Ch. 19, § 5. Level I Screening

(a) Level I screening must be performed by qualified staff of a nursing facility or hospital to determine whether an individual seeking admission to or residing in a nursing facility needs further evaluation because of a suspected mental illness or an intellectual disability. (b) Level I screening includes reviewing the individual's medical records, observing presenting evidence, or reviewing documentation from other reliable sources. A screener must use the following criteria: (i) Mental illness. The screener must consider: (A) Has the individual been diagnosed with a serious mental illness as defined by 42 C.F.R. § 483.102; (B) An individual experiencing temporary anxiety or depressive reactions to a terminal or chronic debilitating condition for which specialized services would not be appropriate, but for which mental health services of a lesser intensity may be required does not qualify as a mental illness for nursing facility screening purposes; (C) Does the individual have a history of mental illness requiring treatment more intensive than outpatient treatment; and (D) Is there presenting evidence of a serious mental illness, including possible disturbances in orientation, affect, or mood that is not attributable to dementia or another medical diagnosis or treatment. (ii) Intellectual Disability. The screener must consider: (A) Has the individual been diagnosed by a physician or other qualified intellectual disability professional of having a primary or secondary diagnosis of intellectual disability as defined by 42 C.F.R. § 483.102; (B) Does the individual have a history of an intellectual disability; (C) Does the individual have cognition or behavior deficits indicating an intellectual disability; and (D) Was the individual referred by an agency that serves persons with an intellectual disability, and the individual was eligible for that agency's services. (c) Upon completion of the Level I screening, the screener will determine whether to refer the individual for a Level II screening. (i) If the determination is that a Level II screening is not necessary, the individual may be admitted to the nursing facility; the individual does not need to be screened again unless there is a significant change in the individual's condition that indicates a Level II screening is then necessary. (ii) If the determination is that a Level II screening is necessary, the individual must undergo Level II screening. (d) The nursing facility must provide written notice to the individual or his or her legal representative if Level II screening is required. This notice is only required for the first Level II screening. (e) The nursing facility must complete documentation in the format specified by the Department.