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April 27, 2018

The Basics of PASRR and Dementia - When Can the Level II Be Terminated?

A Level II evaluation may be halted if the person has a diagnosis solely of dementia, or a diagnosis of dementia in combination with a non-PASRR disability. However, a Level II evaluation should not be halted if a PASRR disability has not yet been ruled out.
PASRR regulations at 42 CFR 483.128(m) permit termination of a Level II evaluation if the evaluator finds that the individual being evaluated:

(1) Does not have Mental Illness (MI) or Intellectual Disability (ID); or (2) Has:
(i) A primary diagnosis of dementia (including Alzheimer's Disease or a related disorder); or
(ii) A non-primary diagnosis of dementia without a primary diagnosis that is a serious MI, and does not have a diagnosis of ID or a related condition.

To clarify, an evaluation may be halted if there is no PASRR condition or if it is determined that the person has a primary diagnosis of dementia and a secondary diagnosis of MI. Conversely, an evaluation should not be halted if the person has a primary diagnosis of MI and a secondary diagnosis of dementia. In making this determination, evaluators should ensure that there is sufficient evidence of (a) the dementia diagnosis and (b) the determination that dementia is primary.

There can be some confusion around what constitutes a “primary” diagnosis, so careful analysis of the evidence should be applied, and States should ensure that evaluators have a consistent understanding of how the term “primary” is being used.
If the person has a co-occurring diagnosis of dementia and ID, the evaluator may not stop the evaluation. However, if the evaluator is in a State that has a categorical determination for people with ID/RC and dementia, they may complete an abbreviated evaluation sufficient to confirm the person’s eligibility for that categorical determination. That determination is only possible if the state is applying a categorical for dementia and ID, as noted at §483.130(h).

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