Outstanding services across the country

We conduct assessment services in the following states:

California

  • California Recovery Program for Healthcare Professionals

    Agency: California Department of Consumer Affairs, including licensing boards: 

    • CA Board of Registered Nursing
    • Dental Board of CA
    • CA Dental Hygiene Board
    • Physical Therapy Board of CA
    • CA Board of Pharmacy
    • CA Physician Assistant Board
    • Osteopathic Medical Board of CA
    • CA Veterinary Medical Board

    The California Recovery Program is a confidential program that provides monitoring and rehabilitation of healthcare professionals whose ability to practice safely has been affected by the use of drugs or alcohol, and in some cases, by mental illness. Our primary mission is equal to that of the Boards’, which is to protect the public and return the participant to safe, professional practice.

    Substance use disorder is recognized by experts as a chronic, relapsing disease. Much like cardiac disease, diabetes or asthma, it is a permanent condition, and when treated and in remission, approximately 65 to 70% of individuals relapse. Treatment followed by supportive monitoring, such as is offered by the Recovery Program, reduces the risk of relapse to less than 20%.

    The Recovery Program is not a treatment program and is not a program of discipline. The Recovery Program is a program of support, monitoring, and accountability.

Connecticut

Delaware

Illinois

  • Preadmission Screening and Resident Review (PASRR)

    Agency: Illinois Department of Healthcare and Family Services (HFS) 

    We have contracted with the State of Illinois Department of Healthcare and Family Services (HFS) to begin managing the assessment process for Preadmission Screening and Resident Review (PASRR) Level I screens and completing Level II Serious Mental Illness (SMI) assessments for individuals applying to, or residing in, Medicaid-certified nursing facilities. New processes for admissions to Specialized Mental Health Rehabilitation Facilities (SMHRF) and Supported Living Programs (SLP) settings and a new service, Follow Up Visits are also included.

    The federally mandated PASRR screening and assessment are used to determine whether the nursing facility is the appropriate placement for individuals with mental illness, intellectual disabilities, or developmental disabilities. PASRR also works as a critical function to help match individuals with the care and services they need.

    Resources: Access tools and supports for conducting PASRR assessments in Illinois

Indiana

Iowa

Maine

  • Overview of Assessing Services Agency (ASA) Support

    Agency:  State of Maine Department of Health and Human Services, Office of Aging and Disability Services (OADS)

    We manage Maine's Statewide Assessment Services Agency, which is an integrated service for assisting individuals across a range of support programs, including Long Term Care (LTC), Acquired Brain Injury (ABI), and Intermediate Care Facilities (ICF), among others.

    Resources: 

  • Long-Term Care (LTC) Advisory

    The Long-Term Care (LTC) Advisory is an assessment that provides advice to the individual and family/guardian to determine if the person is eligible for possible facility admission, or in-home services funded through MaineCare or state funded home-based care programs. Individuals choosing to enter a nursing facility must have this type of assessment to comply with the State statutes unless entering under skilled care.

  • Pre-Admission Screening and Resident Review (PASRR)

    We perform onsite evaluations for individuals suspected of having a mental illness, through the Preadmission Screening and Resident Review (PASRR) program.

    The primary goal of this federally mandated assessment is to determine whether the nursing home is the appropriate placement for individuals with mental illness, intellectual disabilities or developmental disabilities. PASRR also works as a critical function to help match individuals with the care and services they need.

    Resources: 

  • Acquired Brain Injury (ABI)

    Acquired Brain Injury (ABI) is an injury to the brain that results from trauma, infection, vascular lesions, or anoxia. It can result in physical, behavioral or mental dysfunction affecting an individual’s ability to function independently. This evaluation requires a neuropsychologist evaluation and completion of the Mayo Portland Adaptability Inventory and Health and Safety tool to determine medical eligibility for specialized ABI services eith in the facility setting or at home.

  • Other Related Conditions (ORC)

    Other Related Conditions (ORC) constitute Cerebral Palsy, Epilepsy, or other condition besides mental illness which found to be closely related to Intellectual Disability, resulting in impairment or general intellectual functioning or adaptive behavior, similar to that of persons with Intellectual Disabilities and requires similar treatment or services.

    The State of Maine requires a Medical Eligibility Determination assessment and completion of the BMS 99 to determine an individual’s medical eligibility for services under the Other Related Conditions Waiver. The program provides community integration through existing natural supports and community relationships, such as Care Coordination, Home Support, Community Support, and Work Support.

  • Intermediate Care Facilities (ICF) / Intellectual/Developmental Disabilities (IDD)

    Intermediate Care Facilities (ICF) are specialized facilities for Individuals with Intellectual/Developmental Disabilities (IDD), or other related conditions, who require care and services above the level of room and board but not that of a hospital or skilled nursing facility. Medical eligibility requires a physician certification that the person have a need for at least 8 hours of licensed nurse supervision per day. The focus of these facilities is to assist individuals to reach their maximal level of functioning capabilities, with healthcare and rehab services while providing 24 hour care.

Michigan

Mississippi

New Hampshire

  • Comprehensive Assessment for Treatment Services (CAT)

    Agency: New Hampshire Department of Health and Human Services (DHHS) - Division of Children, Youth and Families (DCYF)  

    We have contracted with the New Hampshire Department of Health and Human Services (DHHS) - the Division for Behavioral Health, Bureau for Children’s Behavioral Health and the Division of Children, Youth and Families (DCYF) to manage the state’s independent Comprehensive Assessment for Treatment (CAT) services program as part of the state’s implementation of the Family First Prevention Services Act (FFPSA) and the New Hampshire System of Care (SOC) for Children. The role of Maximus in this partnership is to determine the use of residential services for eligible children and youth by qualified clinicians and that established Medical Necessity will be applied through the use of a standard assessment tool, the Child and Adolescent Needs and Strengths (CANS), for all levels of residential services.

    Interested in working as an independent contractor assessor for the New Hampshire CAT program?  If you are a New Hampshire resident with a minimum of two years of experience working with children and adolescents with behavioral diagnoses, as well as a Bachelor’s degree in human services or a related field, please contact our Recruiting team to learn more: Recruiting@maximus.com

    Resources: 

New Jersey

New York

  • Preadmission Screening and Resident Review (PASRR) Level II

    Agency:  The New York Department of Health, Office of Community Transition Services (CTS)

    We partner with CTS to perform Level II onsite evaluations for individuals suspected of having a mental illness the Preadmission Screening and Resident Review (PASRR) program. PASRR assessments are performed on individuals who are applying to, or residing in, Medicaid-certified nursing homes. The primary objective of this federally-mandated assessment is to determine whether the nursing home is the appropriate placement for individuals with mental illness, intellectual disabilities or developmental disabilities. PASRR also works as a critical function to help match individuals with the care and services they need.

    Resources: 

  • New York Independent Assessor (NYIA)

    Maximus has partnered with the New York State Department of Health to establish the New York Independent Assessor (NYIA) program for New York State Medicaid consumers who want to receive personal care services or community-based long-term services and supports. NYIA Nurse Assessors conduct conflict-free assessments of these individuals using the Community Health Assessment tool to determine whether they qualify for these services. Independent Practitioners—physicians, nurse practitioners, and physician assistants—conduct clinical appointments to determine if the individual is medically stable to receive services in the community. The information collected from the assessment and clinical appointment is used by local Departments of Social Services, Medicaid Managed Care Organizations, and Managed Long Term Care plans to develop the individual’s plan of care and make determinations regarding the services the individual may receive.

  • New York Medicaid Choice (NYMC)

    New York Medicaid Choice (NYMC) is among the largest managed care enrollment programs in the country, serving more than seven million Medicaid consumers. NYMC provides these consumers with education about how managed care works, advises them of their managed care options, and enrolls them in the health plan of their choice. NYMC is a call center- and outreach-based program that provides unbiased information to New York Medicaid recipients and helps them make the best health plan choice for themselves and their families. 

  • Children and Youth Evaluation Service (CYES)

    Maximus has partnered with the New York State Department of Health to establish the Children and Youth Evaluation Service (CYES) program to determine whether a child or youth is eligible for home and community-based services (HCBS) covered by Medicaid. CYES makes eligibility determinations primarily for children and youth aged 0-21 years who have been identified as being Medically Fragile (MDF) or having a Serious Emotional Disturbance (SED). CYES Nurse Evaluators conduct conflict-free evaluations of these children and youth to assess their needs for HCBS and develop person-centered plans of care. CYES Family Support Coordinators provide coordination and referral services and assist HCBS-eligible children or youth to apply for Medicaid.

  • Office of People with Developmental Disabilities (OPWDD)—Coordinated Assessment System (CAS) Assessment Services

    Maximus conducts conflict-free assessments of adults who have intellectual and development disabilities on behalf of the New York State Office for People with Developmental Disabilities (OPWDD). Maximus Assessors use the Coordinated Assessment System (CAS) comprehensive assessment tool to identify the strengths, interests, and needs of these individuals, information which assists in their person-centered care planning.

  • Office of People with Developmental Disabilities (OPWDD)—Children and Adolescent Needs and Strengths (CANS) Assessment Services

    Maximus conducts conflict-free assessments of children and youth aged 6-17 who have intellectual and development disabilities on behalf of the New York State Office for People with Developmental Disabilities (OPWDD). Maximus Assessors use the Child and Adolescent Needs and Strengths (CANS) comprehensive assessment tool to identify the strengths, interests, and needs of these children and youth, information which assists Care Coordination Organizations (CCO) in their person-centered care planning.

  • New York Physician Profile (NYPP)

    The New York Physician Profile (NYPP) program provides key information to health care consumers for every licensed and registered physician who practices in the state via a website and call center. NYPP maintains a database of health care provider profiles for more than 179,000 medical doctors and doctors of osteopathic medicine who are licensed in the state. These profiles include information about a doctor’s education, their practice, legal actions against them, and any professional activities. 

North Dakota - Department of Human Services

North Dakota - Medical Services Division

  • Overview

    Agency:  North Dakota Department of Human Services (DHS), Medical Services Division

    Since 2003, we have partnered with the DHS Medical Services Division to provide evaluation services for multiple programs, that currently include the following:

  • PASRR Level I, Level II and Level of Care

    We partner with the DHS Medical Services Division to perform Level I, Level II and Level of Care (LOC) onsite evaluations for the Preadmission Screening and Resident Review (PASRR) program.

    PASRR is performed on individuals who are applying to, or residing in, Medicaid-certified nursing homes. The main objective of this federally required assessment is to determine whether the nursing home is the appropriate placement for individuals with mental illness, intellectual disabilities or developmental disabilities.

    PASRR also works as a critical function to help match individuals with the care and services they need.

    Resources:

  • Money Follows the Person

    We partner with the DHS Medical Services Division to conduct the initial screening for eligibility (Level of Care) and makes determinations regarding denials for this transition program.

  • Children with Medically Fragile Needs

    This waiver covers children with high medical needs. Ascend reviews Level of Care screens and notification letters are sent to all parties.

  • Program for All-Inclusive Care for the Elderly (PACE)

    The PACE program offers services for individuals living in the community. We review Level of Care screens and send notification letters to all parties.

  • Personal Care

    Personal Care provides services associated with activities of daily living to individuals living in the community to help them maintain independence. We review screens to determine Level of Care needed and provide notification letters to all parties.

  • Home and Community Based Services

    This program offers services to provide an alternative to institutional placement for individuals with defined needs. We perform Level of Care screens and sends notification letters to all parties.

  • Traumatic Brain Injury (TBI)

    The TBI waiver provides services to individuals who have TBI and who would otherwise be eligible to be admitted to a nursing facility. We perform annual Level of Care screens and send notification letters to all parties.

  • Under 21 Psychiatric Services

    We conduct and manage Certificate of Need review and decisions for admissions of children under age 21 with mental health and substance abuse diagnoses seeking admission or continued stays in acute psychiatric and residential treatment centers. In addition, we conduct elective, emergency, and retrospective utilization reviews for persons under the age of 21.

    Resources:

    Access resources and tools for North Dakota's Under 21 Psychiatric Services 

  • Medical Long Term Care Utilization Review

    We perform Medical Long Term Care Utilization Review (admission and continued stay reviews) for several other services provided by the State of North Dakota.

Ohio

Oregon

Tennessee

Virginia

*Accreditations

  • URAC

    The Utilization Review Accreditation Commission (URAC) develops national standards to improve quality, protect consumers and improve health outcomes.

    The Clinical Services Division of Maximus has been granted “Full” accreditation by URAC:

    • Health Utilization Management - 7.4

    Maximus has also been granted several other accreditations:

    • Credentials Verification Organization (CVO) - 4.1
    • Independent Review Organization: External Review - 5.1
    • Workers' Compensation Utilization Management - 7.4

    Learn more about URAC and each accreditation:

     

  • Quality Improvement Organization (QIO)-Like Entity
    • Maximus U.S. Services
       
    • Maximus Federal