FAQs

The Code of Federal Regulations (CFR) provides no specific guidance related to retention of PASRR records, but it does make clear that retention of PASRR records is a requirement.

A Level II evaluation may be halted if the person has a diagnosis solely of dementia, or a diagnosis of dementia in combination with a non-PASRR disability. However, a Level II evaluation should not be halted if a PASRR disability has not yet been ruled out.

There is a common misconception about this. The simple answer is "no" -- a test of intellectual functioning (IQ test) is not required by PASRR regulations.

"The Code of Federal Regulations (CFR) at §483.130(d) provides examples of categories for which the State mental health or intellectual disability authority may make an advance group determination that nursing facility (NF) services are needed, that include: (2) Terminal illness, as defined for hospice purposes in §418.3 of this chapter.

A hospital that has a Medicare provider agreement may provide post-hospital extended care services as specified in 42 CFR 409.20. Rural hospitals with fewer than 100 beds are allowed to use their inpatient facilities to furnish skilled nursing facility services to Medicare beneficiaries and Medicaid recipients.

Regardless of their known diagnoses, all individuals applying to a Medicaid-certified nursing facility (NF) must undergo a Level I screen to determine if the individual possibly has a condition meeting PASRR’s definition of mental illness, intellectual disability or a related condition. A person with a TBI could potentially meet the criteria for a “related condition,” and thus require a Level II evaluation and consideration for specialized services

42 CFR 483.130(h) provides that the State intellectual disability authority may make categorical determinations that individuals with dementia, which exists in combination with an intellectual disability (ID) or a related condition, do not need specialized services.

Per the CFR, at 42 CFR 435.1010, an Institution for Mental Diseases (IMD) is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. Whether an institution is an IMD is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such.CMS’s guidance on how to determine when the IMD exclusion applies is included in Part 4 of the State Medicaid Manual. A key criterion is if the current need for institutionalization for more than 50 percent of all the residents in the facility results from mental diseases. It is important to note that a NF may be an IMD if more than 50 percent of the NF residents require specialized services for treatment of serious mental illnesses, as defined in 42 CFR 483.102(b).

All individuals applying to a Medicaid-certified nursing facility (NF) must be screened for both mental illness and intellectual disability. According to 483.128 (e), if a Level II evaluation is required “The State's PASRR program must use at least the evaluative criteria of §483.130 (if one or both determinations can easily be made categorically as described in §483.130) or of §§483.132 and 483.134 or §483.136 (or, in the case of individuals with both MI and IID, §§483.132, 483.134 and 483.136 if a more extensive individualized evaluation is required).”