[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR483.106]



[Page 548-549]

 

                         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.  483.106  Basic rule.



    (a) Requirement. The State PASARR program must require--(1) 

Preadmission screening of all individuals with mental illness or mental 

retardation who apply as new admissions to Medicaid NFs on or after 

January 1, 1989;

    (2) Initial review, by April 1, 1990, of all current residents with 

mental retardation or mental illness who entered Medicaid NFs prior to 

January 1, 1989; and

    (3) At least annual review, as of April 1, 1990, of all residents 

with mental illness or mental retardation, regardless of whether they 

were first screened under the preadmission screening or annual resident 

review requirements.

    (b) Admissions, readmissions and interfacility transfers--(1) New 

admission. An individual is a new admission if he or she is admitted to 

any NF for the first time or does not qualify as a readmission. With the 

exception of certain hospital discharges described in paragraph (b)(2) 

of this section, new admissions are subject to preadmission screening.

    (2) Exempted hospital discharge. (i) An exempted hospital discharge 

means an individual--

    (A) Who is admitted to any NF directly from a hospital after 

receiving acute inpatient care at the hospital;

    (B) Who requires NF services for the condition for which he or she 

received care in the hospital; and

    (C) Whose attending physician has certified before admission to the 

facility that the individual is likely to require less than 30 days 

nursing facility services.

    (ii) If an individual who enters a NF as an exempted hospital 

discharge is later found to require more than 30 days of NF care, the 

State mental health or mental retardation authority must conduct an 

annual resident review within 40 calendar days of admission.

    (3) Readmissions. An individual is a readmission if he or she was 

readmitted to a facility from a hospital to which he or she was 

transferred for the purpose of receiving care. Readmissions are subject 

to annual resident review rather than preadmission screening.

    (4) Interfacility transfers--(i) An interfacility transfer occurs 

when an individual is transferred from one NF to another NF, with or 

without an intervening hospital stay. Interfacility transfers are 

subject to annual resident review rather than preadmission screening.

    (ii) In cases of transfer of a resident with MI or MR from a NF to a 

hospital or to another NF, the transferring NF is responsible for 

ensuring that copies of the resident's most recent PASARR and resident 

assessment reports accompany the transferring resident.

    (c) Purpose. The preadmission screening and annual resident review 

process must result in determinations based on a physical and mental 

evaluation of each individual with mental illness or mental retardation, 

that are described in Sec. Sec.  483.112 and 483.114.

    (d) Responsibility for evaluations and determinations. The PASARR 

determinations of whether an individual requires the level of services 

provided by a NF and whether specialized services are needed--

    (1) For individuals with mental illness, must be made by the State 

mental health authority and be based on an independent physical and 

mental evaluation performed by a person or entity other than the State 

mental health authority; and

    (2) For individuals with mental retardation, must be made by the 

State



[[Page 549]]



mental retardation or developmental disabilities authority.

    (e) Delegation of responsibility--(1) The State mental health and 

mental retardation authorities may delegate by subcontract or otherwise 

the evaluation and determination functions for which they are 

responsible to another entity only if--

    (i) The State mental health and mental retardation authorities 

retain ultimate control and responsibility for the performance of their 

statutory obligations;

    (ii) The two determinations as to the need for NF services and for 

specialized services are made, based on a consistent analysis of the 

data; and

    (iii) The entity to which the delegation is made is not a NF or an 

entity that has a direct or indirect affiliation or relationship with a 

NF.

    (2) The State mental retardation authority has responsibility for 

both the evaluation and determination functions for individuals with MR 

whereas the State mental health authority has responsibility only for 

the determination function.

    (3) The evaluation of individuals with MI cannot be delegated by the 

State mental health authority because it does not have responsibility 

for this function. The evaluation function must be performed by a person 

or entity other than the State mental health authority. In designating 

an independent person or entity to perform MI evaluations, the State 

must not use a NF or an entity that has a direct or indirect affiliation 

or relationship with a NF.



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