Current DBHDS Definition 

Proposed Definition 

Our Comments 

Serious Mental Illness Adults, 18 years of age or older, who have severe and persistent mental or emotional disorders that seriously impair their functioning in such primary aspects of daily living as personal relations, self-care skills, living arrangements, or employment.? Individuals who are seriously mentally ill and who have also been diagnosed as having a substance use disorder or developmental disability are included.? The population is defined along three dimensions:? diagnosis, level of disability, and duration of illness.? All three dimensions must be met to meet the criteria for serious mental illness.  

Citation 42 CFR 483.102(b) 

1. An individual is considered to have a serious mental illness (MI) if the individual meets the following requirements on diagnosis, level of impairment and duration of illness: 

42 CFR 483.102 (b)(1) does not specifically address age restrictions currently present in the current definition  

a. Diagnosis There must be a major mental disorder diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM).? These disorders are:? schizophrenia, major affective disorders, paranoia, organic or other psychotic disorders, personality disorders, or other disorders that may lead to chronic disability.? A diagnosis of adjustment disorder or a V Code diagnosis cannot be used to satisfy these criteria. 

(i) Diagnosis.  The individual has a major mental disorder diagnosable under the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised in 1987. 

Incorporation of the 1987 edition of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, was approved by the Director of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51 that govern the use of incorporation by reference.[1]   

This mental disorder is— 

(A) A schizophrenic, mood, paranoid, panic or other severe anxiety disorder; somatoform disorder; personality disorder; other psychotic disorder; or another mental disorder that may lead to a chronic disability; but 

(B) Not a primary diagnosis of dementia, including Alzheimer's disease or a related disorder, or a non-primary diagnosis of dementia unless the primary diagnosis is a major mental disorder as defined in paragraph (b)(1)(i)(A) of this section. 

The most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the DSM-5-TR, which was published in 2022 – is it DMAS’ intent to require providers to utilize the 1987 edition and ignore significant enhancements to diagnostic standards since that time? 

b. Level of Disability There must be evidence of severe and recurrent disability resulting from mental illness.? The disability must result in functional limitations in major life activities.? Individuals should meet at least two of the following criteria on a continuing or intermittent basis: 

1) Is unemployed; is employed in a sheltered setting or supportive work situation; has markedly limited or reduced employment skills; or has a poor employment history. 

2) Requires public financial assistance to remain in the community and may be unable to procure such assistance without help. 

3) Has difficulty establishing or maintaining a personal social support system. 

4) Requires assistance in basic living skills such as personal hygiene, food preparation, or money management. 

5) Exhibits inappropriate behavior that often results in intervention by the mental health or judicial system. 

Level of impairment.  The disorder results in functional limitations in major life activities within the past 3 to 6 months that would be appropriate for the individual's developmental stage. An individual typically has at least one of the following characteristics on a continuing or intermittent basis: 

(A) Interpersonal functioning.  The individual has serious difficulty interacting appropriately and communicating effectively with other persons, has a possible history of altercations, evictions, firing, fear of strangers, avoidance of interpersonal relationships and social isolation; 

(B) Concentration, persistence, and pace.  The individual has serious difficulty in sustaining focused attention for a long enough period to permit the completion of tasks commonly found in work settings or in work-like structured activities occurring in school or home settings, manifests difficulties in concentration, inability to complete simple tasks within an established time period, makes frequent errors, or requires assistance in the completion of these tasks; and 

(C) Adaptation to change.  The individual has serious difficulty in adapting to typical changes in circumstances associated with work, school, family, or social interaction, manifests agitation, exacerbated signs and symptoms associated with the illness, or withdrawal from the situation, or requires intervention by the mental health or judicial system. 

42 CFR 483.102 (b)(1) and the current DBHDS definition are similar in levels of disability or impairment (no comments here)