Utah Admin. Code R414-503-7 - Individualized Level II Determinations
The Level II Evaluator may make one of the following individualized determinations:
(1) The
person does not need nursing facility services. This determination disqualifies
the person from admission to a Medicare/Medicaid-certified nursing
facility.
(2) The person does not
need nursing facility services but does need specialized services as defined by
the State Mental Health Authority or Intellectual Disability or Related
Condition Authority. This determination disqualifies the person from admission
to a Medicare/Medicaid- certified nursing facility.
(3) The person needs nursing facility
services but not specialized services. This determination qualifies the person
for admission to a Medicare/Medicaid-certified nursing facility.
(4) The person needs nursing facility
services and requires specialized services. The Level II Evaluation will
specify the specialized services that are needed. This determination qualifies
the person for admission to a Medicare/Medicaid-certified nursing facility. The
State Mental Health Authority or the Intellectual Disabilities or Related
Conditions Authority shall provide a copy of the Level II Evaluation and
findings to the person, the person's legal representative, the nursing
facility, and the attending physician.
(5) Out-of-State Arrangement for Payment: The
state in which the person is a resident (or would be a resident at the time the
person becomes eligible for Medicaid) as defined in
42 CFR 435.403
shall pay for the Level II Evaluation in accordance with
42 CFR
431.52(b).
(6) The nursing facility, in consultation
with the person and his legal representative, shall arrange for a safe and
orderly discharge from the nursing facility, and shall assist with linking the
person to supportive services and preparing the person for discharge if the
person no longer meets the medical criteria for nursing facility services, or a
Level II Evaluation disqualifies the person as no longer eligible for nursing
facility placement.
Notes
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