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
States may apply the categorical determination at 42 CFR 483.130(h), to address a decision not to provide specialized services to individuals with dementia and intellectual disability. “(h) Categorical determinations: Dementia and ID.
The dementia exclusion for mental illness allows for the Level II evaluator to stop the evaluation if they determine that the diagnosis of dementia is primary and the mental illness (MI) diagnosis is secondary. It is important to note that the diagnosis or verification of a diagnosis of MI and...
Since the ICD-10-CM coding went into effect on October 1, 2015, some State PASRR programs have reported an increase in PASRR volume, particularly in referrals for Level II Resident Reviews. The increase is largely attributed to the computer algorithm that converted ICD-9 codes to ICD-10 codes.
There is a common misconception about this. The simple answer is "no" -- a test of intllectual functioning is not required. Here's the reasoning, broken down into its components:
Yes, hospitals can perform Level II evaluations -- provided they have the qualified staff. In order to complete these evaluations, hospitals would first have to negotiate payment rates with the relevant state agency.
A PASRR Level I screen must be completed for all applicants to a Medicaid-certified nursing facility, regardless of payer. A Level I screen must be completed before a resident can be admitted into a nursing facility.
The CFR does not prescribe a particular method of conducting Level I evaluations, leaving states open to their own interpretations. In general, the Level I evaluation is based on pre-existing information, such as prior mental health diagnoses, and information gathered by the screener.
Only the share of time spent on PASRR-related activities can be claimed at the enhanced 75% match.
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.
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.
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).
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.