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MH Home > PASRR > VI. Level II Assessments

PASRR - VI. Level II Assessments

  1. Who Must Be Assessed. Except those persons whose conditions meet the requirements for advance group determinations, all persons who apply for admission to an NF in Maine, who have or are suspected to have a diagnosis of mental illness or developmental disability, must be assessed prior to admission. Assessment is required regardless of the method of payment.
  2. Advance Group Determinations. The following describes conditions which exempt or defer Level II assessments. Admission to an NF is permitted when the applicable conditions are met.
    1. Admission for Convalescent Care. The following conditions apply:
      1. person must have been hospitalized for treatment; and
      2. the discharge does not qualify as an exempted hospital discharge (see V. B. iv, above); and
      3. the expected length of stay is not expected to exceed 30 calendar days. The discharging hospital physician must document in writing that the NF stay is expected to be 30 days or less. If the length of stay exceeds 30 calendar days, the NF must request the Level II assessment to be completed within 40 calendar days of admission.
    2. Respite Care. The following conditions apply:
      1. the person is expected to return to the in-home caregivers following the respite stay; and
      2. no more than 30 calendar days of respite care may be used in any 12 month period; and
      3. the stay may not exceed 15 calendar days.
        If the length of stay exceeds the 30 day annual limit or 15 calendar days, the NF must request the Level II assessment to be completed within 10 calendar days of the 30th day of the annual limit or the 15th day of admission, whichever is applicable.
    3. Terminal Illness. The following conditions apply:
      1. the person has a medical prognosis that life expectancy is 6 months or less if the illness runs its normal course; and
      2. a physician has documented the prognosis in writing. If the length of stay exceeds six months, the NF must notify DHHS. A Level II assessment is not required.
    4. Severe Physical Illness. The following conditions apply:
      1. the person must be have a severe physical illness such as coma, ventilator dependence, functioning at a brain stem level, or diagnoses which result in a level of impairment so severe that the individual could not be expected to benefit from specialized services; and
      2. a physician has documented the diagnosis and condition in writing.
    5. Delirium. The following conditions apply:
      1. an accurate diagnosis cannot be made until the delirium clears; and
      2. a physician documents the diagnosis and condition in writing. If the delirium persists beyond the 30th calendar day of admission, the NF must notify DHHS.
  3. Co-Occurring Disorders. Persons who have or are suspected of having both a mental illness and developmental disability will be provided a Level II assessment that is integrated and coordinated for both disorders. NFs must notify DHHS if an integrated Level II assessment is needed
    Level II Assessment Form - Microsoft Word*, Adobe PDF* (*free viewer)
  4. Diagnostic Cross-Walks. Federal regulations require the use of the DSM, current version, for the identification of mental illnesses and the American Association on Mental Retardation’s 1983 definition. Please refer to the Diagnostic Criteria for mental illness, from the DSM, current version. Information related to the diagnosis of developmental disability is available at the Regional Office nearest you.
  5. Process
    1. Referral. DHHS will arrange for a Level II assessment, to be conducted by a contracted assessment provider for persons suspected of having mental illness and by Developmental Disability Services (OACPDS) for persons suspected of having developmental disability. DHHS will ensure the completion of the Level II assessment. This normally takes nine working days after receipt of the level 1 screen by DHHS.
    2. Evaluation Report. The contracted assessment provider/OACPDS will complete the assessment, confirm the diagnosis or lack of diagnosis of mental illness or developmental disability and the basis for all conclusions, and submit an evaluation report to DHHS. The report, if there is a confirmed diagnosis, must
      1. recommend community NF care and identify the services of a lesser intensity that are required to meet the person’s needs; or
      2. recommend community NF care and identify the specialized services required to meet the person’s needs; or
      3. recommend NF care in a specialized community NF with more intensive specialized services than would be provided at a community NF; or
      4. recommend acute care.
      5. Copies of the report must be provided to the person and a legal representative (if one exists), the NF, the attending physician, and the hospital (if admission is being sought from a hospital).
    3. Notification. Preadmission Screening Services or Developmental Disability Services may notify the NF, the discharging hospital and the person of the recommendations and determination verbally. A written letter of final determination will be provided to the same people to whom the report was provided.