Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › PREADMISSION SCREENING PROGRAM › Section 1181.542 - Who is required to be screened

Current through Register Vol. 54, No. 28, July 13, 2024
(a) OBRA-87 requires only that individuals
					 who are mentally ill or mentally retarded, including persons with other related
					 conditions, as defined by the law, be screened prior to admission. This
					 requirement applies to all those individuals, whether or not the individual is
					 eligible or applying for MA or Medicare benefits. However, this requirement
					 does not displace the existing preadmission assessment requirements for persons
					 eligible or applying for MA-for example, LAMP. This subchapter deals with the
					 OBRA-87 requirement, which is in addition to existing preadmission screening
					 requirements.
(b) OBRA-87 applies
					 only to persons seeking admission to nursing facilities, but it does not apply
					 to persons seeking admission to intermediate care facilities for the mentally
					 retarded (ICF/MR). It also does not apply to persons seeking admission to
					 inpatient psychiatric facilities, institutions for mental diseases, community
					 placement or nursing facilities which are not providers participating in the MA
					 Program or the Medicare Program.
(1)
Who is mentally ill as defined by OBRA-87.
(i) OBRA-87 defines an individual who is
					 mentally ill and therefore subject to screening as an individual who has a
					 primary or secondary diagnosis of mental illness-as defined in the Diagnostic
					 and Statistical Manual of Mental Disorders, 3rd edition-but does not have a
					 primary diagnosis of dementia, including Alzheimer's disease or a related
					 disorder. Thus, an individual who does have a primary diagnosis of dementia,
					 including Alzheimer's disease or a related disorder, is exempt from the OBRA-87
					 preadmission screening requirements.
(ii) The Health and Human Services (HHS)
					 draft criteria seek to limit the OBRA-87 definition to only those individuals
					 with the following types of major mental disorders: schizophrenic; paranoid;
					 major affective; schizoaffective; and atypical psychotic. The Department will
					 apply this limiting definition of mental illness. Thus, an individual has a
					 primary or secondary diagnosis of mental illness for OBRA-87 screening purposes
					 only if the condition falls within the definitions of schizophrenic, paranoid,
					 major affective, schizoaffective or atypical psychotic disorders.
(iii) Since OBRA-87 focuses on the actual
					 condition of the individual seeking admission, the HHS draft criteria indicate
					 that certain information in addition to the diagnoses be reviewed and that the
					 information can be the basis for screening even if the individual does not have
					 a primary or secondary diagnosis of mental illness. The Department will apply
					 these additional criteria. Thus, except as provided in paragraph (3), an
					 individual shall be screened, for OBRA-87 purposes, even if they do not have a
					 primary or secondary diagnosis of mental illness, if one of the following
					 applies:
(A) The individual has a history of
					 mental illness-as limited by definitions in this subparagraph-within the last 2
					 years.
(B) The individual has been
					 prescribed a major tranquilizer on a regular basis in the absence of a
					 justifiable neurological disorder.
(C) There is presenting evidence of mental
					 illness-as limited by definitions in this subparagraph-including possible
					 disturbances in orientation, affect or mood.
(iv) If the individual has a primary
					 diagnosis of dementia-as defined in this subparagraph-even if the individual
					 meets one or more of the additional criteria, the individual is exempt from the
					 preadmission screening process.