Page posted: 7/3/19

Page reviewed:

Page updated: 3/17/26

Legal authority

42 C.F.R. 483, subpart C, 483.100 – 483.138, Minn. Stat. §256B.0911 (LTCC), Minn. Stat. §256B.092 subd. 7, 8 and 8a (Rule 185 case management)

Definitions

OBRA Level II evaluative report: A document that records the results of the in-person evaluation used to assess a person’s need for specialized services. The county/tribal nation completes this document when a person needs nursing facility (NF) level of care. The in-person evaluation must occur before the person is admitted to an NF.

Qualified developmental disability professional (QDDP): Individual qualified to work as an expert with people with developmental disabilities or related conditions. The QDDP has a four-year college degree in an area related to developmental disabilities and a minimum of one-year experience working in that field. For more information on QDDP standards, see CFR Title 42, sec. 483.430.

Specialized services: Services provided to a person with a diagnosis of developmental disabilities or related conditions that result in active treatment (e.g., day training and habilitation, semi-independent living services).

Active treatment: Aggressive, consistent implementation of a 24-hour program with specialized and generic training, treatment, health services and other related services.

Person known to the lead agency (county, tribal nation, managed care organization): Person who actively participates or has a history of participation in Minnesota Health Care Programs (MHCP).

Overview

A person must receive an OBRA Level II evaluative report if either of the following is true:

Purpose

The OBRA Level II evaluative report ensures the person:

Timelines and frequency

The initial OBRA Level II evaluative report must be completed both:

Annual requirement

For NF residents who have developmental disabilities or related conditions, the county/tribal nation must complete an OBRA Level II evaluative report at least annually from the date of the person’s admission. Additional assessments might be required. For information about returning to the community and MnCHOICES assessments, see CBSM – Assessment applicability and timelines.

Change in condition

If a person experiences a significant change of condition, the lead agency must complete a new OBRA Level II evaluative report. (Note: At the federal level, these evaluations are called resident reviews.)

A “significant change” is a major decline or improvement in person’s status that:

Extension of approved length of stay

For NF stays up to 365 days, the county/tribal nation can adjust a person’s previously approved length of stay without completing a second in-person OBRA Level II evaluative report for that review period.

The county/tribal nation must review the person’s progress and determine if the person has had a significant change in condition that would require a new OBRA Level II evaluative report.

If the person needs a new evaluation, the county/tribal nation must:

If the previous OBRA II evaluative report still reflects the person’s current needs, the county/tribal nation must replace the current, approved screening document in MMIS with a new DD screening document that only extends the dates of the person’s stay. The county/tribal nation must include a note to the reviewer with a description of why the date is being extended. The date may not extend beyond 365 days from the in-person OBRA Level II evaluation.

In either situation, the updated DD screening document routes automatically to DHS for approval.

Roles and responsibilities

Senior LinkAge Line

For people on the DD Waiver or who are suspected to have a developmental disability or related condition diagnosis, the Senior LinkAge Line:

The Senior LinkAge Line decides which county/tribal nation to send the PAS based on either:

Note

Completion of PAS in and of itself does not establish or change a person’s CFR. County/tribal financial workers determine the person’s CFR, and they are the only ones who can change the assigned CFR. If a county/tribal nation receives this communication from Senior LinkAge Line but disputes that their county/tribal nation is responsible to complete the OBRA Level II evaluative report, they still should complete the OBRA Level II evaluative report and contact their county/tribal financial worker to resolve the situation for future instances.

Managed care organizations (MCOs)

When a physician refers a person for an NF stay and the person has a suspected DD diagnosis, the MCO:

Then, the CFR/tribal nation completes an in-person OBRA Level II evaluative report using the process described below. The CFR/tribal nation must send the results of the OBRA Level II evaluative report to the MCO. This communication is important, especially when the MCO is responsible to arrange for and provide services to the person.

Counties and tribal nations

The CFR/tribal nation is responsible to provide a QDDP to complete the OBRA Level II evaluative report.

If the person is known to the county/tribal nation, the QDDP reviews the person’s records for diagnosis or history. Three possible scenarios could occur:

If the person is not known to the county/tribal nation, the CFR/tribal nation reviews the person’s records for diagnosis or history. Then, the CFR/tribal nation must follow the process for a person with a diagnosis or history of developmental disabilities or related conditions.

Reimbursement

Effective March 17, 2026, lead agencies should use procedure code T2011 UI for reimbursement when conducting OBRA Level II evaluations for people with developmental disabilities or related conditions.

The lead agency must determine its usual and customary rate per hour when billing for the service, but it should not exceed $400 per evaluation.

Instructions to complete DHS-4248

The OBRA Level II evaluative report for people with developmental disabilities or related conditions, DHS-4248 (PDF) guides the QDDP through obtaining all required information. DHS recommends using Google Chrome to complete this form.

The QDDP gathers information about the person by completing:

Then, the QDDP document the findings using DHS-4248. This includes documenting the person’s:

How to submit

When the QDDP finishes documenting the findings on DHS-4248, the QDDP:

1. Downloads an electronic version to keep as a record

2. Prints a copy to send to the admitting NF

3. Uses the submit button on the online form to send it to DHS (Note: After you submit the form, you can no longer print the evaluation.)

4. Enters information from the DD Screening Document, DHS-3067 (PDF) into MMIS.

Printing

When the QDDP clicks the print button, a second browser tab opens. It is important that the QDDP prints and downloads a copy from this tab before submitting DHS-4248 to DHS. To submit, go back to the first browser tab and click the submit button.

Note

DHS recommends using Google Chrome to complete this form. Follow instructions on the submit page of the form to print this document.