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Services and Supports Required for NF Residents with MI and ID: Meaning of PASRR "Specialized Services"

Tuesday, October 1, 2013

These slides provide written CMS guidance clarifying the definition of "Specialized Services" as the term is used in the PASRR program.

These slides were first presented at the 2013 Annual Conference on Home and Community-Based Services.


Why does the PTAC site make reference to "mental retardation?"

Friday, June 28, 2013

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. Since the passage of "Rosa's Law" in 2010, the term "intellectual disability" must replace "mental retardation" in all federal language. 

Since the federal PASRR regulations have not been revised since they were first published in 1992, the PASRR Final Rule continues to use the term "mental retardation." However, the online version of the Code of Federal Regulations now uses "intellectual disability." In the language used on this site, we adhere to the requirements of Rosa's Law and use the phrase "intellectual disability."

Required Disability-Specific Services: Relationship to PASRR "Specialized Services"

June 11, 2013
Tuesday, June 11, 2013

The June 2013 PASRR webinar took place on Tuesday, June 11 at 1:00PM - 2:30PM Eastern (10AM Pacific) and featured Dan Timmel of the Centers for Medicare and Medicaid Services. Ed Kako of the PASRR Technical Assistance Center moderated the webinar.


2012 Review of State PASRR Policies and Procedures National Report

Monday, June 11, 2012

This report (below) presents the first systematic, empirical effort to document the design of PASRR systems in all States and the District of Columbia. Staff from the PASRR Technical Assistance Center (PTAC) reviewed States policies and procedures kept on file by PASRR Coordinator in CMS Regional Offices. Documentation was collected in late 2009; the results of this review therefore represent a snapshot of PASRR systems design at that time. This review does not capture any information on the implementation of these programs.

The PTAC review team continues to collect State feedback and additional documentation and plans to incorporate this information into its findings. Some States have undertaken dramatic systems change since the documents were first obtained from the Regional Offices in 2009. Specifically, the following states will be reassessed for the subsequent version of this report: Arkansas, Florida, Georgia, Idaho, Iowa, Maine, Massachusetts, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Washington, and Wyoming. Future versions of this report will capture those systems changes.

 


PASRR Regulations (Annotated)

Thursday, February 9, 2012

This file contains an annotated version of the PASRR regulations, with a note explaining the repeal of the "Annual" Requirement in 1996. This document also contains references to other regulations with direct connections to PASRR, making it easier to see how PASRR fits into other aspects of Medicaid.


What is the PASRR definition of intellectual disability?

Wednesday, August 10, 2011

According to CFR 483.102(b)(3), an individual has an intellectual disability (previously mental retardation) if he or she has:

1)    A level of intellectual disability as described in the American Association on Mental Retardation's (AAMR) Manual on Classification in Mental Retardation, published in 1983; or

2)    A related condition, which is defined by 42 CFR 435.1009 as a disability that:

a)     Is attributable to:

i)      Cerebral palsy or epilepsy; or

ii)    Any other condition, other than mental illness, found to be closely related to mental retardation because it impairs intellectual functioning or would require services normally delivered to an individual with impaired intellectual functioning;

b)    Manifests before the reaches age of 22;

c)     Is likely to continue indefinitely; and

d)    Results in substantial functional limitations in three or more of the following life activities:

i)      Self-care;

ii)    Understanding and use of language;

iii)   Learning;

iv)   Mobility;

v)    Self-direction; or

vi)   Capacity for independent living

The CFR cited the AAMR's 1983 Manual because it contained it represented the most current understanding of mental retardation at the time the regulations were published, and because the authors of the original PASRR legislation (in the Omnibus Budget Reconciliation Act of 1987) wished to "pick out" a set of people that would not change over time (so that the application of PASRR would itself not change arbitrarily). Nonetheless, it is very much "of its time."

Notions of mental retardation have evolved considerably since 1983. Indeed, the Association itself has published several revisions to the manual, and has changed its name to The American Association of Intellectual and Developmental Disabilities (AAIDD), reflecting a move away from the (frequently derisive) term "mental retardation." According to Rosa's Law, which was passed by the federal government in October 2010, "intellectual disability" now effectively takes the place of the previously used term "mental retardation." Fundamentally, states must be able to "translate" between the 1983 Manual into the categories of the most recent version or to other, widely recognized definitions of intellectual disability, so that PASRR continues to apply to individuals with the same characteristics, even if the diagnostic categories (i.e., the names) have changed.

The category of related conditions has always been more flexible. This is both an advantage and a disadvantage: It is often difficult to determine whether a disorder really impairs self-care or self-direction. As a consequence, related conditions have sometimes proven controversial. This is a topic that CMS and PTAC will explore in greater depth in the near future.

For reference, this page includes a copy of the 1983 Manual and a copy of Rosa's Law as downloadable PDFs.


What is the PASRR definition of mental illness?

Wednesday, August 10, 2011

According to 42 CFR 483.102(b), a disorder qualifies as a mental illness for PASRR purposes if satisfies three major criteria:

  1. It appears as a major mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Revised (DSM-III-R), published in 1987.
  2. It has resulted in functional impairments in major life activities in the last 3-6 months, including interpersonal functioning, concentration, and adaptation to change; and
  3. The individual has a recent history of treatment, which means at least one of the following:

a. Inpatient hospitalization within the last 2 years; or

b. An episode of "significant disruption" to normal life activities within the last two years, requiring supportive services or the involvement of law enforcement

The CFR cited the DSM III-R because it contained the most current compilation of mental disorders at the time the regulations were published, and because the authors of the original PASRR legislation (in the Omnibus Budget Reconciliation Act of 1987) wished to "pick out" a set of people that would not change over time (so that the application of PASRR would itself not change arbitrarily). Nonetheless, it is very much "of its time"; the PASRR regulations mention disorders that later versions of the DSM excluded (such as "organic brain disorder"). But because the regulations have not been updated, states must continue to use the DSM III-R as a reference point. Fundamentally, states must be able to "translate" between the DSM III-R and the most recent version, so that PASRR continues to apply to individuals with the same characteristics, even if the diagnostic categories (i.e., the names) have changed.


Must PASRR be completed each year for MI/ID residents, as originally specified in 42 CFR 483.100-138?

Tuesday, June 15, 2010

No. The Balanced Budget act of 1996 eliminated the requirement for annual resident review, specifying that reviews are required instead upon changes in condition. A review and determination must be conducted promptly after a nursing facility has notified the state mental health authority or state intellectual disability authority that there has been a significant change in the resident’s physical or mental condition (within an average of 7-9 days). For more information on when a resident review must be conducted, please see our FAQ What is considered a significant change in condition?