Pre-admission Screening and Resident Review (PASRR Level II-MI)

Definition of a serious mental illness for Level II MI: 
The individual has a major mental disorder as determined in the DSM5.

This includes but is not limited to such disorders as a

• Schizophrenia,
• Mood disorder,
• Paranoid disorder,
• Panic disorder,
• Other severe anxiety disorder including Generalized Anxiety Disorder,
• Psychotic disorder or
• Another mental disorder that may lead to a chronic disability
• Suicidal ideation with serious intent to complete suicide or potentially life-ending attempts are indicators to review the person’s mental health. 

Disorders that are not considered a mental illness for Level II MI include

• Any diagnosis of dementia that is not accompanied by a diagnosis of mental illness

If the person has a diagnosis of a mental illness and dementia, that person should be referred for a Level II MH assessment. The Level II assessor will consider whether the person can benefit from mental health treatments that might be provided.

In the past, this has been interpreted to mean that a person must have a past history of psychiatric hospitalizations. However, many people can have serious mental illnesses and live successfully in the larger community without frequent use of psychiatric hospital services. Most of them make use of community supports to assist them with the symptoms of their mental illness. The following are indicators that a person may have a serious mental illness:

• Psychiatric hospitalization
• Frequent use of mental health crisis services
• Using adult rehabilitative mental health services (ARMHS), Assertive Community Support Services (ACT).
• Identified as Disabled by a mental illness for the purposes of Social Security Disability

There are three major possible outcomes to a Level II MI.

• The person does not have a mental illness as defined by the PASSR. The person could be suffering from symptoms that appear to be like a mental illness but have some other etiology (dementia, TBI, etc.).

This person can be admitted to a nursing facility.

• The person has a mental illness and a NF is the most appropriate site for that care to be given. For instance, the person has a major physical illness that needs NF care or the person is convalescing from a surgery or illness. The Level II assessor makes recommendations about what sorts of mental health services the person might benefit from while at the NF. The person can refuse mental health services unless committed and the services are required under that commitment.

The person can be admitted to a nursing facility.

• The person has a mental illness and no physical illness that needs s NF care and they can be better served in a different setting.

The Level II MI assessor has the authority to deny the NF admission and make a recommendation to another setting.

All applicants to either a Medicaid certified NF or boarding care facility, regardless of income, assets, or funding sources, must receive a Preadmission Screen (PAS)Level I screening prior to admission. The Level I screener determines if the person meets nursing home level of care. The County Level II MH assessor determines if the NF is the appropriate place for the person to receive services and whether the person requires mental health services, the LMHA recommends the mental health service and provides the person and nursing facility with information about local service providers. If a person is receiving mental health services prior to NF admission, continuation of those services should continue unless there are significant mitigating circumstances. Please note that meeting NF level of care does not automatically indicate that the NF is the appropriate setting to receive care.

Medicaid is not a legal funding stream for individuals who are referred for a Level II MI until after the appropriateness of the NF setting is approved: i.e. until the Level II MI is finished.

Mental Health Services: Most MA-reimbursed services may be provided to individuals staying at a nursing facility. Most other insurances will cover some mental health services. Check with the person’s insurance carrier.

The state of Minnesota will reimburse counties and tribes up to $400 per episode for a Mental Health Level II assessment. All MH Level II Assessment are billable; the person assessed does not need to be Medicaid eligible for the county or tribe to be reimbursed. Effective September l, 2012 counties are required to use the following process to receive reimbursement for the Level II Assessment:

1. Bill using the 837P transaction requirements
2. Use the county's National Provider Identifier (NPI) as the pay to provider
3. Enter the NPI of the treating provider as the provider rendering the service. If the assessor does not have an NPI of their own, they may use the county NPI as both the pay to and rendering provider. Mental Health Professionals must use their individuals NPI, if completing any diagnostic assessment or diagnostic assessment update.
4. Use the recipient's PMI (Personal Master Index) number
5. Enter the appropriate diagnosis code
6. Submit the cost of the Level II Assessment. Please use the usual and customary rate for the service.
7. Use procedure code T2011
8. Enter 1 for the unit of service
9. A recipient is not required to be on Minnesota Health Care Program to be eligible for the Level II Assessment reimbursement. If the recipient is not on a Minnesota Health Care Program, the county must generate a Person Master Index (PMI) and bill the state for the Level II assessment. A PMI is a unique identification number that MAXIS assigns to each person.

The current edoc is used to guide the MH Level II assessment (Level II Preadmission Screening (PAS) for Persons with Mental Illness). A copy of all Level II paperwork, including all supporting documents, must be sent to the state mental health authority (SMHA) on a monthly basis. The address is

DHS Mental Health Division
PO Box 64981
St Paul, MN 55155-0981

In the spring of 2018, a new on-line reporting tool, the Mental Health Level II (MHLII), will be available to counties and tribes. This tool streamlines the process and determines the appropriate admission type based on entries made by the assessor. The final report can be emailed or printed. The tool also gathers the Level II Mental Health information for the state, eliminating the need for Counties and Tribes to mail forms to the SMHA.

The Level I screening determination or finding is not subject to appeal. However, Level II determinations may be appealed. As part of a Level II appeal, Level I screening findings are subject to review and consideration. Any person who is a potential NF resident or already a resident of a NF and who is adversely affected by a Preadmission Screening or Resident Review determination may initiate an appeal by contacting the Appeals Division, Department of Human Services at (651) 431-3600 or (800) 657-3610. Appeal processes apply only to the person who is seeking admission or their legal representative.