, agitation, sundowning, or resistance to care, these behavioral factors contribute to the medical score. A pattern documented by caregivers and physicians carries more weight than a single incident.

The Arizona Hospital Discharge Toolkit includes a PAS preparation checklist, a functional assessment worksheet you can complete before the evaluation to identify scoring areas, and guidance on when to request a Private PAS versus proceeding directly with the ALTCS application.

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