---
kind: "section"
citation: "42 C.F.R. § 483.118"
title: "42"
number: "483.118"
heading: "Residents and applicants determined not to require NF level of services."
url: "https://uscodex.org/cfr/42/483.118"
---

# §483.118. Residents and applicants determined not to require NF level of services.

- (a) **Applicants who do not require NF services.** If the State mental health or intellectual disability authority determines that an applicant for admission to a NF does not require NF services, the applicant cannot be admitted. NF services are not a covered Medicaid service for that individual, and further screening is not required.
- (b) **Residents who require neither NF services nor specialized services for MI or IID.** If the State mental health or intellectual disability authority determines that a resident requires neither the level of services provided by a NF nor specialized services for MI or IID, regardless of the length of stay in the facility, the State must—
  - (1) Arrange for the safe and orderly discharge of the resident from the facility in accordance with [§ 483.15(b)](/cfr/42/483.15.md?p=b); and
  - (2) **Prepare and orient the resident for discharge.**
- (c) **Residents who do not require NF services but require specialized services for MI or IID—**
  - (1) **Long term residents.** Except as otherwise may be provided in an alternative disposition plan adopted under section 1919(e)(7)(E) of the Act, for any resident who has continuously resided in a NF for at least 30 months before the date of the determination, and who requires only specialized services as defined in [§ 483.120](/cfr/42/483.120.md), the State must, in consultation with the resident's family or legal representative and caregivers—
    - (i) Offer the resident the choice of remaining in the facility or of receiving services in an alternative appropriate setting;
    - (ii) Inform the resident of the institutional and noninstitutional alternatives covered under the State Medicaid plan for the resident;
    - (iii) Clarify the effect on eligibility for Medicaid services under the State plan if the resident chooses to leave the facility, including its effect on readmission to the facility; and
    - (iv) Regardless of the resident's choice, provide for, or arrange for the provision of specialized services for the mental illness or intellectual disability.
  - (2) **Short term residents.** Except as otherwise may be provided in an alternative disposition plan adopted under section 1919(e)(7)(E) of the Act, for any resident who requires only specialized services, as defined in [§ 483.120](/cfr/42/483.120.md), and who has not continuously resided in a NF for at least 30 months before the date of the determination, the State must, in consultation with the resident's family or legal representative and caregivers—
    - (i) Arrange for the safe and orderly discharge of the resident from the facility in accordance with [§ 483.15(b)](/cfr/42/483.15.md?p=b);
    - (ii) Prepare and orient the resident for discharge; and
    - (iii) Provide for, or arrange for the provision of, specialized services for the mental illness or intellectual disability.
  - (3) For the purpose of establishing length of stay in a NF, the 30 months of continuous residence in a NF or longer—
    - (i) Is calculated back from the date of the first annual resident review determination which finds that the individual is not in need of NF level of services;
    - (ii) May include temporary absences for hospitalization or therapeutic leave; and
    - (iii) **May consist of consecutive residences in more than one NF.**

## Notes

### Amendments

[57 FR 56506, Nov. 30, 1992, as amended at 81 FR 68871, Oct. 4, 2016]

### Source

Source: 57 FR 56506, Nov. 30, 1992, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1320a-7, 1395i, 1395hh and 1396r.

### Amendments

[57 FR 56506, Nov. 30, 1992, as amended at 81 FR 68871, Oct. 4, 2016]