§ 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 intellectual disability 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 IID.* If the State mental health or intellectual disability authority determines that a resident requires neither the level of services provided by a NF nor specialized services for MI or IID, regardless of the length of stay in the facility, the State must— ( 1 ) Arrange for the safe and orderly discharge of the resident from the facility in accordance with § 483.15(b); and
( 2 ) Prepare and orient the resident for discharge.
( c ) *Residents who do not require NF services but require specialized services for MI or IID* — ( 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 § 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 intellectual disability.
( 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 § 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 § 483.15(b);
( 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 intellectual disability.
( 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.
[57 FR 56506, Nov. 30, 1992, as amended at 81 FR 68871, Oct. 4, 2016]