[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: 42CFR483.118]



[Page 550-551]

 

                         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.  483.118  Residents and applicants determined not to require NF 



level of services.



    (a) Applicants who do not require NF services. If the State mental 

health or mental retardation authority determines that an applicant for 

admission to a NF does not require NF services, the applicant cannot be 

admitted. NF services are not a covered Medicaid service for that 

individual, and further screening is not required.

    (b) Residents who require neither NF services nor specialized 

services for MI or MR. If the State mental health or mental retardation 

authority determines that a resident requires neither the level of 

services provided by a NF nor specialized services for MI or MR, 

regardless of the length of stay in the facility, the State must--



[[Page 551]]



    (1) Arrange for the safe and orderly discharge of the resident from 

the facility in accordance with Sec.  483.12(a); and

    (2) Prepare and orient the resident for discharge.

    (c) Residents who do not require NF services but require specialized 

services for MI or MR--(1) Long term residents. Except as otherwise may 

be provided in an alternative disposition plan adopted under section 

1919(e)(7)(E) of the Act, for any resident who has continuously resided 

in a NF for at least 30 months before the date of the determination, and 

who requires only specialized services as defined in Sec.  483.120, the 

State must, in consultation with the resident's family or legal 

representative and caregivers--

    (i) Offer the resident the choice of remaining in the facility or of 

receiving services in an alternative appropriate setting;

    (ii) Inform the resident of the institutional and noninstitutional 

alternatives covered under the State Medicaid plan for the resident;

    (iii) Clarify the effect on eligibility for Medicaid services under 

the State plan if the resident chooses to leave the facility, including 

its effect on readmission to the facility; and

    (iv) Regardless of the resident's choice, provide for, or arrange 

for the provision of specialized services for the mental illness or 

mental retardation.

    (2) Short term residents. Except as otherwise may be provided in an 

alternative disposition plan adopted under section 1919(e)(7)(E) of the 

Act, for any resident who requires only specialized services, as defined 

in Sec.  483.120, and who has not continuously resided in a NF for at 

least 30 months before the date of the determination, the State must, in 

consultation with the resident's family or legal representative and 

caregivers--

    (i) Arrange for the safe and orderly discharge of the resident from 

the facility in accordance with Sec.  483.12(a);

    (ii) Prepare and orient the resident for discharge; and

    (iii) Provide for, or arrange for the provision of, specialized 

services for the mental illness or mental retardation.

    (3) For the purpose of establishing length of stay in a NF, the 30 

months of continuous residence in a NF or longer--

    (i) Is calculated back from the date of the first annual resident 

review determination which finds that the individual is not in need of 

NF level of services;

    (ii) May include temporary absences for hospitalization or 

therapeutic leave; and

    (iii) May consist of consecutive residences in more than one NF.