July 26, 2017

The dementia exclusion for mental illness allows for the Level II evaluator to stop the evaluation if they determine that the diagnosis of dementia is primary and the mental illness (MI) diagnosis is secondary. It is important to note that the diagnosis or verification of a diagnosis of MI and dementia are Level II functions required to be conducted by mental health professionals and cannot be done by Level I reviewers.  The identification of dementia must be done by the Level II evaluator as part of the diagnosis or verification of the diagnosis of MI.

As the SMHA cannot perform any Level II evaluation functions (483.106(e)(3)), it would not be appropriate, where a Level I screener believes a person to have both dementia and MI to be present to (a) decide unilaterally that dementia is primary or secondary or (b) forward the documentation directly to the SMHA to make this decision. The information from the Level I screen and any associated documentation would properly be forwarded to the State-designated Level II evaluator.

The mental health authority would make their determination on the dementia exclusion for mental illness based on the evaluator findings.