Preadmission Screening for Nursing Home Placement in New Jersey

Why Clinical Screening Is Required

Before your parent can be admitted to a Medicaid-certified nursing home in New Jersey with Medicaid funding, the state requires proof that they actually need nursing-facility-level care. This is the clinical gate — one of two eligibility hurdles (the other being financial) that must be cleared for MLTSS enrollment.

The screening establishes a Nursing Facility Level of Care (NFLOC) determination. In practical terms, it documents that your parent needs hands-on assistance with at least three activities of daily living (bathing, dressing, toileting, transferring, eating) or has severe cognitive impairment requiring continuous supervision.

New Jersey uses three different screening mechanisms depending on the patient's situation. Which one applies depends on where your parent is and how they are being referred.

EARC: The Hospital Fast Track

The Enhanced At-Risk Criteria (EARC) screening is an expedited, online assessment completed by a certified hospital discharge planner or social worker. It is designed to prevent bed-blocking in acute-care hospitals by providing a fast-track clinical authorization for patients being discharged to a nursing home.

EARC generates a 90-day clinical authorization for SNF placement. But there is a hard time constraint: the authorization is valid for only 10 days after the determination. If the patient is not physically admitted to the nursing home within that 10-day window, the EARC expires and a new screening must be completed.

EARC is limited to patients who are either currently Medicaid-eligible (but not yet enrolled in an MCO) or expected to spend down and become financially eligible within 180 days of admission. The hospital discharge planner initiates the EARC screening directly through the state's online portal.

If your parent is already enrolled in an NJ FamilyCare Managed Care Organization, the EARC process is bypassed entirely. Instead, the hospital contacts the MCO directly for prior authorization. The MCO's care management team evaluates clinical necessity and authorizes a specific network facility.

OCCO Assessment: The In-Person Evaluation

When a patient does not qualify for EARC — transfers from psychiatric units, referrals to specialized care nursing facilities for traumatic brain injury or AIDS, or individuals seeking community-based waiver services — the hospital submits Form LTC-4 to request an onsite assessment from the Office of Community Choice Options (OCCO).

An OCCO clinician conducts an in-person evaluation using the NJ Choice assessment tool. NJ Choice is a standardized instrument that measures functional, medical, and cognitive deficits to produce a formal level-of-care determination.

For community-dwelling applicants (people who are not currently in a hospital or facility), the OCCO assessment is arranged through the county Aging and Disability Resource Connection (ADRC). Contact the statewide line at 1-877-222-3737 to initiate the referral.

The OCCO assessment is more thorough than EARC and takes longer to schedule. By unwritten administrative standard, the nurse must conduct the evaluation within 30 days of the request.

PASRR: The Mandatory Psychiatric Screen

Regardless of which clinical screening pathway applies, every individual entering a Medicaid-certified nursing home must undergo a Preadmission Screening and Resident Review (PASRR) Level I screen (Form LTC-26) before admission. This requirement is federal and applies regardless of payment source — Medicare, Medicaid, or private pay.

The PASRR Level I screen identifies individuals with suspected or diagnosed serious mental illness, intellectual disabilities, or developmental delays. It is a questionnaire, not a clinical examination.

If the Level I screen is negative (no indicators), the patient proceeds to admission.

If the Level I screen is positive, the patient cannot be admitted until the Department of Human Services conducts a comprehensive Level II evaluation. The Level II determines whether the nursing facility is the clinically appropriate setting or whether specialized psychiatric or developmental services are required instead. This adds significant time to the process and can alter the placement plan entirely.

How Families Can Prepare

You cannot complete these screenings yourself — they are performed by certified clinical staff. But you can prepare documentation that strengthens the case for NFLOC determination:

Document specific ADL dependencies. Before the screening, write down exactly which daily activities your parent cannot perform without hands-on help. "She needs help" is not enough. Specifics matter: "She cannot transfer from bed to wheelchair without two-person lift assist. She requires full hands-on bathing. She is incontinent and requires prompted toileting every two hours."

Gather medical records. Recent hospital discharge summaries, physician notes documenting cognitive decline, occupational therapy evaluations, and any neuropsychological testing support the clinical assessment.

Be present if possible. For OCCO assessments, the family member who provides daily care should be in the room. Parents sometimes minimize their deficits during clinical evaluations — stating they "can manage" activities they actually cannot perform safely. Your account of what happens on a daily basis is part of the clinical picture.

The Hospital-to-Home in New Jersey guide includes the ADL documentation worksheet, the EARC timeline checklist, and the complete county ADRC contact directory.

See more New Jersey guides →