The PASRR Technical Assistance Center helps states fulfill the goals of Preadmission Screening and Resident Review

The basics of PASRR and dementia--when can the Level II be terminated?

PASRR regulations at 42 CFR 483.128(m) permit Level II evaluations to be terminated if the Level II evaluator finds that individual has:

“A primary diagnosis of dementia (including Alzheimer’s Disease or a related disorder)” (42 CFR 483.128(m)(2)(i)); or

“A non-primary diagnosis of dementia without a primary diagnosis that is a serious mental illness, and does not have a diagnosis of MR (ID) or a related condition” (42 CFR 483.128(m)(2)(ii)).

An evaluation may be halted if the person has a diagnosis solely of dementia, or a diagnosis of dementia in combination with a non-PASRR disability. However, an evaluation should not be halted if a PASRR disability has not yet been ruled out.

An evaluation may be halted if it is determined that the person has a primary diagnosis of dementia and a secondary diagnosis of mental illness.  Conversely, an evaluation should not be halted if the person has a primary diagnosis of mental illness and a secondary diagnosis of dementia. In making this determination, evaluators should ensure that there is sufficient evidence of (a) the dementia diagnosis and (b) the determination that dementia is primary.   There can be some confusion around what constitutes a “primary” diagnosis, so careful analysis of the evidence should be applied, and States should ensure that evaluators have a consistent understanding of how the term “primary” is being used.  

It is not appropriate to stop a Level II evaluation for a person with a diagnosis of intellectual disability if there is uncertainty about the intellectual disability diagnosis being secondary to the dementia diagnosis.

See FAQ on Categorical Determination – Dementia and Intellectual Disability

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