Nursing Facility Pre-Admission Screening

Any person seeking nursing facility placement in Indiana is required by law to complete the pre-admission screening (PAS) process. This process determines the appropriateness of placement, but does not commit an individual to facility placement. Procedures must be explained to you by the nursing facility staff when you apply for admission.

For more detailed information and overview click here: Indiana’s Pre-Admission Screening IPAS Program

Steps to Entering a Nursing Home

1. Phone Area 9 Agency for more program explanation.
2. Pick up required forms at the Area 9 Agency, any nursing facility or click forms below.
3. Choose a nursing facility of your choice. You can click on “Listing of Area Nursing Home Facilities” below and then visit the facilities you have selected.
4. Return completed forms to Area 9 Agency.
5. The Area 9 PAS department will schedule an in-home visit for the pre-admission screening.
6. An Area 9 PAS assessor will complete the screening and issue a determination of the need.
7. In-home services will be reviewed for Indiana residents.
8. Applicant can then enter the nursing facility.

Items that the nursing facilities will require include chest x-rays and physician’s orders.

Links for Consumers

• Centers for Medicare and Medicaid Nursing Home Assessments/Ratings
• Indiana Department of Health Nursing Facility Report Cards
• Listing of Area Nursing Facilities

During a typical screening, these documents must be completed in a timely manner:

• Application for Long-Term Care Services
• Physician Certification for Long-Term Care Services
• PASRR Level I
• Physician Script for an Emergency Admit, or if a person is an observation bed, a doctor’s order is accepted. (provided by physician)

For Nursing Facilities

Links to documents of interest for nursing facilities:

• Electronic 450B (e-450B) site
• New policies effective 1/1/13 regarding the 450B
• 450B with special language for Priority Diversions or Conversions (print only)
• Freedom of choice form (print only)
• 450B SA/DE
• PAS Do Not Agree Form
• APS Short Term Stay Form
• Link to PAS Manual:

  Part I

  Part II

• Listing of Area Nursing Facilities

Time Frame

The time from initial application to the rendering of a decision is 25 days or less for most applicants. Emergency authorizations may be given when appropriate.

Decision

Notification of the decision for placement will be mailed to you by Area 9. The local decision (4B) is effective for 90 days. However, if there is no admission by that time, the process must be re-initiated. Placement may be made within 90 days of the approval.

Refusal to Participate

Under law, Medicaid funds for your daily care will be withheld for up to one year if you refuse PAS. Medicaid information may be obtained by contacting the county Division of Family Resources.

Out of State

Indiana residents in an out-of-state hospital follow regular PAS procedures for approval to enter an Indiana nursing facility. Out-of-state residents requesting placement in an Indiana facility must await completion of the PAS process prior to admission. When an out of state resident admits to an Indiana hospital via an emergency room, that documentation is required with application. Out of state admissions require: 30 days of doctors orders, nursing notes, medicine records.

The following are HIPAA required release forms:

• Notice of Privacy Practices
• Acknowledgement of Receipt of Notice of Privacy Practices
• Authorization to Release Personal Information

Appeals

Directions on how to appeal a PAS decision are provided on the “PAS From 4B”, which is mailed to you indicating the decision for placement.