If the answer to Minimum Data Set 3.0 Question A1500 is “yes”, and the individual has undergone a significant change in conditioN...

If the answer to Minimum Data Set 3.0 Question A1500 is “yes”, and the individual has undergone a significant change in condition, should the nursing facility (NF) always contact the State Mental Health Authority (SMHA) or State Intellectual Disability Authority (SIDA)?

Yes, the Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual requires the NF to provide notification to the state-designated mental health (MH) or intellectual disability (ID) authority promptly when a resident with mental illness or intellectual disability experiences a significant change in mental or physical status. Referral to the MH/ID authority should be made as soon as the criteria indicative of a significant change are evident. For more information, see FAQ “What is considered a significant change in condition?”

While the notification is required, the MH/ID authorities may exercise their expert judgment about when a Level II evaluation is needed. Each state Medicaid agency, in consultation with the MH/ID authorities, may develop specific processes and guidelines for referral, and which types of significant changes should be referred.