Ohio Nursing Home Level of Care Assessment and SNF Admission

What the Level of Care Assessment Determines

Before your parent can be admitted to an Ohio nursing facility — whether for short-term rehabilitation or long-term custodial care — the applicable clinical and preadmission screenings must be completed. This isn't a formality. The assessment helps determine whether Medicare or Medicaid will pay, and a failed screening can delay or block admission entirely.

Ohio uses two interrelated screening processes: the Nursing Facility Level of Care (NFLOC) determination and the Preadmission Screening and Resident Review (PASSR). The NFLOC confirms that the patient needs the type of care a nursing facility provides. The PASSR screens for serious mental illness (SMI) or developmental disabilities (DD) that would require specialized services beyond what a standard nursing home can offer.

The PASSR Screening: Two Paths

The PASSR is a federal requirement that Ohio implements through two electronic forms, both submitted via the Healthcare Electronic Notification System (HENS):

Path 1 — The 30-Day Convalescent Exemption (Form ODM-7000): If your parent is entering the SNF directly from an inpatient hospital stay for a condition treated during that stay, and the attending physician certifies that rehabilitation is expected to last fewer than 30 days, the hospital discharge planner files a Hospital Exemption Notification (ODM-7000). This allows immediate admission without a full Level I screening. It's the fast track — designed for straightforward post-surgical rehab (hip replacement, cardiac procedure, stroke recovery).

Path 2 — Full Level I Screening (Form ODM-3622): If the expected stay exceeds 30 days, or if the patient is entering from the community (not directly from a hospital), a full Level I screen is required. The discharge planner or facility intake coordinator completes the ODM-3622 electronically via HENS.

If the Level I screen is positive for SMI or developmental disabilities, admission is paused. A Level II clinical evaluation must be completed by Maximus (the state's contracted assessment entity) and approved by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) or the Department of Developmental Disabilities (DODD). This review typically takes up to 3 calendar days and must be completed before admission.

What the NFLOC Assessment Evaluates

The NFLOC determination looks at whether your parent needs the level of daily skilled nursing intervention or daily assistance with activities of daily living (ADLs) provided by a nursing facility. The clinical criteria include:

• Skilled nursing needs: IV medications, complex wound care, ventilator management, tracheostomy care, tube feeding
• Rehabilitation needs: daily physical therapy, occupational therapy, or speech therapy that requires facility-level equipment and supervision
• ADL dependencies: inability to perform bathing, dressing, transferring, toileting, or eating without substantial physical assistance
• Cognitive impairment: the patient requires 24-hour supervision due to wandering, self-harm risk, or inability to recognize and respond to safety hazards

Meeting NFLOC is also the clinical gateway to Ohio's home and community-based waivers (PASSPORT, Assisted Living Waiver) — the same assessment that qualifies someone for a nursing home also qualifies them for home-based alternatives, which is the core design of the waiver system.

Your Parent's Admission Rights

Federal law and Ohio regulations protect several rights during the admission process:

• No guarantor requirement. Under 42 U.S.C. § 1396r, the facility cannot require a family member to sign as personal guarantor as a condition of admission or continued stay.
• Choice of facility. The hospital must offer your parent a choice among available nursing facilities — not just one preferred partner.
• Medicaid cannot be a barrier. A facility that accepts Medicaid cannot refuse admission solely because the patient is Medicaid-eligible rather than private-pay. However, facilities can cite "no available bed" as a reason, and in practice, Medicaid patients may face longer waits for admission.
• Written notice of rights. The facility must provide a written statement of resident rights at admission, including the right to file grievances, the right to privacy, and the right to manage personal funds.

When Admission Is Delayed

If the Level II evaluation delays admission by more than a day or two, your parent remains in the hospital — which creates tension with the hospital's discharge timeline. The hospital may push the family to appeal the discharge timeline separately. In practice, the hospital social worker and the SNF intake coordinator should be coordinating the PASSR screening in parallel with discharge planning, not sequentially.

If you're told the screening is delayed and your parent has nowhere safe to go, contact the hospital patient advocate and request that the care conference include a timeline for PASSR completion.

Navigating the Full Process

The Hospital-to-Home in Ohio guide walks through the PASSR screening sequence, the NFLOC criteria, and the admission paperwork in detail — including a checklist for reviewing the facility's admission agreement before signing.

See more Ohio guides →