PASRR - VI. Level II Assessments
- Who Must Be Assessed. Except those individuals 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, intellectual disability, or other related condition, must be assessed prior to admission. Assessment is required regardless of the method of payment.
- 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.
- Admission for Convalescent Care. The
following conditions apply: (although Federal Regulations allow for an exemption for the following, Maine DHHS requires the completion of a Level I Screen on all people being admitted to an NF, even if the expected length of stay is 30 calendar days or less, as a way of following these individuals in case they remain at the facility for permanent placement (at which time a Level II Assessment may be required).
- person must have been hospitalized for treatment; and
- the discharge does not qualify as an exempted hospital discharge (see V. B. iv, above); and
- 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.
- Respite Care. The following
- the person is expected to return to the in-home caregivers following the respite stay; and
- no more than 30 calendar days of respite care may be used in any 12 month period; and
- 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 contact APS Healthcare to 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.
- Terminal Illness. The following
- the person has a medical prognosis that life expectancy is 6 months or less if the illness runs its normal course; and
- physicianhas documented the prognosis in writing. If the length of stay exceeds six months, the NF must notify APS Healthcare. A Level II Assessment may not be required.
- Severe Physical Illness. The following conditions
- the person must 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
- a physician has documented the diagnosis and condition in writing.
- Delirium. The following conditions apply:
- an accurate diagnosis cannot be made until the delirium clears; and
- a physician documents the diagnosis and condition in writing. If the delirium persists beyond the 30th calendar day of admission, the NF must notify APS Healthcare.
- Admission for Convalescent Care. The following conditions apply: (although Federal Regulations allow for an exemption for the following, Maine DHHS requires the completion of a Level I Screen on all people being admitted to an NF, even if the expected length of stay is 30 calendar days or less, as a way of following these individuals in case they remain at the facility for permanent placement (at which time a Level II Assessment may be required).
- Co-Occurring Disorders. Individuals who have or are suspected of having both a mental illness and/or an intellectual disability and/or an other related condition, will be provided a Level II Assessment that is integrated and coordinated for both disorders
- Diagnostic Cross-Walks. Federal regulations require the use of the DSM-3-R 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-3-R.
- Notification. APS Healthcare will notify the hospital or NF that a Level II Assessment is indicated (based upon Level I Screen results) for individuals suspected of having mental illness, intellectual disability, or other related condition. Medical records will be requested from the hospital, NF and/or other sources as appropriate, in order to conduct a record review to evaluate the individual's conditions and needs. APS Healthcare will ensure the completion of the Level II Assessment. This normally takes nine business days after receipt by APS Healthcare of all necessary documentation to complete Level II Assessment.
- Level II Assessment. APS Healthcare will complete the assessment, confirm the diagnosis or lack of diagnosis of mental illness, intellectual disability, or other related condition, and the basis for all conclusions, and submit an evaluation assessment to DHHS. The assessment, if there is a confirmed diagnosis, must
- recommend community NF care and identify the services of a lesser intensity that are required to meet the person's needs; or
- recommend community NF care and identify the specialized services required to meet the person's needs; or
- recommend NF care in a specialized community NF with more intensive specialized services than would be provided at a community NF; or
- recommend acute care.
- Determination. Copies of the determination letter stating the outcome and recommendations must be provided to the individual and a legal representative (if one exists), the NF, the attending physician, and the hospital (if admission is being sought from a hospital). A copy of the written, full assessment is provided to the above listed parties for mental illness, intellectual disability and/or other related condition.