PASRR and LOCET Louisiana: The Two Screenings Before Nursing Home Admission

Your parent is about to be discharged from a Louisiana hospital, and the plan is a nursing home. The discharge planner mentions two screenings that have to happen first — PASRR and LOCET — and suddenly the transfer that seemed imminent is held up by paperwork, phone calls, and assessments you didn't know existed.

These aren't optional bureaucratic exercises. Both screenings are federally and state-mandated, and the results determine whether your parent can be admitted to a nursing facility, what level of care they'll receive, and whether Medicaid will pay for it.

LOCET: The Level of Care Evaluation Tool

The LOCET is Louisiana's standardized screening instrument that determines whether a person meets the Nursing Facility Level of Care (NFLOC). Every person seeking admission to a nursing home — whether paying privately, through Medicare, or through Medicaid — must have a LOCET assessment completed.

What it evaluates:

• Ability to perform Activities of Daily Living (ADLs): bathing, dressing, toileting, transferring, eating, continence
• Cognitive status and behavioral concerns
• Medical complexity (medication management, wound care, oxygen needs, IV therapy)
• Supervision requirements for safety

Who conducts it: The LOCET is typically completed by phone by a nurse assessor from the Louisiana Department of Health's Office of Aging and Adult Services (OAAS). The hospital social worker or discharge planner initiates the request. The assessor interviews the patient, reviews medical records, and may consult with hospital nursing staff.

How long it takes: Standard LOCET requests are processed within 3 to 5 business days. For urgent hospital discharge situations, an expedited assessment can be requested — but this depends on assessor availability and is not guaranteed.

What a passing result means: If the LOCET determines your parent meets NFLOC, they are clinically eligible for nursing home placement. If they don't meet the threshold — meaning their care needs can be managed in a less restrictive setting — the state will not authorize nursing home admission under Medicaid.

A LOCET determination of "does not meet NFLOC" doesn't mean your parent can't enter a nursing home as a private-pay patient. It means Medicaid won't cover the placement. If the family is willing to pay the private daily rate (typically $180 to $350 per day in Louisiana), the facility may still admit them — but some facilities won't accept private-pay residents who don't have a path to Medicaid coverage.

PASRR: Pre-Admission Screening and Resident Review

PASRR is a federally mandated program (under the Omnibus Budget Reconciliation Act of 1987) designed to prevent the inappropriate institutionalization of people with mental illness or intellectual disabilities in nursing homes.

Every person being considered for nursing home admission in Louisiana must complete a PASRR Level I screening — no exceptions.

PASRR Level I

The Level I screen is a brief questionnaire completed by the referring hospital, physician, or social worker. It asks whether the person has:

• A diagnosis of a serious mental illness (schizophrenia, bipolar disorder, major depressive disorder, psychotic disorders)
• An intellectual or developmental disability
• A related condition (such as cerebral palsy, epilepsy, autism)

If the answer is "no" to all categories: The Level I screen is cleared, and the nursing home admission can proceed (assuming the LOCET is also completed). Most elderly patients being admitted for physical care needs clear Level I quickly.

If the answer is "yes" to any category: A PASRR Level II evaluation is triggered.

PASRR Level II

The Level II evaluation is a comprehensive assessment conducted by the state to determine whether nursing home placement is appropriate for a person with mental illness or intellectual disability, or whether they would be better served in a community-based setting with specialized services.

What it involves:

• A detailed clinical and functional assessment
• Review by the state's designated PASRR evaluator (in Louisiana, this is coordinated through the Office of Behavioral Health or the Office for Citizens with Developmental Disabilities, depending on the diagnosis)
• A determination of whether the person needs the level of care provided by a nursing facility AND whether they need specialized services for their mental illness or intellectual disability

Timeline: Level II evaluations can take 7 to 14 business days. During this period, the patient may remain in the hospital, which creates significant pressure on both the family and the hospital.

Exempted hospital discharges: Federal regulations allow an exemption for certain hospital discharges to nursing facilities. If the patient requires nursing facility services for a condition treated during the hospital stay and the anticipated stay is 30 days or fewer, a provisional admission can proceed while the Level II evaluation is completed. The nursing facility must cooperate with the evaluation and cannot refuse to participate.

How the Two Screenings Work Together

The LOCET and PASRR operate independently but both must be completed before a Medicaid-funded nursing home admission is finalized:

1. Hospital initiates LOCET request through OAAS when nursing home placement is identified as the discharge plan
2. Hospital or referring provider completes PASRR Level I screen — typically a form submitted to the state electronically
3. LOCET assessment completed — nurse assessor determines NFLOC status
4. If PASRR Level I clears — admission proceeds once LOCET is approved
5. If PASRR Level II is triggered — admission may proceed provisionally under exempted hospital discharge rules, but the full evaluation must be completed within the regulatory timeframe

What Families Should Know

You can request a copy of the LOCET results. If the assessment determines your parent doesn't meet NFLOC, ask for the specific functional deficits that were evaluated. Families often find that the phone-based assessment didn't capture the full picture of their parent's care needs — especially if the parent minimizes their limitations during the interview (a common problem with patients who have early-stage dementia or pride-related underreporting).

Advocate during the LOCET call. If possible, be present (or on the phone) when the LOCET assessor interviews your parent. You can provide supplementary information about falls, nighttime wandering, medication errors, and daily care needs that your parent may not report accurately.

A PASRR Level II isn't a denial. It's an evaluation to determine the right care setting. If the Level II determines your parent does need nursing facility care, it also identifies what specialized mental health or developmental disability services must be provided within the nursing home — services the facility is then obligated to deliver.

Don't let screening delays force a bad discharge. If the hospital is pressuring discharge before LOCET/PASRR are complete, the patient has the right to file a discharge appeal with Acentra Health (1-888-315-0636). The appeal stays the discharge while the medical necessity of continued hospitalization is reviewed.

The Hospital-to-Home Louisiana guide includes a complete LOCET/PASRR preparation worksheet, sample advocacy language for the assessment call, and the exact phone numbers and fax lines for expedited screening requests.

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