The Missouri DA-124 form is the state’s Preadmission Screening and Resident Review (PASRR) Level I screening, and it must be completed and approved before anyone is admitted to a Medicaid-certified nursing facility in Missouri. The form has two parts: the DA-124 A/B, which collects social and medical information, and the DA-124 C, which screens for serious mental illness, intellectual disability, and related conditions. Both parts, along with supporting documentation, go to the Central Office Medical Review Unit (COMRU) at the Missouri Department of Health and Senior Services.1Missouri Department of Health and Senior Services. Preadmission Screening and Resident Review (PASRR)
The Two Parts of the Form
DA-124 A/B: Social and Medical
The DA-124 A/B collects the applicant’s demographic and medical information. You’ll need the person’s full legal name, Social Security number, and current primary medical diagnoses. This part is what COMRU uses to determine whether the applicant meets nursing facility level-of-care requirements and to track the applicant through Missouri’s long-term care system. Accuracy in the demographic fields matters; errors here delay everything downstream.2Missouri Department of Health and Senior Services. Pre-Admission Screening and Resident Review
DA-124 C: Mental Health and Intellectual Disability Screen
The DA-124 C is the actual PASRR Level I screening tool. It asks whether the applicant has a history of major mental health conditions such as schizophrenia or bipolar disorder, whether the person has been hospitalized for psychiatric reasons within the past two years, and whether there is evidence of an intellectual disability with onset before age 22.1Missouri Department of Health and Senior Services. Preadmission Screening and Resident Review (PASRR) It also screens for related conditions like cerebral palsy or epilepsy that could require additional support.
Section D of the DA-124 C is where you indicate whether the person qualifies for a special admission category, such as an exempted hospital discharge. If the applicant currently receives specialized services like intensive behavioral therapy or specialized rehabilitation, note that here as well.2Missouri Department of Health and Senior Services. Pre-Admission Screening and Resident Review
What to Gather Before You Start
Incomplete submissions are the most common reason for rejection. COMRU bounces back any application missing a current medication list or a physician signature, usually within a day of receiving it. Have everything on hand before you open the form:2Missouri Department of Health and Senior Services. Pre-Admission Screening and Resident Review
- Recent medical records and current primary diagnoses, with the name of the physician who provided each diagnosis.
- A complete current medication list, including every psychiatric medication. Address every mental-health medication checkbox on the DA-124 C.
- Dates and facility names for any psychiatric hospitalizations within the past two years.
- Any recent psychological evaluations documenting intellectual disability, developmental disability, or related conditions.
- Specific descriptions of functional limitations. Vague language triggers processing delays and requests for more documentation.
- The signature of a physician who can certify the medical information. This has to be in place before you submit.
How to Submit
As of July 1, 2025, Missouri accepts DA-124 submissions through an online portal. The link is on the DHSS PASRR page at health.mo.gov.1Missouri Department of Health and Senior Services. Preadmission Screening and Resident Review (PASRR) Send the DA-124 A/B, the DA-124 C, and all supporting documentation together. COMRU cannot process a Level I screening or a level-of-care determination unless everything arrives at once.2Missouri Department of Health and Senior Services. Pre-Admission Screening and Resident Review
For questions on submission or status, COMRU can be reached at 573-522-3092 or COMRU@health.mo.gov. DHSS also publishes an online training module that walks through each section of both forms, the special admission categories, and common errors.
When You Need to Submit a New DA-124
The screening is required for every applicant before admission, regardless of how the person pays for care, and whether they are coming from a private home, a hospital, or another nursing facility. You also need to submit fresh DA-124 A/B and DA-124 C forms in three other situations:2Missouri Department of Health and Senior Services. Pre-Admission Screening and Resident Review
- A current resident who did not previously meet the criteria for a Level II screening now shows signs of serious mental illness or intellectual disability. Submit the new forms with supporting documentation explaining why the resident now warrants a referral.
- The person has been out of a nursing facility for 60 days or longer and is seeking readmission.
- The Family Support Division requests a new screening for someone reapplying for Medicaid, or the Department of Mental Health requests a re-evaluation.
What Happens After You Submit
A DHSS medical health consultant reviews the forms to answer two questions: does the applicant meet nursing facility level-of-care requirements, and does the applicant show signs of serious mental illness, intellectual disability, or a related condition.3Missouri Department of Mental Health. Pre-Admission Screening and Resident Review If required documents are missing, the application is rejected and emailed back to the original submitter, usually within a day.2Missouri Department of Health and Senior Services. Pre-Admission Screening and Resident Review
A negative screening clears the way for admission. The facility receives confirmation through the portal, and that confirmation is the official record for state audits.
A positive screening means the reviewer has identified a suspected qualifying condition. DHSS then refers the individual to the Missouri Department of Mental Health for a Level II evaluation, an independent physical and mental assessment that determines whether the nursing facility can meet the person’s needs or whether specialized services are required.3Missouri Department of Mental Health. Pre-Admission Screening and Resident Review Federal regulations require these determinations in writing within an annual average of 7 to 9 working days after referral.4eCFR. 42 CFR 483.112 – Preadmission Screening of Applicants for Admission to NFs The Level II result places the applicant into one of three tracks: nursing facility appropriate with no specialized services, nursing facility appropriate with specialized services (such as maintenance-based physical therapy or behavioral support), or nursing facility not appropriate, in which case a different care setting is required.
The Exempted Hospital Discharge
One situation lets a person enter a nursing facility before the Level II evaluation is complete. Under 42 CFR 483.106(b), an exempted hospital discharge applies when all three of the following are true:5eCFR. 42 CFR 483.106 – Basic Rule
- The individual is admitted directly from a hospital after receiving acute inpatient care.
- Nursing facility services are needed for the same condition treated at the hospital.
- The attending physician certifies before admission that the individual is likely to need fewer than 30 days of nursing facility care.
The Level I screening is still required. The exemption only waives the Level II timeline. Mark Section D of the DA-124 C to indicate this category. If the stay runs longer than 30 days, the state mental health or intellectual disability authority must complete a Level II review within 40 calendar days of the original admission date.5eCFR. 42 CFR 483.106 – Basic Rule