PASRR and Level of Care Assessment in Kentucky

Every Medicaid-Certified Nursing Home Admission in Kentucky Requires This Screening

Before a patient can be legally admitted to any Medicaid-certified nursing facility in Kentucky, federal law mandates the Preadmission Screening and Resident Review (PASRR) process. This applies regardless of payment source — whether the patient is paying privately, covered by Medicare, or applying for Medicaid. The screening exists to identify individuals with Serious Mental Illness (SMI), Intellectual Disabilities (ID), or related conditions and ensure they are placed in the appropriate care setting with necessary specialized services.

In practice, this screening runs through Kentucky's Level of Care System (KLOCS), an online portal managed by the Department for Medicaid Services.

Level I: The Universal Gate

A PASRR Level I screening must be completed for every person seeking admission to a Medicaid-certified Kentucky nursing facility. The discharging hospital or the receiving nursing facility's staff complete this screening through KLOCS. It is a standardized set of questions designed to flag indicators of SMI, intellectual disability, or related conditions.

If the Level I screening finds no indicators of these conditions, the process moves directly to the level of care determination. If it does flag indicators, the case is automatically routed in KLOCS to a Level II evaluation.

Level II: The Specialized Evaluation

When Level I triggers indicators, the designated regional Community Mental Health Center (CMHC) receives the referral through KLOCS and has a statutory limit of nine business days to complete a comprehensive Level II evaluation. This evaluation determines whether the patient's needs can be appropriately met in a nursing facility or whether specialized psychiatric or developmental disability services in a different setting would be more appropriate.

The Level II evaluation includes:

• A comprehensive psychiatric or psychological assessment
• A determination of whether the nursing facility can provide the specialized services the patient requires
• A recommendation on appropriate placement and service plan

For families, the key concern is timing. A Level II evaluation adds up to two weeks to the admission process. If your parent is ready for discharge from the hospital but the PASRR Level II is pending, the hospital cannot transfer them to the nursing facility until the evaluation is complete.

The Hospital Exemption (Form MAP-4092)

Kentucky provides an important workaround. If the discharging physician certifies that the patient is likely to require fewer than 30 calendar days of nursing facility care for recovery from an acute condition, the hospital can bypass the Level II evaluation using Form MAP-4092 (Hospital Exemption).

This is common for patients transitioning from acute hospital care to short-term rehab. The hospital exemption allows immediate SNF placement without waiting for a full Level II evaluation. However, if the stay subsequently exceeds 30 days, the nursing facility must immediately request a Level II evaluation through KLOCS. Missing this deadline can create compliance problems for the facility.

The Level of Care Determination Under 907 KAR 1:022

Separate from the PASRR screening, Kentucky requires a clinical determination that the patient meets the nursing facility level of care standard defined under administrative regulation 907 KAR 1:022. This assessment evaluates:

• Activities of Daily Living (ADLs): The patient's ability to independently perform bathing, dressing, toileting, transferring, and eating
• Skilled medical needs: Whether the patient requires daily skilled nursing services, medication management, wound care, or other clinical interventions
• Cognitive impairment: Whether dementia, delirium, or other cognitive conditions prevent safe independent living

The Peer Review Organization reviews the clinical history and physical (H&P) uploaded into KLOCS and typically renders a determination within three business days. This determination is also required for HCB Waiver eligibility — the same nursing facility level of care standard applies to both institutional and home-based Medicaid long-term care.

What This Means for Your Parent's Discharge Timeline

The PASRR and level of care processes add administrative days to any nursing facility transition. Your hospital case manager should initiate the KLOCS submission early in the hospital stay — ideally as soon as a nursing facility placement is being considered, not on the day of discharge.

Ask the case manager:

• Has the PASRR Level I been submitted in KLOCS?
• Did the Level I trigger a Level II referral?
• If yes, has the regional CMHC been contacted, and what is their estimated timeline?
• Has the physician uploaded the H&P for the level of care determination?

If your parent is using the hospital exemption (MAP-4092) for a short-term rehab stay but the recovery stalls and long-term placement becomes likely, make sure the nursing facility files for the Level II evaluation and a full level of care determination before the 30-day window closes.

The Kentucky Hospital-to-Home Transition Guide includes a level of care worksheet based on the 907 KAR 1:022 criteria, helping families evaluate whether their parent meets the standard before the formal assessment — and building a clinical paper trail that supports the application.

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