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

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.

Qualified developmental disability professional (QDDP): Person qualified to work as an expert with people with developmental disabilities (DD) or related conditions. The QDDP has a four-year college degree in an area related to DD and a minimum of one-year experience working in that field. For more information on QDDP standards, refer to C.F.R 42 §483.430.

Specialized services: Services provided to a person with a diagnosis of DD 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.

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:

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

Annual requirement

For NF residents who have DD 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. The county of financial responsibility (CFR) is responsible to monitor and ensure the OBRA Level II evaluation is completed annually.

Note

The county/Tribal Nation must offer people younger than age 65 a MnCHOICES assessment annually. People may choose to participate or decline this assessment under certain criteria (refer to CBSM – Choice to waive annual assessment). People age 65 and older may request a MnCHOICES assessment at any time.

For information about returning to the community and MnCHOICES assessments, refer to CBSM – Assessment applicability and timelines.

Change in condition

If a person experiences a significant change of condition, the county/Tribal Nation must complete a new OBRA Level II evaluative report. (Note: At the federal level, these evaluations are called resident reviews.) Any entity can report a significant change, including the NF.

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 Level 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 they are extending the date. 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.

Minnesota Aging Pathways

For people who are on the DD Waiver or who are suspected to have a DD or related condition diagnosis, Minnesota Aging Pathways:

Minnesota Aging Pathways decides which county/Tribal Nation to send the PAS based on either:

Note

Completion of PAS does not establish or change the person’s CFR. County/Tribal Nation financial workers determine the person’s CFR and are the only ones who can change it.

If a county/Tribal Nation receives this communication from Minnesota Aging Pathways but does not think they are responsible to complete the OBRA Level II evaluative report, they still should complete the OBRA Level II evaluative report. Then, they should contact their county/Tribal Nation 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 or related condition diagnosis, the MCO:

Then, the CFR/Tribal Nation completes an in-person OBRA Level II evaluative report. 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. The QDDP follows the process below to complete and enter the OBRA Level II evaluative report.