The Code of Federal Regulations (CFR) at §483.130(d) provides examples of categories for which the State mental health or intellectual disability authority may make an advance group determination that nursing facility (NF) services are needed, that include: (2) Terminal illness, as defined for hospice purposes in §418.3 of this chapter. The definition provided of hospice care is:
“Hospice care means a comprehensive set of services described in 1861(dd)(1) of the Act, identified and coordinated by an interdisciplinary group to provide for the physical, psychosocial, spiritual, and emotional needs of a terminally ill patient and/or family members, as delineated in a specific patient plan of care.”
PASRR applies by the certification type of a facility. It does not depend upon any facts about the individual, including insurance type (Medicaid, Medicare, or private pay). An individual who elects to enter hospice in a Medicaid-certified NF cannot be admitted until PASRR is complete. In other words, there must be documentation of a negative Level I screening or a completed Level II evaluation and determination.
As for NFs generally, residents who choose hospice are still subject to Resident Review upon Significant Change in Status. The one caveat is if the institution has distinct parts that are not Medicaid-certified. If an individual choosing hospice enters a facility part that is not Medicaid-certified, then PASRR does not apply.