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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 always contact the State Mental Health Authority or State Intellectual Disability Authority?

Yes, the 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 MI/ID authorities may exercise their expert judgment about when a Level II evaluation is needed. Each State Medicaid Agency, in consultation with the MI/ID authorities, may develop specific processes and guidelines for referral, and which types of significant changes should be referred.