A resident review (RR) and determination must be conducted promptly (within an average of 7-9 days) after a nursing facility has notified the state mental health authority or state intellectual disability authority that there has been a significant change in the resident’s physical or mental condition that affects the individual's disability-specific needs.
There is no federal guideline specific to PASRR that defines “significant change in condition.” CMS recommends states utilize the change of condition protocol in the MDS 3.0 to inform what defines “significant change in condition.” According to the MDS 3.0 manual (page 2-20 attached below), a “significant change” is a decline or improvement in a resident’s status that:
- Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, is not “self-limiting” (for declines only);
- Impacts more than one area of the resident’s health status; and
- Requires interdisciplinary review and/or revision of the care plan.
The state Medicaid agency can work with the state mental health and state intellectual disability authorities to define the set of criteria that would lead to a referral for a Level II resident review. Good person-centered practice is to reassess an individual whenever there is a possibility that his or her MI/ID condition might have changed, because those changes would require a revised plan of care.