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In 1993, CMS published regulations to implement requirements under OBRA ‘87 that all applicants to and residents of Medicaid-certified nursing homes be evaluated for mental illness and intellectual disability to ensure that nursing home placement was appropriate and, if so, the nursing home was adequately equipped to serve the individual’s needs. Because these regulations have not been updated since, they are now misaligned with statutory requirements that were later amended and refer to outdated diagnostic manuals and definitions. Lessons learned from 30 years of implementation also indicate that some regulations are duplicative, overly prescriptive, or vague. This rule updates the regulations to remedy these issues.