Ftag of the Week – F646 MD/ID Significant Change Notification (Pt. 1)

Next up on the CMSCG Blog “Ftag of the Week” series, we’re reviewing F646 MD/ID Significant Change Notification. The purpose of this regulation is to ensure that individuals who have a Mental Disorder or Intellectual Disability and who experience a significant change in status continue to receive needed care and services in the most appropriate care setting. This is accomplished by requiring that providers notify the appropriate authority promptly after an individual with MD/ID has a significant mental or physical change so the authority can conduct a resident review.

Let’s start with some definitions. For information on what is considered a Mental Disorder, Intellectual Disability or related condition, as well as an overview of PASRR, hop over to our Ftag of the Week for F645 PASARR Screening for Mental Disorder/ Intellectual Disability.

PASARR, Defined

Per Appendix PP of the State Operations Manual, Preadmission Screening and Resident Review (PASARR) is a federal requirement which ensures individuals who have a mental disorder or intellectual disabilities are not inappropriately admitted to a nursing home for long-term care. As its name implies, there is a required preadmission screening where all applicants for nursing homes which are Medicaid-certified are evaluated for MD/ID. This evaluation helps ensure that these individuals are offered the most appropriate care setting to meet their needs, which often times is not a nursing home, and that they receive the services they need in that setting. There is always an emphasis regarding ensuring these individuals are placed in the least restrictive setting, such as a community setting like a group home, or that they are appropriately placed in a setting for services that a nursing home may not be able to provide, such as at an acute care provider.

If a decision is made to admit an individual to the nursing home, this regulation comes into play if the resident experiences a significant change.

Significant Change, Defined

Those of you who are familiar with the MDS 3.0 likely understand this term, as well as the accompanying Significant Change in Status (SCSA) Assessment, but we’ll discuss them regardless. The important thing to recognize related to F646 is that just because a resident experiences a Significant Change doesn’t mean that it meets the reporting requirements for the purposes of this regulation. We’ll get into that in Part 2 of this series.

A Significant Change, as defined in Appendix PP, is a major decline or major improvement in a resident’s status that:

• Impacts more than one area of the resident’s health status and
• Requires interdisciplinary review and/or revision of the resident’s care plan and
• Will not normally resolve itself without intervention from staff or through implementation of standard disease-related clinical interventions and the decline is not considered “self-limiting”

“Self-limiting” is defined as when a condition will normally resolve itself without further staff intervention or clinical interventions to address the condition.

If a resident meets the guidelines for improvement or decline, the interdisciplinary team must complete a comprehensive assessment – the Significant Change in Status Assessment. For more information on these guidelines, check out our Ftag of the Week for F637 Comprehensive Assessment After Significant Change.

Nursing facilities are required to notify the state mental health (SMH) authority or state intellectual disability authority when a resident with one of these conditions has a significant change in mental or physical condition. In Part 2 of our Ftag of the Week for F646, we’ll explain more about when notifications need to be made and what else you need to know about specific procedures.