TOPIC: LEVEL I

All individuals who apply to reside in a Medicaid-certified nursing facility, regardless of payer, are required to receive a Level I PASRR screen to identify mental illness or intellectual disabilities. If an individual is suspected to have mental illness or an intellectual disability, a Level II evaluation is conducted to confirm this. A Level II must not merely rubber stamp the outcome of the Level I. Rather it must “look behind” the diagnosis of record to identify the “true” diagnosis. This presentation will further discuss the relationship between Level I and Level II evaluations and highlight common misconceptions as well as promising practices.

There are no federal requirements regarding who must request Level I screens, but CFR 42-§483.102 is clear that all individuals who apply to reside in a Medicaid-certified nursing facility, regardless of payer, are required to receive a Level I screen to identify individuals with a mental illness, intellectual disability, or related condition. The Medicaid agency is responsible for the PASRR program as a whole and states are permitted to design their program, including who is responsible for requesting the Level I screen, as they choose.

According to CFR 42-§483.102, a PASRR Level I screen must be completed for all applicants to a Medicaid-certified nursing facility, regardless of payer. A Level I screen must be completed before a resident can be admitted into a nursing facility. If a current nursing facility resident experiences a significant change in his or her mental or physical condition, the individual is subject to a Resident Review evaluation.

Regardless of their known diagnoses, all individuals applying to a Medicaid-certified nursing facility (NF) must undergo a Level I screen to determine if the individual possibly has a condition meeting PASRR’s definition of mental illness, intellectual disability or a related condition. A person with a TBI could potentially meet the criteria for a “related condition,” and thus require a Level II evaluation and consideration for specialized services

All individuals applying to a Medicaid-certified nursing facility (NF) must be screened for both mental illness and intellectual disability. According to 483.128 (e), if a Level II evaluation is required “The State's PASRR program must use at least the evaluative criteria of §483.130 (if one or both determinations can easily be made categorically as described in §483.130) or of §§483.132 and 483.134 or §483.136 (or, in the case of individuals with both MI and IID, §§483.132, 483.134 and 483.136 if a more extensive individualized evaluation is required).”

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.