[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR483.136]



[Page 543-544]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 483_REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES--Table 

of Contents

 

 Subpart C_Preadmission Screening and Annual Review of Mentally Ill and 

                      Mentally Retarded Individuals

 

Sec. 483.136  Evaluating whether an individual with mental retardation 

requires specialized services (PASARR/MR).



    (a) Purpose. The purpose of this section is to identify the minimum 

data needs and process requirements for the State mental retardation 

authority to determine whether or not the applicant or resident with 

mental retardation, as defined in Sec. 483.102(b)(3) of this part, 

needs a continuous specialized services program, which is analogous to 

active treatment, as defined in Sec. Sec. 435.1009 and 483.440 of this 

chapter.

    (b) Data. Minimum data collected must include the individual's 

comprehensive history and physical examination results to identify the 

following information or, in the absence of data, must include 

information that permits a reviewer specifically to assess:

    (1) The individual's medical problems;

    (2) The level of impact these problems have on the individual's 

independent functioning;

    (3) All current medications used by the individual and the current 

response of the individual to any prescribed medications in the 

following drug groups:

    (i) Hypnotics,

    (ii) Antipsychotics (neuroleptics),

    (iii) Mood stabilizers and antidepressants,

    (iv) Antianxiety-sedative agents, and

    (v) Anti-Parkinson agents.

    (4) Self-monitoring of health status;

    (5) Self-administering and scheduling of medical treatments;

    (6) Self-monitoring of nutritional status;

    (7) Self-help development such as toileting, dressing, grooming, and 

eating;

    (8) Sensorimotor development, such as ambulation, positioning, 

transfer skills, gross motor dexterity, visual motor perception, fine 

motor dexterity, eye-hand coordination, and extent to which prosthetic, 

orthotic, corrective or mechanical supportive devices can improve the 

individual's functional capacity;

    (9) Speech and language (communication) development, such as 

expressive language (verbal and nonverbal), receptive language (verbal 

and nonverbal), extent to which non-oral communication systems can 

improve the individual's function capacity, auditory functioning, and 

extent to which amplification devices (for example, hearing aid) or a 

program of amplification can improve the individual's functional 

capacity;

    (10) Social development, such as interpersonal skills, recreation-

leisure skills, and relationships with others;

    (11) Academic/educational development, including functional learning 

skills;

    (12) Independent living development such as meal preparation, 

budgeting and personal finances, survival skills, mobility skills 

(orientation to the neighborhood, town, city), laundry, housekeeping, 

shopping, bedmaking, care of clothing, and orientation skills (for 

individuals with visual impairments);

    (13) Vocational development, including present vocational skills;

    (14) Affective development such as interests, and skills involved 

with expressing emotions, making judgments, and making independent 

decisions; and

    (15) The presence of identifiable maladaptive or inappropriate 

behaviors of the individual based on systematic observation (including, 

but not limited to, the frequency and intensity of identified 

maladaptive or inappropriate behaviors).



[[Page 544]]



    (c) Data interpretation--(1) The State must ensure that a licensed 

psychologist identifies the intellectual functioning measurement of 

individuals with MR or a related condition.

    (2) Based on the data compiled in paragraph (b) of this section, the 

State mental retardation authority, using appropriate personnel, as 

designated by the State, must validate that the individual has MR or is 

a person with a related condition and must determine whether specialized 

services for mental retardation are needed. In making this 

determination, the State mental retardation authority must make a 

qualitative judgment on the extent to which the person's status 

reflects, singly and collectively, the characteristics commonly 

associated with the need for specialized services, including--

    (i) Inability to--

    (A) Take care of the most personal care needs;

    (B) Understand simple commands;

    (C) Communicate basic needs and wants;

    (D) Be employed at a productive wage level without systematic long 

term supervision or support;

    (E) Learn new skills without aggressive and consistent training;

    (F) Apply skills learned in a training situation to other 

environments or settings without aggressive and consistent training;

    (G) Demonstrate behavior appropriate to the time, situation or place 

without direct supervision; and

    (H) Make decisions requiring informed consent without extreme 

difficulty;

    (ii) Demonstration of severe maladaptive behavior(s) that place the 

person or others in jeopardy to health and safety; and

    (iii) Presence of other skill deficits or specialized training needs 

that necessitate the availability of trained MR personnel, 24 hours per 

day, to teach the person functional skills.



[57 FR 56506, Nov. 30, 1992; 58 FR 25784, Apr. 28, 1993]