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April 10, 2018

How does a categorical determination for dementia and intellectual disability affect the PASRR process?

42 CFR 483.130(h) provides that the State intellectual disability authority may make categorical determinations that individuals with dementia, which exists in combination with an intellectual disability (ID) or a related condition, do not need specialized services.
A categorical determination for dementia and ID can be applied at the Level I screening, but the categorical must be determined at the Level II evaluation phase of PASRR. Beyond the specialized services determination, there is no basis for ending a Level II evaluation for an individual with an intellectual disability diagnosis, as the evaluation still determines if nursing facility services are needed.
Under 42 CFR § 483.128(j), findings must be issued in the form of an abbreviated written evaluative report which—

(1) Identifies the name and professional title of the person applying the categorical determination and the data on which the application was made;
(2) Explains the categorical determination(s) that has (have) been made and, if only one of the two required determinations can be made categorically, describes the nature of any further screening which is required;
(3) Identifies, to the extent possible, based on the available data, NF services, including any mental health or specialized psychiatric rehabilitative services, that may be needed; and
(4) Includes the bases for the report's conclusions.

A categorical determination for dementia and intellectual disability also requires the issuing of a written determination notice per the following 483.130(k)(l) requirements:

(k) Notice of determination. The State mental health or intellectual disability authority must notify in writing the following entities of a determination made under this subpart:
1. The evaluated individual and legal representative;
2. The admitting or retaining NF;
3. The individual or resident’s attending physician; and
4. The discharging hospital, unless the individual is exempt from preadmission screening as provided at §483.106(b)(2).

(l) Contents of notice. Each notice of the determination made by the State mental health or intellectual disability authority must include:
1. Whether a NF level of service is needed;
2. Whether specialized services are needed;
3. The placement options that are available to the individual consistent with these determinations; and
4. The rights of the individual to appeal the determination

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