Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.040 - Preadmission Screening and Resident Review

Current through Reg. 50, No. 138; July 16, 2024
(1) Purpose. This rule applies to all Florida
				Medicaid-certified nursing facilities (NF), regardless of payer source; all
				providers rendering NF services to Florida Medicaid recipients; and all
				entities that perform a function in the Preadmission Screening and Resident
				Review (PASRR) process as specified in this rule.
(2) Definitions.
(a) Hospital Discharge Exemption - Exception
				to the Level II evaluation and determination requirement prior to admission to
				an NF in accordance with Title 42, Code of Federal Regulations (CFR), section
				483.106(b)(2)(i)(A)-(C).
(b)
				Intellectual Disability (ID) - As defined in
				42 CFR
				483.102(b)(3). The diagnosis
				of ID includes related conditions, i.e., individuals who have a severe, chronic
				disability that meets all of the following conditions:
1. Is attributable to one of the following:
a. Cerebral palsy or epilepsy.
b. Any other condition, (other than mental
				illness), found to be closely related to ID because the condition results in
				impairment of general intellectual functioning or adaptive behavior similar to
				that of persons diagnosed with ID, and requires treatment or services similar
				to those required for these persons.
2. Is manifested before the person reaches
				the age of 22 years.
3. Is likely
				to continue indefinitely.
4.
				Results in substantial functional limitations in three or more of the following
				areas of major life activity:
a.
				Self-care.
b. Understanding and use
				of language.
c. Learning.
d. Mobility.
e. Self-direction.
f. Capacity for independent
				living.
(c)
				Inter-Facility Transfer - The transfer of a resident from one NF to another
				NF.
(d) Level I PASRR Screen -
				Process to identify diagnosed or suspected ID, serious mental illness (SMI), or
				both, based on information gathered by the screener.
(e) Level II Evaluation and Determination -
				An in-depth, individualized, assessment of the individual to confirm whether
				the applicant to an NF has SMI, ID, or both; to assess the need for NF
				services; and evaluate what specialized services, if any, are needed.
(f) New Admission - An individual admitted to
				any NF for the first time, who was not readmitted or admitted as an
				inter-facility transfer.
(g)
				Preadmission Screening and Resident Review - Federal requirement mandated by
				42 CFR
				483.100-483.138.
(h) Readmission - When an NF resident is
				transferred to a hospital and returns to any NF within 90 calendar
				days.
(i) Resident Review (RR) - An
				evaluation and determination conducted by state-designated authorities when an
				NF resident experiences a significant change in his or her physical or mental
				status.
(j) Serious Mental Illness
				(SMI) - As defined in 42 CFR
				483.102(b)(1).
(k) Significant Change - A decline or
				improvement in an NF resident's physical or mental status that is anticipated
				to require intervention.
(l)
				Specialized Services - Services specified by the state, or its designee, that
				are not covered in the NF per diem, and are required for appropriate placement
				in the NF setting for individuals with ID, SMI, or both.