Level II involves a comprehensive evaluation of ID/MI, and a determination of the need for specialized services.
The state intellectual disability authority (SIDA) is responsible for both evaluations and determinations related to possible intellectual disabilities, developmental disabilities, and related conditions. The SMRA may delegate these responsibilities to another state agency (e.g., the state department on aging) or to a contractor.
The state mental health authority (SMHA) is responsible for determinations related to MI. However, an entity independent of the SMHA must complete the evaluations for MI. A qualified mental health professional must conduct the evaluation for possible MI. CMS recommends that Level II evaluator qualifications include enough training to comprehend psychiatric reports. Such training can be found among psychiatrists, clinical psychologists, clinical social workers, and some nurses.
For both MI and ID evaluations, CMS encourages use of Level II evaluators with a personal commitment to person-centeredness and maximum community integration. Especially when utilizing outside vendors to conduct Level II evaluations, states are encouraged to define specific and stringent requirements for these evaluators to ensure a commitment to the spirit of PASRR.
At the same time, states should be careful not to make their requirements so stringent that the evaluation and determination process becomes unacceptably slow. For example, requiring psychiatrists to perfrom the psychosocial evaluation for PASRR/MI is generally impractical, especially in rural areas, where the density of such professionals is generally low. It is better for the state -- and for the individuals whom PASRR is meant to serve -- if a range of professionals can perform the evaluation.