1005 Preadmission Screening Criteria for an Applicant or Member who is Developmentally Disabled (DD)

 

Policy

 

The Administration shall conduct a PAS assessment of an applicant or member who is DD using one of three PAS instruments specifically designed to assess an applicant or member in the following age groups:

·         12 years of age and older,

·         6 through 11 years of age, and

·         0 through 5 years of age.

The PAS instruments for an applicant or member who is DD include three major categories:

·         Intake information category. The Assessor solicits intake information category information on an applicant’s or member’s demographic background. The components of this category are not included in the calculated PAS score.

·         Functional assessment category. The functional assessment category differs by age group as indicated below:

o   For an applicant or member 12 years of age and older, the Assessor solicits the functional assessment category information on an applicant’s or member’s:

§  Need for assistance with independent living skills, including hand use, ambulation, wheelchair mobility, transfer, eating or drinking, dressing, personal hygiene, bathing or showering, food preparation, community mobility, and toileting;

§  Communication skills and cognitive abilities, including expressive verbal communication, clarity of communication, associating time with an event and action, and remembering an instruction and a demonstration; and

§  Behavior, including aggression, verbal or physical threatening, self-injurious behavior, and resistive or rebellious behavior.

o   For an applicant or member 6 through 11 years of age, the Assessor solicits the functional assessment category information on an applicant’s or member’s:

§  Need for assistance with independent living skills, including rolling and sitting, crawling and standing, ambulation, climbing stairs or ramps, wheelchair mobility, dressing, personal hygiene, bathing or showering, toileting, level of bladder control, and orientation to familiar settings;

§  Communication, including expressive verbal communication and clarity of communication; and

§  Behavior, including aggression, verbal or physical threatening, self-injurious behavior, running or wandering away, and disruptive behavior.

o   For an applicant or member 6 months through 5 years of age, the Assessor scores items in the developmental milestones section based on the age of the applicant or member.

o   For an applicant or member less than 6 months of age, the Assessor shall not complete a functional assessment. The Assessor shall include a description of the applicant’s or member’s development in the PAS instrument narrative summary.

·         Medical assessment category. The Assessor solicits medical assessment category information on an applicant’s or member’s:

o   Medical condition;

o   Specific services and treatments the applicant or member receives or needs and the frequency of those services and treatments;

o   Current medication;

o   Medical stability;

o   Sensory functioning;

o   Physical measurements; and

o   Current placement, ventilator dependency, and eligibility for DES Division of Developmental Disabilities program services.

The Assessor shall use the PAS instrument to assess an applicant or member who is DD. A copy of the PAS instrument is available from the Administration. The Administration uses the PAS instrument responses to calculate three scores: a functional score, a medical score, and a total score.

·         Functional score.

o   The Administration calculates the functional score from responses to scored items in the functional assessment category. For each response to a scored item, a number of points is assigned, which is multiplied by a weighted numerical value. The result is a weighted score for each response.

o   The functional assessment items in the following categories are scored:

§  For an applicant or member 12 years of age and older, all items in the behavior section are scored. Designated items in the independent living skills, communication skills, and cognitive abilities sections also are scored;

§  For an applicant or member 6 through 11 years of age, all items in the communication section are scored. Designated items in the independent living skills and behavior sections also are scored; and

§  For an applicant or member 6 months through 5 years of age, all age-specific items are scored.

o   The sum of the weighted scores equals the functional score. The range of weighted scores per item is presented below:

Age Group

Range for Weighted Score per Item

Maximum Functional Score Attainable

12 and older

0 – 11.2

124.1

6 through 11

0 – 24

112.5

6 months through 5

0 – 5.0

106.02

 

o   No minimum functional score is required.

·         Medical score.

o   The Administration calculates the medical score from  responses to scored items in the medical assessment category. For each response to a scored item, a number of points is assigned. 

o   The medical assessment items in the following categories are scored:

§  For an applicant or member 12 years of age and older and 6 years of age through 11 years of age, designated items in the medical conditions section are scored; and

§  For an applicant or member 6 months of age through 5 years of age designated items in the medical conditions, services and treatments, and medical stability sections are scored.

o   For an applicant less than 6 months of age, only the medical assessment section of the PAS is completed. There is no weighted or calculated score assigned. The Assessor shall refer the applicant or member for physician consultant review in accordance with Section 1006.

o   The sum of the points equals the medical score. The range of points per item and the maximum medical score attainable by an applicant or member is presented below:

Age Group

Range for Weighted Score per Item

Maximum Functional Score Attainable

12 and older

0 – 20.6

21.4

6 through 11

0 – 2.5

5

6 months through 5

0 – 10

60

 

o   No minimum medical score is required.

 

·         Total score.

o   The sum of an applicant’s or member’s functional and medical score equals the total score.

o   The total score is compared to the established threshold score as calculated under this Section. For an applicant or member who is DD, the threshold score is 40.

o   An applicant or member is determined at immediate risk of institutionalization if the total score is equal to or greater than 40.

The following matrices represent the number of points available and the respective weight for each scored item.

·         Functional assessment points. The lowest value in the range of points available per item in the functional assessment category, zero, indicates minimal to no impairment. Conversely, the highest value indicates severe impairment.

·         Medical assessment points. The lowest value in the range of points available per item in the medical assessment category, zero, indicates that the applicant or member:

o   Does not have the scored medical condition,

o   Does not need the scored medical or nursing services, or

o   Does not receive the scored medical or nursing services.

  • Age Group 12 and Older Functional Assessment Category/Item

  • Points Available per Item (P)

  • Weight (W)

  • Range of Possible Weighted Score per Item (P) x (W)

  • INDEPENDENT LIVING SKILLS SECTION

  • Hand Use, Food Preparation

  • 0 – 3

  • 3.5

  • 0 – 10.5

  • Ambulation, Toileting, Eating, Dressing, Personal Hygiene

  • 0 – 4

  • 2.8

  • 0 – 11.2

  • COMMUNICATIVE SKILLS AND COGNITIVE ABILITIES SECTION

  • Associating Time, Remembering Instructions

  • 0 – 3

  • 0.5

  • 0 – 1.5

  • BEHAVIOR SECTION

  • Aggression, Threatening, Self-Injurious

  • 0 – 4

  • 2.8

  • 0 – 11.2

  • Resistive

  • 0 – 3

  • 3.5

  • 0 – 10.5

 

  • Age Group 12 and Older Medical Assessment Category/Item

  • Points Available per Item (P)

  • Weight (W)

  • Range of Possible Weighted Score per Item (P) x (W)

  • MEDICAL CONDITIONS SECTION

  • Cerebral Palsy, Epilepsy

  • 0 – 1

  • 0.4

  • 0 - 0.4

  • Moderate, Severe, or Profound Mental Retardation

  • 0 – 1

  • 20.6

  • 0 - 20.6

  • Age Group 6 through 11 Functional Assessment Category/Item

  • Points Available per Item (P)

  • Weight (W)

  • Range of Possible Weighted Score per Item  (P) x (W)

  • INDEPENDENT LIVING SKILLS SECTION

  • Climbing Stairs, Wheelchair Mobility, Bladder Control

  • 0 – 3

  • 1.875

  • 0 – 5.625

  • Ambulation, Dressing, Bathing, Toileting

  • 0 – 4

  • 1.5

  • 0 – 6

  • Crawling or Standing

  • 0 - 5

  • 1.25

  • 0 – 6.25

  • Rolling or Sitting

  • 0 – 8

  • 0.833

  • 0 – 6.66

  • COMMUNICATION SECTION

  • Clarity

  • 0 – 4

  • 1.5

  • 0 – 6

  • Expressive Communication

  • 0 – 5

  • 1.25

  • 0 – 6.25

  • BEHAVIOR SECTION

  • Wandering

  • 0 – 4

  • 6

  • 0 – 24

  • Disruptive

  • 0 – 3

  • 7.5

  • 0 – 22.5

 

  • Age Group 6 through 11 Medical Assessment Category/Item

  • Points Available per Item (P)

  • Weight (W)

  • Range of Possible Weighted Score per Item (P) x (W)

  • MEDICAL CONDITIONS SECTION

  • Cerebral Palsy, Epilepsy

  • 0 – 1

  • 2.5

  • 0 - 2.5

 

 

  • Age Group 6 months through 5 Functional Assessment Category/Item

  • Points Available per Item (P)

  • Weight (W)

  • Range of Possible Weighted Score per Item (P) x (W)

  • DEVELOPMENTAL MILESTONES SECTION (FACTORS MEASURING AN INDIVIDUAL’S DEGREE OF FUNCTIONAL GROWTH)

  • 6 – 9 Months

  • 0 – 1

  • 5.0

  • 0 – 5.0

  • 9 – 11 Months

  • 0 – 1

  • 4.1

  • 0 – 4.1

  • 12 – 17 Months

  • 0 – 1

  • 2.9

  • 0 – 2.9

  • 18 – 23 Months

  • 0 – 1

  • 2.125

  • 0 – 2.125

  • 24 – 29 Months

  • 0 – 1

  • 1.75

  • 0 – 1.75

  • 30 – 35 Months

  • 0 – 1

  • 1.55

  • 0 – 1.55

  • 36 – 47 Months

  • 0 – 1

  • 1.34

  • 0 – 1.34

  • 48 – 59 Months

  • 0 – 1

  • 1.14

  • 0 – 1.14

  • 60 Months+

  • 0 – 1

  • 1.03

  • 0 – 1.03

 

  • Age Group 6 months through 5 Medical Assessment Category/Item

  • Points Available per Item (P)

  • Weight (W)

  • Range of Possible Weighted Score per Item (P) x (W)

  • MEDICAL ASSESSMENT

  • Cerebral Palsy

  • 0 – 1

  • 5.0

  • 0 – 5.0

  • Epilepsy

  • 0 – 1

  • 5.0

  • 0 – 5.0

  • Moderate, Severe, or Profound Mental Retardation

  • (36 months and older only)

  • 0 – 1

  • 15.0

  • 0 – 15.0

  • Autism + M-CHAT: Fails at least six M-CHAT based questions

  • (18 months and older only)

  • 0 – 1

  • 7.0

  • 0 – 7.0

  • Autism + Behaviors: Exhibits at least 3 of 4 specific behaviors

  • (36 months and older only)

  • 0 – 1

  • 5.0

  • 0 – 5.0

  • Autism + Behaviors: Exhibits at least 6 of 8 specific behaviors

  • (36 months and older only)

  • 0 – 1

  • 10.0

  • 0 – 10.0

  • Drug Regulation + Administration

  • (6 months to 35 months)

  • 0 – 1

  • 1.0

  • 0 – 1.0

  • Drug Regulation + Administration

  • (36 months and older)

  • 0 – 1

  • 1.5

  • 0 – 1.5

  • Non-Bowel/Bladder Ostomy Care

  • (6 months to 35 months)

  • 0 – 1

  • 7.0

  • 0 – 7.0

  • Non-Bowel/Bladder Ostomy Care

  • (36 months and older)

  • 0 – 1

  • 5.0

  • 0 – 5.0

  • Tube Feeding

  • (6 months to 35 months)

  • 0 – 1

  • 7.0

  • 0 – 7.0

  • Tube Feeding

  • (36 months and older)

  • 0 – 1

  • 5.0

  • 0 – 5.0

  • Physical Therapy or Occupational Therapy

  • (6 months to 35 months)

  • 0 – 1

  • 1.0

  • 0 – 1.0

  • Physical Therapy or Occupational Therapy

  • (36 months and older)

  • 0 – 1

  • 1.5

  • 0 – 1.5

  • Acute Hospital Admission: One

  • 0 – 1

  • 1.0

  • 0 – 1.0

  • Acute Hospital Admission: Two or More

  • 0 – 1

  • 2.0

  • 0 – 2.0

  • Direct Care Staff Trained

  • (6 months to 35 months)

  • 0 – 1

  • 0.5

  • 0 – 0.5

  • Direct Care Staff Trained

  • (36 months and older)

  • 0 – 1

  • 1.0

  • 0 – 1.0

  • Special Diet

  • 0 – 1

  • 2.0

  • 0 – 2.0

 

Definitions

Term

Definition

Aggression

Physically attacking another, including:

·         Throwing objects;

·         Punching;

·         Biting;

·         Pushing;

·         Pinching;

·         Pulling hair; or  

·         Scratching.

Ambulation

The ability to walk, including quality of the walking and the degree of independence in walking.

Associating time with an event and an action

An applicant’s or member’s ability to associate a regular event with a specific time-frame.

Bathing or showering

An applicant’s or member’s ability to complete the bathing process, including:

·         Drawing the bath water;

·         Washing;

·         Rinsing;

·         Drying all parts of the body; and

·         Washing the hair.

Clarity of communication

An ability to speak in recognizable language or use a formal symbolic substitution, such as American Sign Language.

Climbing stairs or a ramp

An applicant’s or member’s ability to move up and down stairs or a ramp.

Community mobility

An applicant’s or member’s ability to move about a neighborhood or community independently, by any mode of transportation.

Current or currently

As defined in Section 1003.

Crawling and standing

An applicant’s or member’s ability to crawl and stand with or without support.

Developmental milestone

A measure of an applicant’s or member’s functional abilities, including:

·         Fine and gross motor skills;

·         Expressive and receptive language;

·         Social skills;

·         Self-help skills; and

·         Emotional or affective development.

Disruptive behavior

Inappropriate behavior by an applicant or member, including:

·         Urinating or defecating in inappropriate places;

·         Sexual behavior inappropriate to time, place or person; or

·         Excessive whining, crying or screaming that interferes with an applicant’s or member’s normal activities or the activities of others and requires intervention to stop or interrupt the behavior.

Dressing

An applicant’s or member’s ability to put on and remove an article of clothing. Dressing does not include the ability to put on or remove braces, nor does it reflect an applicant’s or member’s ability to match colors or choose clothing appropriate for the weather.

Eating or drinking

The process of putting food and fluid by any means into the digestive system.

Expressive verbal communication

An applicant’s or member’s ability to communicate thoughts with words or sounds.

Food preparation

An applicant’s or member’s ability to prepare a simple meal, including a sandwich, cereal, or a frozen meal.

Frequency

Number of times a specific behavior occurs within a specified interval.

Functional assessment

As defined in Section 1003.

Hand use

An applicant’s or member’s ability to use both hands, or one hand if the applicant or member has only one hand or has the use of only one hand.

Intervention

As defined in Section 1003.

M-CHATTM

Modified Checklist for Autism in Toddlers

Medical assessment

As defined in Section 1003.

Personal hygiene

The process of tending to one’s appearance. Personal hygiene may include:

·         Combing or brushing hair;

·         Washing face and hands;

·         Shaving;

·         Performing routine nail care;

·         Oral hygiene (including denture care); and

·         Menstrual care.

Personal hygiene does not include aesthetics such as styling hair, skin care, and applying cosmetics.

Remembering an instruction and demonstration

An applicant’s or member’s ability to recall an instruction or demonstration on how to complete a specific task.

Resistiveness or rebelliousness

An applicant’s or member’s inappropriate, stubborn, or uncooperative behavior. Resistiveness or rebelliousness does not include an applicant’s or member’s difficulty with processing information or reasonable expression of self-advocacy that includes an applicant’s or member’s expression of wants and needs.

Rolling and sitting

An applicant’s or member’s ability to roll and sit independently or with the physical support of another person or with a device such as a pillow or specially-designed chair.

Running or wandering away

An applicant or member leaving a physical environment without notifying or receiving permission from the appropriate individuals.

Self-injurious behavior

An applicant’s or member’s repeated behavior that causes injury to the applicant or member.

Special diet

A diet planned by a dietitian, nutritionist, or nurse that includes high fiber, low sodium, or pureed food.

Toileting

As defined in Section 1003.

Verbal or physical threatening

Any behavior in which an applicant or member uses words, sounds, or action to threaten harm to self, others, or an object.

Vision

As defined in Section 1003.

Wheelchair mobility

An applicant’s or member’s mobility using a wheelchair. Wheelchair mobility does not include the ability to transfer to the wheelchair.

 

Proof

Proof of immediate risk of institutionalization shall be demonstrated through:

·         Applicant or member score equal to or higher than the applicable PAS threshold score; or

·         Finding by a physician consultant reviewer that the applicant or member has this status.

 

Legal Authority

 

Program

Legal Authorities

ALTCS

AAC 9-28-305