TOPIC: PASRR DISABILITIES

There is no federal requirement that a Level II evaluation be completed prior to the individual returning to the nursing facility (NF). A Level II evaluation is required when there is a significant change in a resident’s condition. When a resident is returning from a hospital stay, there may be a clear change in condition. In instances where the significant change is evident, the individual would be subject to a Resident Review upon their return to the nursing facility, per CFR §483.106(b)(3).

Identifying related conditions may involve some discretion on the part of a clinician or evaluator. However, although related conditions are treated by PASRR as a subset of intellectual disability, note the definition of related condition does not require that an individual have an intellectual disability so long as other related conditions criteria are met.

According to 42 CFR 483.102(b), a disorder qualifies as a mental illness (MI) for PASRR purposes if it satisfies three major criteria

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.

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.

The dementia exclusion for mental illness allows for the Level II evaluator to stop the evaluation if they determine that the diagnosis of dementia is primary and the mental illness (MI) diagnosis is secondary. It is important to note that the diagnosis or verification of a diagnosis of MI and dementia are Level II functions required to be conducted by mental health professionals and cannot be done by Level I reviewers. The identification of dementia must be done by the Level II evaluator as part of the diagnosis or verification of the diagnosis of MI.

This webinar was hosted on behalf of the State of Washington to discuss the dementia exclusion for Serious Mental Illness (SMI).

This presentation will touch on background information on dementia diagnosis and treatment as well as the interface of dementia with mental illness and intellectual disability. The presentation will also discuss when dementia warrants placement in a skilled nursing facility.

To define an intellectual disability, 42 CFR 483.102(b)(3)(i) incorporates by reference the definition in AAMD's 1983 Manual. Copies of that manual are hard to find. An scanned copy is provided here.