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. Not all individuals enter NFs from hospitals, and the discharge planning process can vary dramatically depending on the circumstances of the individual and the practices of the discharging hospital. Moreover, Level I's can be completed quite quickly, since they are by design preliminary screens, and can be administered by staff with little or no expertise in MI or ID.
The situation for Level II is quite different. Between discovering a positive Level I and issuing a Level II determination, states much achieve an annual average of 7-9 working days. Because this is an average, the elapsed time for some individuals could easily be longer; longer times be expected in rural areas, for example, where evaluators are less common and where they may need to travel. Of course, if it takes a state longer to issue determinations for individuals in rural areas, it must take the state less time to issue determinations for individuals in more urban parts of the state. This is necessarily true mathematically.