By Austin Senior Advisor Care Team · October 26, 2026
Every person entering a Medicaid-certified Texas nursing facility needs a PASRR Level 1 screening, private pay included. Here is who completes it, the four outcomes, which Austin-area agency does the evaluation, and where it stalls.
The screening nobody warns you about
Your mother is at Dell Seton Medical Center on Red River. The case manager says she needs a nursing facility, not assisted living, and she has found a bed with an opening Thursday. Then Thursday comes and the admission does not happen. Nobody can tell you exactly why. Somebody uses the word PASRR and spells it out slowly.
PASRR stands for Preadmission Screening and Resident Review. It is a federal requirement, written at 42 CFR 483.100 through 483.138, and it applies to every single person seeking admission to a Medicaid-certified nursing facility in Texas. Not Medicaid applicants. Everyone. HHSC says it plainly: the screening is required regardless of funding source, including for people paying privately and including veterans.
That last point catches families hard. You can be writing a $9,000 cheque every month out of your parent's savings and still be waiting on a state screening you had never heard of. Medicaid certification is a property of the building, not of your parent's wallet, and almost every nursing facility in the Austin area is Medicaid-certified.
What follows is what the process actually is, who holds each piece of it, and the three or four places it tends to stall. It is worth knowing before Thursday rather than after.
The form that has to exist before the bed does
The process starts with a one-page form called the PL1, the PASRR Level 1 Screening. It asks, among other things, three questions in Section C: is there a suspected mental illness, a suspected intellectual disability, or a suspected developmental disability? A later section records the type of admission being sought.
The PL1 is completed by the referring entity, which HHSC defines as the first entity that recommends or refers the person for nursing facility placement. From a hospital, that is the discharge planner. From a parent's own house, it can be the family. It can also be a physician's office, a home care agency, or law enforcement.
The nursing facility is explicitly not supposed to be the referring entity. HHSC's own guidance for nursing facilities describes facility staff working the screening at a hospital as a PASRR violation. Facility admissions staff may help fill the form in, but the referral has to come from whoever is actually sending your parent.
This matters because of where the bottleneck usually sits. If the discharge planner has not started the PL1, nothing downstream can move, and the nursing facility cannot fix it for them. If you are three days out from a discharge, the single most useful question you can ask is: has the PL1 been completed, and what did Section C come back as?
Four doors out of the Level 1 screen
The PL1 produces one of four outcomes, and which one you get determines whether anything else has to happen before your parent moves in.
Negative. No to all three Section C questions. The form travels with your parent in the transfer packet, the facility enters it into the state's long-term care portal at admission, and the PASRR process is over. This is the common case and it costs you nothing.
Exempted hospital discharge. A physician at a medical acute care hospital, not a psychiatric one, certifies that your parent is likely to need fewer than 30 days of nursing facility care. Short-term rehab after a hip fracture is the classic version. Even if the screen is positive, no evaluation is required unless the stay actually runs past 30 days. If it does, the portal alerts the local authority and the evaluation begins then.
Expedited admission. Seven specific situations let the admission happen immediately with the evaluation done afterwards: convalescent care expected to run longer than 30 days, terminal illness with a life expectancy of six months or less, severe physical illness such as ventilator dependence or Parkinson's disease, delirium pending assessment, emergency protective services for no more than seven days, brief respite for an in-home caregiver, and coma or brain-stem-level functioning.
Positive preadmission. This is the one that holds things up, and it applies when the person is coming from the community rather than from a hospital or another facility. The referring entity faxes the paper PL1 to the local authority, and the facility may not admit your parent and may not submit the form to the portal until the evaluation is done. Your parent stays where they are in the meantime. A hospital discharge is not in this category, which is precisely why the exempted and expedited routes exist.
Dementia is not what this screen is looking for
This is the most common misunderstanding about PASRR, and getting it wrong wastes weeks. Families with a parent who has Alzheimer's assume the mental illness question applies to them. It does not.
The federal definition at 42 CFR 483.102(b)(1)(i)(B) excludes a primary diagnosis of dementia, including Alzheimer's disease or a related disorder. A non-primary dementia diagnosis counts only when the primary diagnosis is itself a major mental disorder. HHSC states the practical version directly: a primary diagnosis of dementia or Alzheimer's does not make a person PASRR positive for mental illness.
What the mental illness screen is actually looking for is narrower than people expect. It requires a major mental disorder, functional impairment within the last three to six months, and a recent treatment history, meaning either more than one inpatient psychiatric hospitalisation in the past two years or a significant disruption in the past two years that required supportive services or law enforcement involvement. A long-standing anxiety diagnosis managed on medication, with no hospitalisations, typically does not clear that bar.
The disability questions have their own definitions. Intellectual disability means significant limits in intellectual functioning and adaptive behaviour that began before age 18. A related developmental condition means something like cerebral palsy, epilepsy, or a closely related condition, appearing before age 22, likely to continue indefinitely, and substantially limiting at least three of the following: self-care, language, learning, mobility, self-direction, and the capacity for independent living.
Every person still needs a PL1 whatever the diagnosis. A dementia diagnosis does not exempt your parent from the form. It just usually means the answer is no, and the form becomes a formality rather than a delay. If you have just received a diagnosis, our first-month guidance covers what else to deal with.
Who actually does the evaluation around Austin
If the screen is positive, the evaluation is not done by the hospital or the nursing facility. It is done by the local authority for the county, and in the Austin metro that is three different organisations depending on where your parent is going.
Travis County is served by Integral Care, at 1430 Collier St., Austin 78704. Its main line is 512-447-4141, and its 24-hour intake and crisis line is 512-472-4357. Integral Care is both the local mental health authority and the local intellectual and developmental disability authority for Travis County, so the same agency handles either arm of the screen.
Williamson County is served by Bluebonnet Trails Community Services, at 844-309-6385 or 512-255-1720, which also covers Bastrop, Burnet, Caldwell, Fayette, Gonzales, Guadalupe, and Lee. Hays County is served by Hill Country Mental Health and Developmental Disabilities Centers, at 833-426-4332 or 830-792-3300, which also covers Blanco, Comal, Kendall, Llano, and a long list of Hill Country counties further west.
That split is a genuinely practical thing to know. A discharge from a Round Rock hospital to a Georgetown facility routes to Bluebonnet Trails. A discharge from the same hospital to a South Austin facility routes to Integral Care. A Kyle or San Marcos placement routes to Hill Country. The county of the receiving facility decides which agency has the file, and an evaluation sitting in the wrong inbox is a week lost.
The timeframes are fixed. The local authority must make face-to-face contact within 72 hours of being notified, and must submit the completed evaluation within seven calendar days. That is the standard for preadmission, expedited, and exempted cases alike.
What a positive screen is supposed to get your parent
PASRR is not purely a gate. A positive evaluation unlocks a category called specialized services, which are things the nursing facility's ordinary daily rate does not include.
Some are delivered by the facility itself: habilitative physical, occupational, and speech therapy aimed at relearning or keeping daily living skills; a customized manual wheelchair with an adapted seating system; and durable medical equipment such as gait trainers, positioning wedges, and pressure-reducing mattresses.
Others are delivered by the local authority into the facility. For a resident with an intellectual or developmental disability, that list includes service coordination, day habilitation of up to five days a week and six hours a day, independent living skills training, behavioural support, and employment assistance and supported employment. For a resident with mental illness, the services are delivered through the state's Texas Resilience and Recovery framework.
Two documents are worth asking for by name. Form 1014, the PASRR Evaluation Summary Report, is completed by the local authority after the evaluation and must be given to your parent or their legally authorised representative before the care planning meeting, who signs to confirm they received it. And the facility must hold the initial interdisciplinary team meeting within 14 calendar days of admission. That meeting is where the specialized services get put into the actual care plan, which is a different thing from being recommended on paper.
Where it breaks, and what you can do about it
The honest weakness in this system is that nobody downstream has much incentive to chase it. HHSC's own guidance tells nursing facilities that if the local authority does not show up to do the evaluation, the facility has no required action and HHSC staff will follow up. That is accurate and it is also a description of a gap. The family is the only party with a reason to call on day four.
The second place it breaks is readmission after a hospital stay. The rules are specific. If your parent is an acute inpatient for more than 30 days and goes back to the same facility, a new PL1 is required. Under 30 days back to the same facility, no new PL1. Going to any different facility after any acute inpatient stay, a new PL1 is required. Families who move a parent between facilities after a hospitalisation routinely get caught by that third rule.
The third thing worth knowing is the boundary. PASRR covers nursing facilities. It does not cover assisted living, which in Texas is licensed and inspected on an entirely separate track. If the plan shifts from a nursing facility to a Type B assisted living community, PASRR stops being your problem and the licence type question starts. And if your parent already has a negative PL1 on file but later has a significant change in condition suggesting mental illness, 26 TAC 303.102 requires a resident review, with the evaluation due within seven calendar days of the alert.
If the process is stuck and the hospital clock is running, the long-term care ombudsman for the Austin region is Capital Area Area Agency on Aging at 512-916-6054, covering Travis, Williamson, Hays, Bastrop, Blanco, Burnet, Caldwell, Fayette, Lee, and Llano. Note that the Area Agency on Aging of Central Texas in Belton is a different agency serving different counties. Ombudsman help is free and confidential. For a discharge you believe is unsafe, our guide to appealing a hospital discharge covers the separate Medicare process, and how Texas hospital discharge works covers the rest of the sequence.
One last thing we cannot tell you: there is no published figure for how often PASRR delays an Austin-area nursing facility admission, or for how long. We looked. HHSC does not publish it by county or by local authority. Anyone who quotes you an average is guessing.
