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.
Nursing facility (NF) is a term of art that refers to long-term care facilities certified by the state survey agency (SSA) to provide services to Medicaid recipients.
Whether PASRR applies depends entirely on the certification of the facility, and not on any fact about the individual who is applying for admission to that facility. If an individual is applying to a Medicaid-certified facility, PASRR must be administered before he or she can be admitted.
Recall that PASRR stands for "Preadmission Screening and Resident Review." By definition, PAS ("Preadmission Screening") must be performed before an individual is admitted to a Medicaid-certified nursing facility.
No. Some significant changes in status may have a dramatic impact on a resident's MI/ID status, while others may have little or no impact.
A level II Preadmission Screen (PAS) must be completed for all applicants who meet NF level-of-care requirements, and who have been identified as having possible MI and/or ID by the Level I evaluation.
No federal requirement specifically addresses this issue. A Level II evaluation is required when there is a change in a resident’s condition. When a resident is returning from a hospital stay, there may be a clear change in condition.
No. The Balanced Budget act of 1996 eliminated the requirement for annual resident review, specifying that reviews are required instead upon changes in condition.
Level II involves a comprehensive evaluation of ID/MI, and a determination of the need for specialized services.