New Additional OBRA Exemptions

As of December 1, 2010, there are new exemptions to the OBRA nursing home pre-admission screening process for those with mental illness. The new process recognizes that there is a wide range of functional impairment within diagnoses. Since this process is meant to ensure those with significant needs are getting the services they need, those with lower levels of need may be exempted from the process. In other words, if the patient otherwise meets criteria for the preadmission screen, but has had none of the following they will likely be exempt.

Within the past two years, the individual has NOT:

• had one psychiatric hospitalization
• been in a psychiatric day treatment, respite or crisis stabilization program
• been in a residential treatment setting due to a mental disorder
• experienced intervention by housing or law enforcement officials due to a mental disorder
• required support services to maintain functioning at home due to a mental disorder.

This exemption must be documented with an exemption letter.

The Exemption Letter

If the answer to all of these questions is negative, then contact HES at 978-524-7100 x106 (the same people that you would ordinarily call to give the results of the screen). Tell them that you think the patient does not meet the criteria for Serious Mental Illness due to the absence of all of the above criteria. Ask for a "Pre-Admission Screening and Resident Review (PASRR) Level II Exemption Notification" letter. This letter should be sent with the patient when she/he goes to the nursing home and a copy should be retained.

Otherwise Proceed with OBRA Screen

If the patient had any of the services in 1-5 above, they are considered to have serious mental illness and, unless otherwise exempt, do need a full pre-admission screen (i.e., do the "OBRA").

-Thanks to Sue Streeter for bringing this to our attention.

For more information:  OBRA page

3/11