The Level II screening is triggered by evidence of a serious mental illness (MI), Intellectual or Developmental Disabilities(IDD) or condition related to Intellectual or Developmental Disabilities (RC) as defined by state and federal guidelines. The purpose of the Level II screening is to determine if the individual has any special needs due to his/her identified condition that need to be addressed in a nursing facility or if those special needs are so significant that they cannot be met in a nursing facility and can only be met in a psychiatric hospital or a specialized facility dedicated to the care of the developmentally disabled. For those suspected of meeting state and federal PASRR criteria for MI or IDD/RC, Level II screens must be performed both prior to admission (PAS) to assess for both NF placement appropriateness and specialized service needs.

When the submitted Level I screen indicates that the individual does have indicators of a serious mental illness or developmental disability, s/he will be referred for a Level II face-to-face evaluation. The Level II must be completed prior to the individual's admission to a Medicaid certified nursing facility (regardless of whether the individual is a Medicaid recipient or is a private payee). The referral source will be notified of the need for a Level II screen during the initial notification via Provider Link or fax, and the process discussed in Section II.C.i called Pre-admission Screen PAS is initiated. It is important to note that an identified PASRR Level I screen with suspected MI, I/DD or RC can not be completed (referred for a face-to-face assessment) until a FL-2 or MDS, and current History and Physical are received by the NC Medicaid clinical reviewer.

Please note, "Related Conditions" are not a form of intellectual disability but produce similar functional impairments and require similar treatment or services and must: a) emerge before the age of 22; b) be expected to continue indefinitely; and c) result in substantial functional limitations of three or more life activities (self-care, understanding and use of language, learning, mobility, self-direction, and capacity for independent living).

If the Level II outcome determination indicates that nursing facility placement is not appropriate, the referral source will be notified by written notification of the determination. The applicant/resident and/or legal guardian will also receive written notification, accompanied by notification of appeal rights through the fair hearing process.

The NC Medicaid notifies the referral source that a Level II PASRR screen is required and requests that medical records be available for the on-site assessor.

  • A face to face in-depth assessment is performed by the field assessor.
  • When the final determination is made, a PASRR number is assigned, if appropriate and sent to the referral source.
  • A letter is mailed by the NC Medicaid to the resident/responsible party informing them of the final decision and their appeal rights.
  • If the individual is a Medicaid recipient, the referral source contacts Medicaid's fiscal agent (1-800-688-6696 or 1-919-851-8888) and proceeds with the Medicaid nursing facility prior approval process
  • The receiving nursing facility submits the North Carolina Nursing Facilities Tracking Form to the NC Medicaid.
  • The NC Medicaid will forward the North Carolina Level I Screening Form to the nursing facility for the resident's file.

Pre-admission Screens (PAS)

Level II face-to-face Pre-admission screens (PAS) must occur prior to admission (excluding those situations described in Change In Condition Section) and are completed within 7 business days. The referral source will be asked to send some or all of the following patient information to the NC Medicaid PASRR department which is required to make an appropriate assessment of the individual's present condition. This information is considered to be part of the Level II screening by Federal regulations:

The following information will be required:

  1. A current history and physical (performed within the past 12 months) that includes: Complete medical history; review of all body systems
  2. A comprehensive drug history including, but not limited to, current or immediate past use of medications that could mask symptoms or mimic mental illness
  3. Current physician's orders and treatments
  4. Copies of most recent intellectual testing, if available (only requested for individuals with mental retardation or related conditions)
  5. A copy of the FL2, MDS, or physician notes which document diagnosis. Upon receipt of this information, the information is assessed for referral to a Level II face to face evaluation

Results of the face-to-face assessment and medical record information are reviewed by NC Medicaid PASRR professionals, a summary of findings is completed documenting recommended placement and specialized services needs. A verbal call is placed to the referring facility within seven (7) business days from the date the Level II referral notification was first completed.

The admitting nursing facility must notify the NC Medicaid PASRR department of the individual's date of admission via a Tracking Form. In order to receive written results of these processes, the referral source must identify the admitting placement on the initial screen. This can be accomplished by faxing/mailing the Tracking Form (Appendix B). Level II outcome determinations resulting in a "C", "B", or "J" alpha code remain valid unless the resident experiences a change in status. Significant changes and other conditions which require an update, as described in Section II.D should be reported to NC Medicaid PASRR department using the Level I screening process.

Dementia Exemption

When the referral source is initiating a Level I identification screen for an individual with MI or IDD/RC and the individual also has a primary diagnosis of a dementing illness (e.g., Dementia or Alzheimer's Disease), the individual may not require Level II screening or may be allowed an abbreviated categorical Level II screen. The referral source can avoid unnecessary Level II screens and the delays associated with them if they can provide clear evidence of a dementia diagnosis, e.g., a neurological assessment and diagnosis, a mental status exam establishing symptoms of disordered memory and orientation, or other information specific to establishing that the symptoms of dementia supersede the symptoms/conditions associated with mental illness or mental retardation.

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