Wyo. Code R. 048-0037-19
Chapter 19: Nursing Facility Preadmission Screening and Annual Resident Review for Mental Illness and Intellectual Disability
Effective Date: 10/23/2025 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0037.19.10232025
Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter under the Wyoming Medical Assistance and Services Act, Wyoming Statutes §§ 42-4-101 through -124.
(a) This Chapter governs nursing facility preadmission screening and annual resident review for mental illness and intellectual disability and related conditions.
(b) This Chapter applies to all individuals applying for admission into a nursing facility and all residents of a nursing facility regardless of the individual or resident's source of payment for nursing facility services.
(c) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. The contents of manuals and bulletins are subordinate to the provisions of this Chapter.
(a) Except as otherwise specified in the Wyoming Department of Health, Medicaid Rules, Chapter 1 or defined in this Chapter, the terminology used in this Chapter has the standard meaning used in healthcare, Medicaid, and Medicare.
(b) 'Chapter' - a chapter in the Wyoming Department of Health, Medicaid Rules.
(c) 'Individual' - includes a resident of a nursing facility.
(d) 'Intellectual disability' - includes 'related condition'.
(e) 'PASRR' - preadmission screening and annual resident review.
(f) 'SIDA' - state intellectual disability authority.
(g) 'SMHA' - state mental health authority.
(a) Mental Illness.
(i) A nursing facility must not admit an individual with a mental illness unless before admission, the SMHA determines, based on a physical and mental evaluation performed by an entity other than SMHA, that the individual requires nursing facility services because of the individual's physical and mental condition.
(ii) If an individual requires nursing facility services, the SMHA must also determine whether the individual requires specialized services.
(b) Intellectual disability.
(i) A nursing facility must not admit an individual with an intellectual disability unless, before admission, the SIDA determines, based on a physical and mental evaluation performed by an entity other than the SIDA, that the individual requires nursing facility services because of the individual's physical and mental condition.
(ii) If an individual requires nursing facility services, the SIDA must also determine whether the individual requires specialized services.
(c) A nursing facility that admits an individual with a mental illness or an individual with an intellectual disability before a determination of appropriate placement is subject to:
(i) Denial of Medicaid payment for an otherwise Medicaid-eligible individual; and
(ii) Regardless of the individual's source of payment for nursing facility services, the Department may impose any of the remedies specified in Chapter 5
(a) Level I screening must be performed by qualified staff of a nursing facility or hospital to determine whether an individual seeking admission to or residing in a nursing facility needs further evaluation because of a suspected mental illness or an intellectual disability.
(b) Level I screening includes reviewing the individual's medical records, observing presenting evidence, or reviewing documentation from other reliable sources. A screener must use the following criteria:
(i) Mental illness. The screener must consider:
(A) Has the individual been diagnosed with a serious mental illness as defined by 42 C.F.R. § 483.102;
(B) An individual experiencing temporary anxiety or depressive reactions to a terminal or chronic debilitating condition for which specialized services would not be appropriate, but for which mental health services of a lesser intensity may be required does not qualify as a mental illness for nursing facility screening purposes;
(C) Does the individual have a history of mental illness requiring treatment more intensive than outpatient treatment; and
(D) Is there presenting evidence of a serious mental illness, including possible disturbances in orientation, affect, or mood that is not attributable to dementia or another medical diagnosis or treatment.
(ii) Intellectual Disability. The screener must consider:
(A) Has the individual been diagnosed by a physician or other qualified intellectual disability professional of having a primary or secondary diagnosis of intellectual disability as defined by 42 C.F.R. § 483.102;
(B) Does the individual have a history of an intellectual disability;
(C) Does the individual have cognition or behavior deficits indicating an intellectual disability; and
(D) Was the individual referred by an agency that serves persons with an intellectual disability, and the individual was eligible for that agency’s services.
(c) Upon completion of the Level I screening, the screener will determine whether to refer the individual for a Level II screening.
(i) If the determination is that a Level II screening is not necessary, the individual may be admitted to the nursing facility; the individual does not need to be screened again unless there is a significant change in the individual’s condition that indicates a Level II screening is then necessary.
(ii) If the determination is that a Level II screening is necessary, the individual must undergo Level II screening.
(d) The nursing facility must provide written notice to the individual or his or her legal representative if Level II screening is required. This notice is only required for the first Level II screening.
(e) The nursing facility must complete documentation in the format specified by the Department.
(a) A nursing facility must not admit an individual whom the level I screening determined a Level II screening was required until the Level II screening is completed and the determination is that a nursing facility is an appropriate placement.
(b) If there has been a previous Level II screening and the residents physical or mental functioning has significantly changed, the nursing facility must request a new Level II screening promptly by completing and submitting a new Level I form. The nursing facility must indicate on the Level I form that a new Level II screening is being requested because of a significant change in the person’s physical or mental functioning.
(c) Nursing facilities must timely comply with the PASRR requirements.
(i) The Department will not pay for nursing facility services furnished to an individual before the Level II screening is completed and the proper authority determines placement of the individual in a nursing facility is appropriate.
(ii) The Department may impose any of the remedies in Chapter 5 for failure to timely comply with PASRR requirements for non-Medicaid eligible individuals.
(d) A categorical determination takes into account that certain diagnoses, levels of severity of illness, or need for a particular service clearly indicate that admission to or residence in a nursing facility is appropriate without a Level II screening. An individual with a mental illness or an intellectual disability who meets the criteria for any category in this section is deemed appropriate for nursing facility placement. The individual must still be evaluated for a specialized services determination.
(i) Terminal illness. A diagnosis of terminal illness constitutes a Level II determination of appropriate placement and specialized services are not required.
(ii) Severe medical condition. A diagnosis of a severe medical condition constitutes a Level II determination of appropriate placement if an individual who has a mental illness or has an intellectual disability meets the criteria for severe medical condition if the individual or resident is comatose, ventilator dependent, or functioning at the brain stem level or has chronic obstructive pulmonary disease, severe Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, congestive heart failure, severe cardiovascular accident, quadriplegia, advanced multiple sclerosis, end stage renal disease, severe diabetic neuropathy, or refractory anemia that is so severe that the individual could not be expected to benefit from specialized services for a mental illness or an intellectual disability.
(iii) Convalescent care. An individual who has a mental illness or an intellectual disability and requires nursing facility services of no more than 120 days constitutes a Level II determination of appropriate placement. Thirty days before the end of the 120 days, the nursing facility must refer the individual for a Level II screening to determine if the individual has a mental illness or an intellectual disability and has an acute physical illness which:
(A) Requires hospitalization; and
(B) Does not meet the criteria for an exempt hospital discharge as defined in 42 C.F.R. § 483.106.
(iv) Provisional placement. An individual who requires a nursing facility stay of no more than fourteen days. Before the end of the fourteen days, the nursing facility must refer the individual for a Level II screening to determine if the individual has a mental illness or intellectual disability and requires admission for:
(A) Delirium, where an accurate diagnosis cannot be made until the delirium clears; or
(B) Respite care.
(v) Emergency admissions. The individual has a mental illness, or an intellectual disability and requires a nursing facility stay of no more than seven days for his or her protection. Before the end of the seven days, the nursing facility must refer the individual for a Level II screening.
(e) Criteria for Level II screening.
(i) Each individual referred for a Level II screening, regardless of payment source, must be evaluated for medical necessity pursuant to Chapter 22.
(ii) Level II screening must be performed using the minimum criteria specified by CMS in §§ 4251 through 4253 of the State Medicaid Manual appropriate for the specific individual. The State Medicaid Manual is published by CMS and is available from CMS or the Department.
(iii) SMHA and SIDA must review the mental and physical evaluations and the determinations of medical necessity and determine whether, based on the individual’s physical and mental condition, he or she requires the level of services provided by a nursing facility.
(iv) Determination of need for specialized services.
(A) The need for specialized services for an individual with a mental illness must be determined using the procedures and protocols of the SMHA. The procedures and protocols of the SMHA are available from the SMHA or the Department.
(B) The need for specialized services for persons with an intellectual disability must be determined using the procedures and protocols of the SIDA. The procedures and protocols are available from SIDA or the Department.
(f) Level II screening determines the appropriateness of nursing facility placement and the need for specialized services. Following are the possible determinations.
(i) Individual requires nursing facility services but does not require specialized services:
(A) Nursing facility placement is appropriate; and
(B) Mental health services of a lesser intensity than specialized services may be recommended.
(ii) Individual requires nursing facility services and specialized services:
(A) Nursing facility placement is appropriate; and
(B) Specialized services are appropriate.
(iii) Individual does not require nursing facility services but requires specialized services and chooses to remain in the nursing facility under the thirty month rule, defined in 42 C.F.R. § 483.130:
(A) Nursing facility services are deemed appropriate; and
(B) Specialized services are appropriate.
(iv) Individual does not require nursing facility services or specialized services:
(A) Nursing facility placement is not appropriate and admission is denied; or
(B) If the individual is already admitted, the nursing facility must arrange an orderly discharge including preparation and orientation for discharge.
(v) Individual does not require nursing facility services but does require specialized services that cannot be provided in the nursing facility:
(A) Nursing facility placement is not appropriate and admission is denied; or
(B) If the individual is already admitted, the nursing facility must arrange an orderly discharge including preparation and orientation for discharge.
(vi) There is no evidence of a serious mental illness or of an intellectual disability:
(A) Nursing facility placement is appropriate; but
(B) Specialized services are not appropriate.
(vii) Individual has a primary or secondary diagnosis of dementia without a diagnosis of an intellectual disability:
(A) Nursing facility placement is appropriate; but
(B) Specialized services are not appropriate.
(viii) Evaluation not completed due to death or discharge:
(A) PASRR not complete; and
(B) Medicaid payment for nursing facility services will not be authorized.
(g) Notice of Level II determination.
(i) The Department must notify the nursing facility in writing of the results of each Level II determination; and (ii) The Department must notify the individual in writing of the Level II determination.
(a) The Department shall not pay for nursing facility services furnished to an individual until:
(i) The completion of the Level I screening which determines Level II screening is not required; or
(ii) If the Level I screening determines Level II screening is required, the completion of the Level II screening and a determination that nursing facility placement is appropriate; and
(iii) The completion of the evaluation of medical necessity pursuant to Chapter 22 which determined that nursing facility services are medically necessary.
(b) Retroactive payments.
(i) For individuals that do not require Level II screening, Medicaid payment commences upon the Department’s receipt of the Level I screening results if the Department has an evaluation and finding of medical necessity pursuant to Chapter 22.
(ii) For individuals who require Level II screening, Medicaid payment commences upon the completion of the Level II screening which indicates that nursing facility services are appropriate, except as otherwise specified in this Chapter. Payment is retroactive to the date of the completion of the Level II screening, provided there was an evaluation of medical necessity pursuant to Chapter 22. Payments for residents permitted to continue to reside in a nursing facility pursuant to the thirty month rule defined in 42 C.F.R. § 483.130, are contingent upon completion of a Level II screening, regardless of whether the screening determines that nursing facility services are appropriate.
Section 8. Incorporation. Incorporation by reference incorporates the version, edition, or standard existing at the effective date of this Chapter.