interRAI Assessment Maryland: How to Prepare and What to Expect

The Assessment That Controls Everything

Every Maryland Medicaid home care program — Community First Choice, the Community Options Waiver, CPAS, and ICS — requires a clinical functional assessment before services begin. The outcome of this evaluation determines whether your parent qualifies, which programs they can access, and how many care hours are approved. Getting it wrong means fewer hours, the wrong program, or a denial that triggers a months-long appeal.

Maryland transitioned to the interRAI Home Care (iHC) assessment instrument in early 2025, replacing the older STEPS assessment for all general long-term care evaluations. This change came through MDH Provider Transmittal PT 64-25. At the same time, the county-level units that conduct these assessments — formerly called Adult Evaluation and Review Services (AERS) — were realigned to focus on clinical assessments and nurse monitoring.

What the Evaluator Assesses

A registered nurse from your local health department conducts the interRAI assessment in your parent's home. The evaluation covers:

Activities of daily living (ADLs). The evaluator scores your parent's ability to perform bathing, dressing, eating, toileting, transferring (moving between bed and chair), and walking or mobility. Each ADL is rated on a scale from independent to total dependence.

Cognitive function. Memory, decision-making ability, communication, and orientation to time, place, and person. Cognitive scores carry significant weight — a parent who is physically capable of bathing but cognitively unable to initiate or sequence the steps is scored as needing hands-on assistance.

Behavioral symptoms. Wandering, verbal or physical aggression, resistance to care, socially inappropriate behavior, and repetitive behaviors. These are particularly relevant for parents with dementia and directly affect the type and intensity of care authorized.

Health conditions and medical complexity. Current diagnoses, medications, recent hospitalizations, fall history, skin integrity, pain levels, and nutritional status. Unstable medical conditions strengthen the case for nursing facility level of care.

Environmental assessment. Safety of the home environment, availability of informal caregivers, and the adequacy of the current care arrangement.

Why Preparation Matters

Parents with cognitive impairment routinely perform better during structured evaluations than they do in daily life. A parent with moderate dementia may answer the nurse's questions coherently, make eye contact, and appear far more capable than they actually are when unsupervised. This phenomenon — sometimes called "showtiming" — can result in an assessment that understates your parent's actual care needs.

You need to be present during the evaluation and provide the evaluator with concrete, documented evidence of your parent's functional status on their worst days.

How to Prepare

Keep a written log for two weeks before the assessment. Record specific incidents with dates and times: falls, missed medications, confusion episodes, inability to dress or bathe without hands-on help, leaving the stove on, wandering attempts, aggressive reactions during personal care, and nighttime disorientation. Specific examples carry far more weight than general statements.

Describe worst-case scenarios, not averages. The evaluator needs to understand the level of care required to keep your parent safe. If your parent can dress themselves on good days but needs complete assistance three days out of five, communicate the three-out-of-five reality.

Bring medical documentation. Hospital discharge summaries, medication lists, physician notes about cognitive decline or functional limitations, and any existing diagnoses (dementia, Parkinson's, stroke history) provide clinical context that supports higher care needs.

Address nighttime safety. If your parent wanders at night, gets up and falls, or needs repositioning, make sure the evaluator knows. Overnight care needs are often underassessed when the evaluation happens during daytime hours.

Do not coach your parent. Do not tell them to perform worse than they actually do — evaluators are trained to detect exaggeration. Instead, simply make sure the evaluator sees the full picture, including the struggles your parent might try to hide out of pride or habit.

What Happens After the Assessment

The interRAI assessment produces a standardized clinical profile that determines your parent's level of care. Two outcomes matter most:

Nursing facility level of care (NFLOC). If your parent meets this threshold — significant impairment across multiple ADLs or severe cognitive limitations requiring hands-on assistance — they qualify for CFC (no waitlist), the COW (waitlist), and ICS (if transitioning from a nursing facility with income above $2,982).

Below NFLOC but needing at least one ADL. Your parent qualifies for CPAS, which covers lighter personal assistance.

The Supports Planning Agency then uses the assessment results to draft a Person-Centered Plan of Service — the document that specifies care hours, service types, and whether the care model is agency-managed or consumer-directed. The approved hours directly reflect the clinical scores, so a thorough assessment translates directly into adequate care.

If You Disagree with the Results

If the assessment underscores your parent's needs and results in a denial or insufficient care hours, you have the right to appeal. The appeal must be filed within 90 days of the determination notice with the MDH Office of Health Services Appeals Unit. To preserve existing services during a reduction appeal, file within 10 days of the notice date.

Bring your written log, medical documentation, and any witness statements from family members or other caregivers who observe your parent's daily functioning. The appeal process involves an administrative hearing where you can present this evidence.

The Maryland Home Care, Waivers & Support Guide includes an assessment preparation checklist, a daily care log template, and detailed instructions for the appeal process if the initial evaluation does not reflect your parent's true needs.

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