Delaware Medicaid Pre-Admission Screening: PAE Tool-001 and PASRR Explained

Why the Screening Exists

Delaware requires a clinical pre-admission screening before anyone can receive Medicaid-funded long-term care — whether in a nursing home, through home-based services under DSHP-Plus, or in an assisted living facility. The screening exists to confirm that the applicant genuinely needs a nursing-home level of care and is not being institutionalized inappropriately.

Meeting the financial eligibility requirements (income at or below $2,485/month and assets at or below $2,000) is only half the qualification. The clinical screening is the other half, and without it, DMMA will not approve long-term care Medicaid regardless of the applicant's financial situation.

The PAE Tool-001

The Pre-Admission Evaluation Long-Term Care Tool-001 is the standardized clinical assessment that Delaware uses to determine whether an applicant meets the nursing-home level of care. A physician, hospital discharge planner, or qualified nurse assessor completes the form and submits it to DMMA's Central Intake Unit (CIU).

The PAE Tool-001 evaluates the applicant across three clinical domains:

Activities of Daily Living (ADLs). The assessment measures the applicant's physical ability to perform essential self-care tasks: bathing, dressing, grooming, eating, toileting, transferring (moving from bed to chair), and mobility. To meet the clinical threshold, the applicant must require hands-on physical assistance with at least two distinct ADLs. "Hands-on" means the applicant cannot complete the task with verbal cues or standby supervision alone — someone must physically help them.

Cognitive and behavioral impairment. Severe memory loss, disorientation, wandering, or dangerous behaviors resulting from Alzheimer's disease, vascular dementia, or traumatic brain injury can satisfy the level-of-care requirement even if the applicant remains physically capable of performing basic ADLs. The assessment documents the severity and frequency of cognitive symptoms and their impact on the applicant's safety.

Skilled clinical interventions. If the applicant requires daily skilled medical care — IV medication administration, continuous tube feeding, specialized wound care, or intensive rehabilitative therapy — this alone can qualify them for the nursing-home level of care.

The CIU reviews the completed PAE Tool-001, sometimes requests additional medical records, and issues a level-of-care determination. This determination authorizes the specific care setting: nursing facility, HCBS home care, or assisted living.

PASRR Level I Screening

Every applicant transitioning to a nursing facility — whether from a hospital, from home, or from another care setting — must also complete a Pre-Admission Screening and Resident Review (PASRR) Level I screening. This is a federal requirement, not a Delaware-specific rule.

The PASRR Level I is a brief screening tool that checks whether the applicant has a serious mental illness, an intellectual disability, or a related condition. Its purpose is to ensure that people with these conditions are not placed in nursing homes when they should instead receive specialized treatment in a community setting.

If the Level I screening identifies a potential mental illness or intellectual disability, the applicant is referred for a more detailed PASRR Level II evaluation, which determines whether nursing facility placement is appropriate and what specialized services must be provided.

The Level I screening determines whether a Level II evaluation is needed. Complete the screening alongside the PAE Tool-001 as part of the nursing-facility placement process; do not assume a Level II review is unnecessary or that Medicaid payment is authorized until the required reviews are complete.

Who Completes the Forms

The PAE Tool-001 is typically completed by:

• The parent's primary care physician
• A hospital social worker or discharge planner (if the parent is being discharged from a hospital)
• A nurse assessor at the nursing facility

The PASRR Level I is usually completed by the hospital discharge planner or the nursing facility's admissions coordinator.

As the family member, your role is to make sure these forms get submitted to the CIU. Hospitals and nursing facilities do this routinely, but in a crisis situation — especially when a parent is at home and declining rapidly — the family may need to coordinate with the primary care physician to get the PAE Tool-001 completed and sent in.

Timing

The CIU processes PAE Tool-001 submissions continuously. Timing depends on the setting, the nurse assessment, and any additional medical records the CIU requests. The clinical screening runs in parallel with the financial eligibility determination — they are separate tracks handled by different parts of DMMA and DSS.

The Medicaid application is not approved until both tracks clear.

If you are coordinating both the clinical and financial sides of a Medicaid application, the Delaware Medicaid Long-Term Care & Asset Protection Guide maps out the full parallel process — financial documentation, Miller Trust setup, clinical screening, and MCO enrollment — so nothing falls through the gap between the two tracks.

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