The Wisconsin Department of Health Services would like to remind nursing facilities and PASRR county liaisons about the PASRR STE process. This information applies to individuals admitting to a nursing facility under a PASRR STE.

For nursing facilities

• Nursing facilities must request county approval for all STEs using the County Review of Nursing Home, IMD, or ICF/IID Referrals, F-20822. The PASRR county liaison must fill out, sign, and date F-20822.
• Requests for F-20822 must be made prior to admission.
• Requests for F-20822 should be made by completing a Level I PASRR screen for the resident, and then printing and faxing the Level I to the PASRR County Liaison.
  Once the signed F-20822 form is received, Nursing Facilities should upload the F-20822 to the individual’s specific PASRR ID within the ForwardHealth Level I Wizard to show the STE has been approved.
• If it is determined that the individual (who is suspected of having a mental illness and/or a development disability) will need to stay beyond the STE exemption period, a PASRR Level II Evaluation must be completed. Nursing Facilities should update the individual’s existing Level I in the ForwardHealth Wizard to indicate “Yes” to “Is the person staying longer than the permitted exemption period?” and upload the requested clinical documentation.

For PASRR county liaisons

• Nursing facilities will continue to fax requests for approval for STEs.
• Requests use the County Review of Nursing Home, IMD, or ICF/IID Referrals, F-20822, which is filled out by the PASRR county liaisons.
• PASRR county liaisons should sign and date F-20822.
• F-20822 should be returned to nursing facilities via fax in a timely manner.

For out-of-state STE requests

Nursing facilities seeking 30-day recuperative care short-term exemptions for out-of-state residents can request approval by faxing the PASRR 30-Day Information Required for PASRR Exemption Letter Request, F-02784, to the number listed on the form. This form does not apply to in-state residents.