How to Fill Out and Submit the Maryland PASRR Level I Screen

The Maryland PASRR Level I screen is a short yes-or-no questionnaire that hospital discharge planners and nursing facility staff submit through Telligen’s Qualitrac portal before anyone is admitted to a Medicaid-certified nursing facility in the state. It flags whether the person may have a serious mental illness, an intellectual disability, or a related condition that calls for a deeper Level II evaluation. Most determinations come back within one to three business days.

Who the Screen Applies To

Federal rules require a Level I screen for every person seeking admission to a Medicaid-certified nursing facility, no matter how care is paid for: Medicaid, Medicare, private insurance, or out of pocket.¹ Private-pay residents are not exempt from the screen itself, though the state does not cover specialized services identified for them if a Level II is triggered.

The screen is looking for two things. The first is a serious mental illness: schizophrenia, a mood disorder, a paranoid or severe anxiety disorder, a personality disorder, or another psychotic disorder that causes functional limitations and has required more than routine outpatient treatment within the past two years.² The second is an intellectual disability or a related condition such as cerebral palsy or epilepsy that appeared before age 22 and is expected to continue indefinitely.

A primary diagnosis of dementia, including Alzheimer’s disease, does not by itself produce a positive screen. If the person has both dementia and a major mental disorder, only a Level II evaluator can decide which is primary; the Level I screener does not make that call.³

Where to Get the Form

Maryland’s live submission runs through Telligen’s Qualitrac system at telligenmd.qualitrac.com. If you do not yet have a login, email qtregistration@telligen.com or call (888) 276-7075.⁴ A PDF of the paper form (DHMH 4345) is still posted on the Maryland Department of Health site and is useful as a worksheet or reference, but the submission has to be made in Qualitrac.⁵

Filling Out the Form

Identifying Information

The form opens with the individual’s legal name, date of birth, Social Security number, sex, the actual or requested nursing facility admission date, current location, and a contact person with a phone number. The member ID and date of birth have to match what is on file in Maryland’s MMIS system exactly; otherwise, Qualitrac will not pull the member record and you cannot move forward.⁴ If the patient is not found, use “Add Member” to create the record before starting the screen.

Section A: Exempted Hospital Discharge

Section A decides whether the person qualifies for a short-term bypass of the Level II evaluation. Three things must all be true:

The person is being admitted directly from a hospital after acute inpatient care.
The nursing facility stay is for the same condition treated in the hospital.
The attending physician has certified, before admission, that the stay will likely last fewer than 30 days.⁶

Three “yes” answers mean you can sign, date, and submit without completing the rest. One “no” means you continue through Sections B and C. The physician-signed exemption form must be uploaded to the Documentation panel in Qualitrac.⁴ One caution: if a resident admitted under the exemption ends up staying 30 days or longer, a new PASRR screen and resident review has to be completed within 40 calendar days of the original admission.¹

Section B: Intellectual Disability and Related Conditions

Four yes-or-no questions:

Does the individual have a diagnosis of ID or a related condition? If yes, specify.
Is there any history of ID or a related condition before age 22?
Does the person show cognitive or behavioral signs that may point to ID or a related condition?
Is the individual being referred by, or found eligible for services by, an agency that serves people with ID or related conditions?⁶

A single “yes” is enough to screen positive on this section.

Section C: Serious Mental Illness

Three questions, and all three have to be “yes” for a positive MI result:

Diagnosis: does the individual have a major mental disorder? List the diagnosis and DSM code.
Level of impairment: has the disorder caused serious functional limitations in the past three to six months, such as difficulty with interpersonal functioning, concentration, or adapting to change?
Recent treatment: in the past two years, has the person received psychiatric treatment more intensive than outpatient care more than once (for example, partial hospitalization or inpatient stays), or had a significant disruption to their living situation that required supportive services or intervention by housing or law enforcement?⁶

This mirrors the federal definition at 42 CFR 483.102(b)(1). A diagnosis by itself is not enough.² If any one of the three answers is “no,” the MI section screens negative.

Submitting Through Qualitrac

In the portal, select “PASRR Level 1” as the review type and “Prospective” as the timing. Work through the required panels: Authorization Request, Dates of Service, Coverage, Providers, Diagnosis, Procedures, and Documentation. The procedure panel auto-populates for a Level 1 PASRR. In Documentation, upload the signed Exempted Hospital Discharge form if Section A applies, or a copy of the patient’s face sheet. Type your username into the attestation and click Submit.⁴ You can monitor the status from your Qualitrac dashboard. If the portal is inaccessible, call Telligen at (888) 276-7075.

After You Submit

Maryland regulation sets the turnaround at three business days for hospital-to-nursing-facility transfers and five business days for all other screenings. Telligen has averaged about one calendar day in practice.⁷

A negative determination clears the way for admission. A positive determination triggers a referral for a Level II evaluation, a more comprehensive assessment of whether the person actually needs nursing facility care, community-based care, or specialized services. In Maryland the referral goes to the local health department, which conducts the evaluation and forwards findings to the Behavioral Health Administration for mental illness cases or the Developmental Disabilities Administration for intellectual disability cases.⁸ The facility has to wait for the final Level II determination letter before accepting the resident.

Mistakes That Delay the Screen

The single most common problem is a mismatch between the member ID or date of birth entered in Qualitrac and what MMIS has on file. The record will not come up, and the screen cannot proceed.⁴

Section A is the next frequent trip-up. If any one of the three exemption questions is “no,” Sections B and C still have to be completed; submitting on three “yes” answers when the physician has not actually certified a stay under 30 days creates a false exemption that unravels later.

In Section C, a positive screen requires all three criteria. Flagging someone positive on diagnosis alone sends them into an unnecessary Level II and delays admission. Check the clinical record for the functional limitation and the qualifying treatment history before marking the form.

When a Resident Needs a New Screen

The Level I is not a one-time task. Federal law requires a new review whenever a resident already in a nursing facility has a significant change in physical or mental condition, meaning a major decline or improvement that will not resolve on its own, affects more than one area of health, and calls for the care plan to be revised.⁹ Typical triggers include increased behavioral or psychiatric symptoms, symptoms that have not responded to treatment, a medical improvement big enough that placement may need to change, a resident expressing a wish to leave, a return from an inpatient psychiatric stay, or new evidence of an intellectual disability that was not previously identified.

Outside of those triggers, the PASRR done at admission stays on file in Maryland. Facilities do not have to repeat it quarterly.⁷

1
eCFR. 42 CFR Part 483 Subpart C – Preadmission Screening and Annual Review of Mentally Ill and Mentally Retarded Individuals
2
eCFR. 42 CFR 483.102 – Applicability and Definitions
3
PASRRAssist. PASRR Disabilities
4
Telligen Qualitrac. Maryland UCA: PASRR and Level of Care Request Training – Qualitrac
5
Maryland Department of Health. Pre-Admission Screening and Resident Review (PASRR) for Individuals with Mental Illness
6
Maryland Department of Health. Maryland PASRR Level I ID Screen Form
7
Maryland Department of Health. PASRR FAQ
8
Maryland Department of Health. Preadmission Screening and Resident Review
9
PASRR Technical Assistance Center. What Is Considered a Significant Change in Condition