January 8, 2020

Level II evaluations for individuals with intellectual disabilities and/or related conditions:

According to 42 CFR 483.106(e)(1) and 42 CFR §483.106(e)(2) of the Code of Federal Regulations (CFR), evaluations for individuals with intellectual disabilities (ID) and/or related conditions (RC) are the responsibility of the state intellectual disability authority (SIDA). Thus, the state intellectual disability authority may complete ID/RC Level II evaluations.

42 CFR 483.106 (e)(1) allows the SIDA to delegate, by subcontract, the evaluation to another entity, but the SIDA must retain ultimate responsibility for the performance of this duty. Additionally, 42 CFR 483.106(e)(1)(iii) explicitly prohibits the SIDA from delegating evaluations to a NF or an entity that has a direct or indirect affiliation or relationship with a NF. NFs and their staff may not perform Level II evaluations on behalf of the SIDA.

The SIDA has discretion in determining the qualifications of the personnel who perform the evaluations. However, the CFR does provide instruction for the type of credentials necessary to conduct and interpret IQ testing results for individuals with intellectual disability or a related condition, if such testing is necessary. (See FAQ -Do PASRR Regulations Require a Test of Intellectual Functioning be Completed as a Part of Level II Evaluations for Individuals with Intellectual Disabilities and Related Conditions?)

Level II evaluations for individuals with mental illness:

According to 42 CFR §483.106(d)(1) and (e)(3) of the CFR the state mental health authority (SMHA) does not have responsibility for the Level II evaluations for individuals with mental illness, only the Level II determinations. The SMHA cannot perform the evaluations but may contract with another entity to perform them. Alternatively, the State Medicaid Agency (SMA) may designate an entity to perform MI evaluations. The entity the SMHA or SMA contracts with must not be a NF or an entity that has a direct or indirect affiliation or relationship with a NF. NFs cannot perform Level II evaluations on behalf of the State.
The CFR gives the SMA discretion in determining the qualifications of the person who performs the evaluation, so long as that person is a mental health professional. Additionally, the CFR indicates that a physician must either complete the medical history and physical exam required in the evaluation, or review and concur with its conclusions (42 CFR 483.134 (c)(1)).