TOPIC: NURSING FACILITY PLACEMENTS

This webinar focused on how states can use a PASRR to divert or transition individuals from nursing facilities into Home and Community-Based Waiver Services (HCBS). Key takeaways included understanding the context of long-term services and supports (LTSS) in the public health emergency, the history of PASRR, and the role of PASRR for nursing facility diversion and transition.

Need for nursing facility (NF) services is defined by individual states, all of whom establish NF level of care (LOC) criteria. The LOC assessments are conducted for NF applicants separately from the PASRR process, but Section 1919(b)(3)(F) of the Social Security Act prohibits NFs from admitting any new resident who has serious mental illness (SMI) or an intellectual disability or related condition (ID/RC), unless it has been determined by the State Mental Health Authority (SMHA) or State Intellectual Disability Authority (SIDA) that because of the physical and mental condition of the individual, nursing facility services are needed.

This webinar will help attendees understand PASRR’s role in helping individuals make an informed choice about where they receive services.

Although Nursing Facilities (NFs) are primarily responsible for helping individuals transition to the community, PASRR can play a vital role in helping NFs develop individualized plans of care that support successful transition. The “common ground” of NFs and State PASRR programs is the well-being of the individual.

The Code of Federal Regulations (CFR) at §483.130(d) provides examples of categories for which the State mental health or intellectual disability authority may make an advance group determination that nursing facility (NF) services are needed, that include: (2) Terminal illness, as defined for hospice purposes in §418.3 of this chapter.

Per the CFR, at 42 CFR 435.1010, an Institution for Mental Diseases (IMD) is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. Whether an institution is an IMD is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such.CMS’s guidance on how to determine when the IMD exclusion applies is included in Part 4 of the State Medicaid Manual. A key criterion is if the current need for institutionalization for more than 50 percent of all the residents in the facility results from mental diseases. It is important to note that a NF may be an IMD if more than 50 percent of the NF residents require specialized services for treatment of serious mental illnesses, as defined in 42 CFR 483.102(b).