The purpose of a Level II Evaluation is to avoid unnecessary
or inappropriate nursing facility admission of persons with serious mental
illness or intellectual disabilities or related conditions. The Level II
evaluation ensures that persons with serious mental illness or intellectual
disabilities or related conditions are recommended for specialized services
when a health care professional determines there is a need for specialized
services during the evaluation process. The Department bases Level II
Evaluations on the criteria set forth in
42 CFR
483.130. Level II Evaluations must address
the level of nursing services, specialized services, and specialized
rehabilitative services needed for the patient.
(1) The health care professional who
completes the Level I screening shall refer the person to a contracted mental
health PASRR Evaluator for the Level II Evaluation if the Level I Screening
indicates the person meets all of the following criteria:
(a) The person has a serious mental illness
as defined by the State Mental Health Authority and identified by the Level I
Screening;
(b) The diagnosis of
mental illness falls within the diagnostic groupings as described in the
Diagnostic and Statistical Manual; and
(c) In addition to the criteria listed in
Subsection R414-503-4(1)(a)(b), the person meets any one of the following
criteria:
(i) The person has undergone
psychiatric treatment at least twice in the last two years that is more
intensive than outpatient care;
(ii) Due to a significant disruption in the
person's normal living situation, the person requires supportive services to
maintain the current level of functioning at home or in a residential treatment
center; or
(iii) The person
requires intervention by housing or law enforcement officials.
(2) The health care
professional who completes the Level I screening shall refer the person to the
Intellectual Disability or Related Condition Authority for the Level II
Evaluation if the Level I Screening indicates the person meets at least one of
the following criteria:
(a) The person has
received a diagnosis of an intellectual disability or related
condition;
(b) The person has
received a diagnosis of epilepsy or seizure disorder with onset before 22 years
of age;
(c) The person has a
history of intellectual disability or related condition, or an indication of
cognitive or behavioral patterns that indicate the person has an intellectual
disability or related condition; or
(d) The person is referred by any agency that
specializes in the care of persons with intellectual disabilities or related
conditions.
(3) The
health care professional who completes the Level I screening shall refer the
person to both the contracted mental health PASRR Evaluator and the
Intellectual Disability or Related Condition Authority if the person meets the
criteria for Subsection R414-503-4(1) and (2).
(4) The health care professional who
completes the Level I screening shall provide written notice of a Level II
Evaluation referral to the person, the person's legal representative, and the
prospective nursing facility.
(5)
If the person does not meet the criteria in Subsection R414-503-4(1) or (2),
the Department may not require a further PASRR Evaluation unless there is a
significant change in condition.
