The requirement of “screening out” individuals with a primary diagnosis of serious mental illness or mental retardation falls to the states. The review process known as Pre-admission Screening and Annual Resident Review (PASARR), at 42 C.F.R. 483, Subpart C, has two components.  First, prior to admission, the state must determine if the individual with serious mental illness or mental retardation requires nursing facility care.

The state's second review is an annual review to determine whether nursing facility placement for the resident with serious mental illness or mental retardation remains appropriate.

For those identified by the screening as having serious mental illness, the next step depends on the resident’s physical and mental treatment needs and their length of stay in the facility.

• For those of any condition not needing nursing facility (NF) care, there is no admission.

• For residents, in facility, not needing NF care and not needing specialized services, the state must arrange for safe and orderly discharge.

• For applicants and residents who need both NF care and specialized services, they may enter or stay in facility and the state must provide the specialized services needed.

• For residents who have been in facility for less than 30 months and no longer need NF care but continue to need specialized services, the state must:  a) in consultation with the family and caregivers, arrange for the resident’s safe and orderly discharge and b) continue to provide the specialized services needed regardless of resident’s placement.

• For residents who have been in facility for more than 30 months and no longer need NF care but continue to need specialized services, the state must:  a) in consultation with the family and caregivers, offer resident the option of receiving appropriate treatment in a non  institutional setting, and b) continue to provide the specialized services needed regardless of resident’s placement.

Appeals concerning PASARR determinations are covered by 10A NCAC 22H