March 8, 2018

The CFR does not specify how quickly Level I's must be completed, and with good reason: There is no baseline against which to establish timing requirements. Not all individuals enter NFs from hospitals, and the discharge planning process can vary dramatically depending on the circumstances of the individual and the practices of the discharging hospital. Moreover, Level I's can be completed quite quickly, since they are by design preliminary screens, and can be administered by staff with little or no expertise in MI or ID.

The situation for Level II is quite different. According to 42 CFR §483.112(c), between identifying the need for a Level II (a positive Level I) and issuing a Level II determination, states must achieve an annual average of 7-9 working days. Because this is an average, the elapsed time for some individuals could be longer; longer times might be expected in rural areas, for example, where evaluators are less common and where they may need to travel. Of course, if it takes a state longer to issue determinations in some situations, it must take the state less time to issue determinations for other situations, so that mathematically the annual average falls below 9 working days. The CFR notes at §483.112(3) that states may elect to compute separate averages for evaluations completed for individuals with serious mental illness and those with intellectual disabilities/related conditions.