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January 25, 2018

Can states refer to the DSM-5 in their operations guidelines related to PASRR, or do they need to incorporate the CFR reference to the DSM III?

Part 42, Subpart C of the Code of Federal Regulations (CFR) contains the guiding regulations for PASRR compliance. Currently, 42 CFR 483.106(b) includes a reference to the DSM-III-R in the definition of serious mental illness; the DSM-III-R was the most current edition of the DSM available when the PASRR regulations were promulgated in 1992.

Given the important role PASRR plays in helping NFs develop individualized plans of care, CMS understands there would be sound policy reasons for state mental health and intellectual disability authorities to use the updated version of the DSM when writing PASRR procedures. States that choose to use the more current DSM in their PASRR operational guidance will not risk being out of compliance for that reason.

While not specific to PASRR enforcement, it is worth noting that the most current version of the CMS Survey & Certification State Operations Manual Appendix PP gives surveyors a definition of “mental disorder” that refers to the DSM-5: “Mental disorder” is a syndrome characterized by a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. Arlington, VA: American Psychiatric Association Publishing, 2013.).

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