There is no federal requirement that a Level II evaluation be completed prior to the individual returning to the nursing facility (NF). A Level II evaluation is required when there is a significant change in a resident’s condition. When a resident is returning from a hospital stay, there may be a clear change in condition. In instances where the significant change is evident, the individual would be subject to a Resident Review upon their return to the nursing facility, per CFR §483.106(b)(3).
In other cases, it might take a period of readjustment back at the NF before changes to the resident's condition become apparent. In these situations, the NF should use the Minimum Data Set (MDS) Significant Change in Status Assessment to evaluate whether a Resident Review is indicated (i.e., whether a significant change in condition is present).