Any activity that cannot be clearly tied to the administration of PASRR cannot be claimed at the enhanced 75% match. Examples include, but are not limited to:
CMS generally reimburses nursing facility level of care (NF LOC) determinations at the 50% match rate. However, states that integrate their NF LOC determination activities with PASRR as described below can receive the enhanced 75% match rate.
Activities that can be clearly tied to the administration of PASRR, and in accordance with the Cost Allocation Plan, can be claimed at the enhanced 75% match.
A Cost Allocation Plan (CAP) is a narrative description of the procedures that a state will use in identifying, measuring, and allocating costs that it incurs in supporting programs it administers or supervises.
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...
The PASRR Final Rule (57 FR 56450) was published in 1992, at which time the term "mental retardation" was still widely used. In the time since the PASRR Final Rule was published, the term "intellectual disability" has come to replace "mental retardation" in most state laws.
A swing bed is a bed that changes (or "swings") between providing hospital services and providing Medicare or Medicaid nursing facility services.
The key to meaningful interstate coordination is to share Level II evaluation facts rather than Level II evaluation conclusions or outcomes.
The PASRR determination has implications for appropriate services, placement, and funding for such an individual. The state’s intellectual disability authority (SIDA) should be consulted in the review and discussion about how to deal with the lack of documentation to establish diagnosis prior to...
There are no federal requirements regarding who must request Level I screens, but all individuals who apply to reside in a Medicaid-certified nursing facility, regardless of payer, are required to receive a Level I screen to identify individuals with a MI or ID.
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).
The CFR does not specify how quickly Level I's must be completed, and with good reason: There is no baseline against which to establish timing requirements.
According to CFR 483.102(b)(3), an individual has an intellectual disability (previously mental retardation) if he or she has:
42 CFR 483.100-138 is largely mute about the timing of Resident Reviews. Recall that the CFR still described an annual Resident Review; it has not been updated to reflect subsequent legislative changes.
All individuals applying to a Medicaid-certified NF must be screened both for mental illness and for intellectual disability. An individual who tests positive on both screens must undergo a Level II for mental illness and a Level II for intellectual disability.
If an individual is transferred from one NF to another NF, they need not be re-evaluated. If the individual is transferred from one NF to another with an intervening hospital stay (e.g., for inpatient psychiatric treatment), a new Preadmission Screen is not required.
No. It is illegal for NFs to perform a PAS or RR. The PAS must be performed before an individual is admitted to the NF, and must be conducted by parties unaffiliated with the NF.
All individuals applying to a Medicaid-certified NF must undergo at minimum a Level I evaluation, whether they have TBI, some other mental disability, or no mental disability. Whether an individual with TBI should test positive at Level I depends upon when the TBI was acquired.
For a variety of reasons, including the availability of evaluators, it may not always be possible to perform a complete psychiatric evaluation on an individual before they are admitted to a NF.
The so-called “IMD exclusion” bars federal contributions to the cost of medically necessary inpatient care incurred in treating Medicaid beneficiaries ages 21-64 who receive care in institutions that qualify as IMDs.