Pre-Admission Screening in West Virginia: The PAS Assessment and Five-Deficit Threshold

Before your parent can enter a Medicaid-certified nursing facility or enroll in the Aged and Disabled Waiver in West Virginia, they must pass a medical gate: the Pre-Admission Screening (PAS) assessment. This evaluation determines whether the patient meets a "nursing facility level of care" — and in West Virginia, that means demonstrating at least five documented functional deficits.

The PAS is where many families hit an unexpected wall. Your parent may clearly need help, but if the clinical documentation doesn't hit five specific deficits, the application stalls.

What the PAS-2000 Assessment Evaluates

The PAS-2000 is a standardized clinical evaluation form submitted to Acentra Health, West Virginia's Utilization Management Contractor. A registered nurse reviews the patient's medical records and conducts either an in-person assessment (for ADW waiver applicants) or a records review (for facility admissions).

The assessment scores deficits across several categories:

Activities of Daily Living (ADLs): Each ADL is scored on a level system. To count as a deficit, the patient must require hands-on physical assistance (Level 2 or higher):

• Eating
• Bathing
• Dressing
• Grooming
• Transferring (bed to chair)
• Walking/mobility
• Toileting

Continence: Bladder or bowel incontinence counts as a deficit only at Level 3 — frequent or total incontinence. Occasional episodes don't qualify.

Cognitive orientation: Total disorientation or comatose state (Level 3 or higher). Mild confusion or forgetfulness alone doesn't count.

Skin integrity: Stage 3 or 4 decubitus ulcers (pressure sores penetrating beyond superficial skin layers).

Emergency evacuation: Physical or mental inability to leave a building without active assistance during an emergency.

Skilled nursing needs: Suctioning, tracheostomy care, ventilator dependence, parenteral fluids, sterile wound dressings, or irrigations.

Medication administration: Complete inability to self-administer medications.

Why Five Deficits Is a High Bar

Most states require a general demonstration of "nursing facility level of care." West Virginia quantifies it with the five-deficit threshold, making the standard more concrete but also more rigid.

The most common qualifying pattern: three to four ADL deficits (bathing, dressing, transferring, and walking), plus incontinence at Level 3, plus inability to evacuate independently. A patient who needs help with bathing, dressing, and cooking but can walk independently and manages continence might score only three deficits — short of the threshold.

This matters because the PAS is a point-in-time evaluation. If the nurse visits on a day when your parent is feeling relatively well, the score may not reflect their worst days.

How to Prepare for the Assessment

Preparation doesn't mean exaggerating your parent's condition. It means making sure the assessment captures the full picture:

Document the worst days, not the best. Keep a log for at least two weeks before the assessment showing which ADLs your parent needed help with each day, how many incontinence episodes occurred, any falls, and any instances where they couldn't remember to take medications. Bring this log to the assessment.

Get physician documentation. If your parent's doctor has noted functional limitations, cognitive decline, or skin integrity concerns in recent medical records, request copies. The PAS nurse can reference physician notes in their evaluation.

Don't coach the patient. The nurse is trained to detect inconsistencies. If your parent insists they can do everything independently (as many proud elderly patients do), the nurse will score based on observed function. Instead, have an honest conversation with your parent beforehand about why accurately describing their limitations matters for getting the help they need.

Understand the transfer rules. An approved PAS-2000 is tied to a specific facility. If the patient later transfers to a different nursing home — even one owned by the same company — a new PAS must be completed. If a nursing home resident is hospitalized and returns to the same facility after 60 days, the PAS must be redone.

What Happens If the Assessment Falls Short

If the PAS comes back with fewer than five deficits, you have options:

• Request a reassessment if you believe the evaluation didn't capture your parent's true functional level. Document the specific deficits you believe were missed or underscored.
• Pursue the Lighthouse Program instead — it requires only two ADL deficits and has no Medicaid eligibility requirement. While it doesn't provide the same scope of services as the ADW, it can provide up to 60 hours of monthly in-home care.
• Wait and reapply if your parent's condition is declining. A PAS taken three months later may yield different results.

The West Virginia Hospital Discharge Guide includes a PAS preparation workbook with a deficit tracking log, a self-assessment checklist that mirrors the PAS scoring categories, and guidance on documenting functional limitations for the Acentra Health nurse.

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