According to §1903(a)(2)(C) of the Social Security Act and 42 CFR 433.15(b)(9), activities th
Yes, the CMS Long-Term Care Facility Resident Assessment Instrument (RAI) User’s Manual requires the NF to provide notification to the State-designated mental health (MH) or intellectual disability (ID) authority promptly
Level II evaluations for individuals with intellectual disabilities and/or related conditions:
Federal regulations governing PASRR do not specify restrictions on who can conduct Level I screens.
Part 42, Subpart C of the Code of Federal Regulations (CFR) contains the guiding regulations for PASRR compliance.
According to 42 CFR 483.106(a)(2), Basic Rule, the only true exemption from PASRR is the Exempted Hospital Discharge (EHD).
PASRR is guided by federal regulations that require: (1) all individuals being considered for admission to a Medicaid-certified nursing facility (NF) be screened prior to admissi
Per Section 1919(e)(7)(B)(iii) of the Social Security Act, Resident Reviews are required for NF residents experiencing a “significant change in condition.” (Note that this provision replaced the requirement that PASRR Resident Reviews must b
According to 42 CFR §483.106(b)(4) of the Code of Federal Regulations (CFR), when an individual is transferred from one nursing facility (NF) to another NF, with or without an intervening hospital stay, the individual is not considered a “new admission” and does not need preadmission screening.
Originally when the PASRR regulations were completed in 1992, Resident Reviews were required annually.
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.
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.
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.
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.
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.
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.
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.