The WV PAS-2000 nursing home form is West Virginia’s pre-admission screening tool for deciding whether someone qualifies for Medicaid-funded nursing facility care or a home and community-based waiver program. A physician completes it after examining the applicant, submits it through the Atrezzo portal, and an Acentra Health nurse reviews the documentation against the state’s clinical benchmarks. Getting it right the first time matters, because missing fields, absent signatures, or thin documentation of functional deficits produce denials that delay placement by weeks.
Where to Get the Form
The PAS-2000 lives on the Acentra Health WV ASO website as a fillable PDF, with a second handwriting version labeled “WV PAS + Supplemental Questions.”1WV ASO. Nursing Facility Program Applicants and families do not complete it themselves. The clinical sections must be filled out by a physician (M.D. or D.O.) who has evaluated the person, so the practical first step is asking the applicant’s doctor, hospital discharge planner, or a nursing facility admissions coordinator to start the process.2WV Policy. 427.00 – Nursing Home Pre-Admission Screening
What you can do in advance is put the records the provider will need in one place:
- A current medication list with dosages and frequency for every prescription.
- Recent hospital records — discharge summaries, operative reports, and imaging from the past several months.
- Chronic condition documentation, including diagnosis letters, specialist notes, and treatment plans for conditions like dementia, diabetes, or heart failure.
- Insurance and demographic details: Medicaid ID if already enrolled, Social Security number, date of birth, and current address.
Having this material assembled before the physician sits down with the form prevents the back-and-forth that stalls so many applications.
Who Signs the Form
Two signatures are required on the hard copy: the physician who performed the clinical evaluation, and the applicant or their authorized representative.2WV Policy. 427.00 – Nursing Home Pre-Admission Screening Both must appear on a printed copy of the form even when the data has been entered electronically. If the provider files through the online portal, the signed hard copy should be faxed or attached to the electronic submission.
Self-reported information alone will not carry the clinical sections. The physician has to base the assessment on their own examination and the applicant’s documented medical history, not on what the family describes at an intake conversation. A form completed without direct physician evaluation gets rejected.
What the Clinical Review Looks For
The PAS-2000 measures the applicant’s ability to perform activities of daily living and documents the medical conditions that require professional oversight. To qualify for the Medicaid nursing facility benefit, the assessment must identify at least five deficits.2WV Policy. 427.00 – Nursing Home Pre-Admission Screening Fewer than five and the request is denied. Deficit categories include bathing, dressing, grooming, eating, toileting, and mobility, each scored by how much help the person actually needs, from full independence to total hands-on assistance.
Medical conditions that demand daily professional intervention also count. Wound care for advanced pressure ulcers, physician-ordered daily injections, ventilator dependence, and intravenous therapy are the kinds of needs that show why a home setting without clinical staff would be unsafe. The provider has to describe these conditions specifically enough that a reviewing nurse can verify clinical necessity. Vague notes like “needs help with daily tasks” will not survive review.
The most common mistake on this section is documenting the applicant’s best-day performance rather than their typical daily reality. The form should reflect what the person needs on an average day, not what they can occasionally manage with maximum effort. If someone can dress themselves once in a while but usually cannot, the score should reflect the usual inability. Deficits that do not line up with the underlying diagnoses — severe mobility limitations on someone with no documented musculoskeletal or neurological condition, for example — raise a flag and trigger additional review or denial.
Submitting Through Atrezzo
Since March 2021, providers have submitted PAS-2000 data through the Atrezzo portal at portal.kepro.com.1WV ASO. Nursing Facility Program The older method of uploading through the West Virginia Medicaid Management Information System is no longer the standard pathway. Providers new to Atrezzo have to complete a web user request form to gain access.
Inside the portal, the provider searches for the applicant using name and date of birth, selects “Assessment” as the case type, and chooses the West Virginia contract and plan. The system walks through a questionnaire covering every section of the PAS. Each section auto-saves, and all required fields must show complete before the system permits final submission.3WV ASO. West Virginia PASRR Atrezzo User Guide Providers can also submit by fax. Either way, the signed hard copy with both signatures needs to accompany the submission.
File the form well ahead of any planned admission. For hospital discharges to a nursing facility, the hospital’s case management team usually handles this. Families arranging a planned admission from home should allow at least two to three weeks for the full screening and review cycle.
What Happens After You Submit
Once a complete PAS-2000 reaches the system, an Acentra Health nurse reviews the documented deficits and medical needs against the Bureau for Medical Services clinical benchmarks.1WV ASO. Nursing Facility Program This Level I review is typically completed within two business days of receiving a complete submission.2WV Policy. 427.00 – Nursing Home Pre-Admission Screening If the reviewer needs more information — a missing lab result, clarification on a diagnosis, or a fuller description of a deficit — the provider has five business days to respond. Miss that window and the PAS is deactivated and has to be resubmitted from scratch.
The reviewer is deciding two things: whether the applicant meets medical eligibility for nursing facility placement, and whether the applicant may need a Level II PASRR evaluation for mental illness or intellectual disability. If Level I flags one of those possibilities, the case moves to Level II, adding five to seven business days.4WV ASO. Level II Attachment
Level II PASRR Screening
Federal law requires that anyone entering a Medicaid-certified nursing facility be screened for serious mental illness, intellectual disability, or related conditions. When Level I flags a possibility, the case is referred to Psychological Consultation & Assessment, Inc. (PC&A), which conducts Level II evaluations either on-site or through a desk review of clinical records.2WV Policy. 427.00 – Nursing Home Pre-Admission Screening A desk review is often finished within 24 hours if no additional records are needed.4WV ASO. Level II Attachment
Level II determines whether the individual needs specialized services that a nursing facility may not be equipped to provide, such as active psychiatric treatment or habilitation programs for intellectual disabilities. A finding that someone needs specialized services does not automatically disqualify them from nursing facility admission, but the care plan has to include those services or the person may be better served in an alternative setting.
The Notice of Decision
After review concludes, the applicant receives a formal Notice of Decision by mail stating whether nursing facility level of care was approved or denied, the specific reasons, and the effective date. Keep a copy of the submitted PAS-2000, any fax confirmations, and the Notice of Decision together. You will need them if you appeal, and if questions come up later about coverage dates.
What Clinical Approval Doesn’t Cover
Passing the PAS-2000 clinical screening is only half of Medicaid eligibility for nursing home care. The applicant must also meet Medicaid’s financial rules, which apply an income test, an asset test, spousal impoverishment protections for a spouse remaining at home, and a five-year look-back on asset transfers. Those rules run on their own track and are not decided through the PAS-2000. Families should also be aware that Medicaid can recover nursing facility payments from the estate of a recipient who was 55 or older when benefits were paid, with specific exemptions.5WV BMS. Chapter 900 Estate Recovery Both topics deserve their own conversation with an elder law attorney, ideally well before an application is filed.
Appealing a Denial
If the PAS-2000 review comes back as a denial, the applicant has the right to a fair hearing. West Virginia allows 90 days from the effective date of the action to file the request.6WV DHHR. Fair Hearing and/or Conference Request Form The request can be made orally or in writing, and you can also request a pre-hearing conference — an informal meeting that sometimes resolves the issue without a full hearing.
Appeals go to the Board of Review, which operates under the West Virginia Office of Inspector General and is independent from the Bureau for Medical Services and Acentra Health. You can reach them by:7WV OIG. Board of Review
- Mail: Board of Review, State Capitol Complex, Building 6, Room 817, Charleston, WV 25305
- Email: OIGBOR@wv.gov
- Phone: 304-352-0805
- Online: an electronic submission form on the Board of Review website
At the hearing, you can present additional medical evidence, bring witnesses, and have an attorney or authorized representative argue on your behalf. If the original denial rested on thin documentation rather than a genuine lack of medical need, submitting more detailed physician notes or updated medical records often turns the case around. A successful appeal can produce retroactive approval of benefits back to the original application period. Missing the 90-day window forfeits the right to contest that specific determination, though nothing stops you from filing a new PAS-2000 with stronger documentation.