A.
Preadmission screening shall be performed for all individuals seeking admission
to a Medicare or Medicaid-certified nursing facility, regardless of the source
of payment for the nursing facility services or the individuals known
diagnoses. The purpose of the preadmission screening and resident review
(PASRR) process is to identify applicants or residents who have a diagnosis of
serious mental illness or mental retardation (hereafter referred to as
intellectual/developmental disability) and to determine whether these
individuals require nursing facility services and/or specialized services for
their mental condition.
1. An individual is
considered to have a serious mental illness (MI) if the individual meets the
requirements on diagnosis, level of impairment and duration of illness as
described in federal regulations.
a.
Diagnosis. The individual has a diagnosis of major mental disorder as
categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th
Edition (DSM IV) or its successor.
i. A
mental disorder may include schizophrenia, mood, paranoid, panic, or other
severe anxiety disorder, somatoform disorder, personality disorder, other
psychotic disorder, or another mental disorder that may lead to a chronic
disability.
ii. A primary diagnosis
of dementia, including Alzheimer's disease or a related disorder, or a
non-primary diagnosis of dementia would not be included as a mental disorder
unless the primary diagnosis is a major mental disorder as previously
defined.
b. Level of
Impairment. Within the past three to six months, the mental disorder has
resulted in functional limitations in major life activities that would be
appropriate for the individual's developmental stage.
c. Duration of Illness. The individual's
treatment history indicates that he/she:
i.
received psychiatric services more intensive than outpatient treatment more
than once in the past two years; or
ii. as a result of the disorder, experienced
an episode of significant disruption to the normal living situation within the
last two years that either required supportive services to maintain functioning
at home (or in a residential treatment environment) or resulted in intervention
by housing or law enforcement officials.
2. An individual is considered to have
intellectual/developmental disability if the individual meets the criteria as
described in the
American Association on Intellectual and Developmental
Disabilities Manual on Intellectual Disability: Definition, Classification, and
Systems of Supports, 11th edition, or its successor.
a.
Intellectual/Developmental
Disability (I/DD)-a disability that originates before
the age of 18 and is characterized by significant limitations in both
intellectual functioning (reasoning, learning, problem solving) and adaptive
behavior, which covers a range of everyday social and practical
skills.
b. These provisions also
apply to persons with related conditions as described in federal
regulations.
