The PASRR Technical Assistance Center helps states fulfill the goals of Preadmission Screening and Resident Review

When does a level II evaluation need to be conducted?

A level II Preadmission Screen (PAS) must be completed for all applicants who meet NF level-of-care requirements, and who have been identified as having possible MI and/or ID by the Level I evaluation.

NF applicants with suspected MI/ID may be exempted from a Level II screen if their stay will last fewer than 30 days (for example, for rehabilitation following hospital discharge). Residents with suspected MI/ID who stay longer than 30 days must undergo a Level II screen.

Full Level II evaluations can be omitted under certain circumstances where the need is clear or time-limited. The state mental health and intellectual disability authorities may develop categories based on certain diagnoses, illness severity levels, or the need for particular services (such as a ventilator) where the services of a NF would normally be needed. Moreover, a determination of some kind is always needed. Relative to typical determinations, categorical determinations may depend more heavily on information in the applicant's medical history, and they may be abbreviated.

Time-limited, provisional admissions can be made for cases of delirium, for cases involving a risk of self-injury, or for caregiver respite. The state can define these provisional categories to carry the categorical determination that specialized services are not required. The state may also establish a category in which a dual diagnosis of intellectual disability or related condition with dementia does not require specialized services. Note that these categories must be approved by CMS as part of the state plan before they can be applied to individual NF applicants.

Level II evaluations must also be conducted on NF residents with MI/ID any time there is a change in condition. (CMS recommends that states use Section 2.6 of the MDS 3.0 Manual change of condition protocol, which is attached below.) If the MDS indicates suspected MI/ID, the NF must notify the Medicaid agency or its designee, which must then arrange a Level II Resident Review (RR). If the MDS indicates a significant change in condition, the NF must notify the Medicaid agency or its designee, which must then determine whether the change in condition data support the need for a RR.

PTAC currently serves as a contractor for CMS.
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