What should a SNF pre-admission review cover?

The interdisciplinary review should consider whether the facility can safely meet the applicant’s clinical, behavioral, equipment, pharmacy, staffing, environmental, payer, and discharge-planning needs. Confirm required records and clarify unresolved risks before acceptance. Avoid promises that operations cannot reliably support.

The goal of pre-admission review

A pre-admission review answers one question before you say yes: can this facility safely meet this person’s needs from the first hour? Accepting residents you cannot care for leads to readmissions, harm, grievances and survey citations. Federal rules also require facilities to admit only residents whose needs they can meet and to follow specific screening and admission-agreement requirements.

What to review

1. Clinical needs: diagnoses, recent hospital course, current orders, wounds, IV therapy, oxygen, tracheostomy or ventilator needs, dialysis schedule, tube feeding, isolation requirements, pain management and recent falls.
2. Medications: high-cost or specialty drugs, controlled substances, antibiotics with end dates, and medications your pharmacy may not stock quickly.
3. Behavioral and cognitive needs: dementia, wandering or elopement history, behaviors, substance use and psychiatric diagnoses.
4. PASRR: every applicant must have a Level I Preadmission Screening and Resident Review before admission (42 CFR 483.20(k)). If it identifies possible serious mental illness or intellectual disability, the Level II evaluation and determination must be completed per state rules before admission, except for allowed exemptions such as certain hospital discharges.
5. Functional status and equipment: transfer needs, weight for bariatric equipment, specialty mattress and mobility devices.
6. Payer and authorization: Medicare eligibility and qualifying stay, Medicare Advantage authorization, Medicaid status or pending application, and private pay arrangements.
7. Discharge goals: short-term rehab versus long-term care, and the resident’s own goals and preferences.

Check against your facility assessment

Compare the applicant’s needs with your facility assessment under 42 CFR 483.71. If you do not currently have staff competencies, equipment or services for a need, you must either arrange them before admission or decline.

Admission-agreement rules to remember

• You cannot require a third-party guarantee of payment as a condition of admission (42 CFR 483.15(a)(3)).
• You cannot require residents to waive their rights or potential Medicare or Medicaid eligibility.
• Policies on transfer, discharge and the services you provide must be the same for all residents regardless of payment source (42 CFR 483.15(a)).

Who should be involved

The admissions director coordinates. The DON or a clinical liaison reviews clinical needs. The business office confirms payer. For complex cases, include therapy, dietary, pharmacy and the administrator. Use a checklist so every referral gets the same review.

A quick go/no-go checklist

Common mistakes

• Accepting based on the referral summary without reviewing hospital notes and orders.
• Admitting on Friday evening before medications or equipment are confirmed.
• Missing PASRR Level II requirements.
• Not telling the floor what is coming.

Frequently asked questions

How fast should we respond to referrals?

Hospitals often choose the first facility that responds. Aim to answer within one to two hours, but not at the expense of a real clinical review.

Can we decline a referral?

Yes, if you cannot meet the person’s needs. Document the reason, and make sure decisions are not discriminatory.

CMS resources: CMS Nursing Homes guidance and the current 42 CFR Part 483.