This inspection is one in a series of Office of Inspector General reports on individuals with mental illness in nursing facilities. A companion to this report, "Younger Nursing Home Residents with Mental Illness: Pre-Admission Screening and Resident Review Implementation and Oversight" (OEI 05-99-00700) examines the admission and mental health screenings of Medicaid beneficiaries, ages 22-64, who have a serious mental illness and reside in nursing facilities. In that study we found that State implementation of Pre-Admission Screening and Resident Review (PASRR) systems, the primary mechanism by which individuals with mental illness in nursing facilities are monitored, is inadequate to identify whether younger individuals with mental illness are appropriately screened, evaluated and placed in nursing facilities.

This report attempts to ascertain the extent to which younger individuals with mental illness reside in nursing facilities. In addition, we wanted to identify the amount of Medicaid funds spent to care for this population. The national average for percentage of individuals in nursing facilities being treated for mental illness is unknown. A recent review of the National Nursing Home Surveys estimates that in 1995, there were approximately 12,000 nursing facility residents under age 65 with a primary mental illness diagnosis. We believe this figure may not accurately reflect the number of younger nursing facility residents with serious mental illness. 

The Health Care Financing Administrations (HCFA) Medicaid Statistical Information System (MSIS) collects claims and eligibility data for medical services reimbursed with Title XIX funds. Its purpose is to "collect, manage, analyze and disseminate information on eligibles, recipients, utilization and payment for services covered by State Medicaid programs."

The HCFA Minimum Data Set (MDS) collects resident assessment information "to aid in the survey and certification of Medicare/Medicaid long-term care facilities and to study the effectiveness and quality of care given in those facilities." The MDS is also intended to "support regulatory, reimbursement, policy, and research functions."