Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1181 - NURSING FACILITY CARE
Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY
PREADMISSION SCREENING PROGRAM
Section 1181.541 - Preadmission screening program

Universal Citation: 55 PA Code ยง 1181.541

Current through Register Vol. 54, No. 44, November 2, 2024

(a) Section 1396r(e)(7)(A) of 42 U.S.C.A. provides: "Effective January 1, 1989, the State must have in effect a preadmission screening program, for making determinations using criteria developed under 42 U.S.C.A. § 1396r(f)(8) and described in 42 U.S.C.A. § 1396r(b)(3)(F) for mentally ill and mentally retarded individuals (as defined in subparagraph G) who are admitted to nursing facilities on or after January 1, 1989. The failure of the Secretary (of HHS) to develop minimum criteria . . . shall not relieve any State of its responsibility to have a preadmission screening program under this subparagraph."

(b) Section 1396r(b)(3)(F) of 42 U.S.C.A. provides: "A nursing facility must not admit, on or after January 1, 1989, any new resident who-"

(1) "is mentally ill (as defined in (42 U.S.C.A. § 1396r(e)(7)(G)(i))) unless the State mental health authority has determined (based on an independent physical and mental evaluation performed by a person or entity other than the State mental health authority) prior to admission that, because of the physical and mental condition of the individual, the individual requires the level of services provided by a nursing facility, and, if the individual requires such level of services, whether the individual requires active treatment for mental illness, or"

(2) "is mentally retarded (as defined in (42 U.S.C.A. § 1396r(e) (7)(G)(ii))) unless the State mental retardation or developmental disabilities authority has determined that, because of the physical and mental condition of the individual, the individual requires the level of services provided by a nursing facility, and, if the individual requires such level of services, whether the individual requires active treatment for mental retardation."

(c) Health and Human Services (HHS) has issued draft criteria for states to use in making preadmission screening determinations. The preadmission screening program is being implemented by the Department based on its analysis of the HHS draft criteria and the requirements which Congress has established in OBRA-87 itself. The Department is the state authority with respect to the administration of mental health, mental retardation and developmental disability programs, as well as for the MA Program.

This section cited in 55 Pa. Code § 1181.511 (relating to provider conditions of participation).

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