Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM
Article 3 - PREADMISSION SCREENING (PAS)
Section R9-28-304 - Preadmission Screening Criteria for an Applicant or Member who is Elderly or Physically Disabled (EPD)

Universal Citation: AZ Admin Code R 9-28-304

Current through Register Vol. 30, No. 38, September 20, 2024

A. The PAS instrument for an applicant or member who is EPD includes the following categories:

1. Intake information category. The assessor solicits intake information category information on an applicant's or member's demographic background. The components of the intake information category are not included in the calculated PAS score.

2. Functional assessment category. The assessor solicits functional assessment category information on an applicant's or member's:
a. Need for assistance with activities of daily living, including:
i. Bathing,

ii. Dressing,

iii. Grooming,

iv. Eating,

v. Mobility,

vi. Transferring, and

vii. Toileting in the residential environment or other routine setting;

b. Communication and sensory skills, including hearing, expressive communication, and vision; and

c. Continence, including bowel and bladder functioning.

3. Emotional and cognitive functioning category. The assessor solicits emotional and cognitive functioning category information on an applicant's or member's:
a. Orientation to person, place, and time. In soliciting this information, the assessor shall also take into account the caregiver's judgment; and

b. Behavior, including:
i. Wandering

ii. Self-injurious behavior,

iii. Aggression,

iv. Resistiveness, and

v. Disruptive behavior.

4. Medical assessment category. The assessor solicits medical assessment category information on an applicant's or member's:
a. Medical conditions that have an impact on the applicant's or member's functional ability in relation to activities of daily living, continence, and vision;

b. Medical condition that requires medical or nursing service and treatment;

c. Medication, treatment, and allergies;

d. Specific services and treatments that the applicant or member is currently receiving; and

e. Physical measurements, hospitalization history, and ventilator dependency.

B. The assessor shall use the PAS instrument to assess an applicant or member who is EPD as specified in this Section. A copy of the PAS instrument is available from the Administration. The Administration uses the assessor's PAS assessment to calculate three scores: a functional score, a medical score, and a total score.

1. Functional score:
a. The Administration calculates the functional score from responses to scored items in the functional assessment and emotional and cognitive functioning categories. 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.

b. In the functional assessment matrix, all items in the following categories are scored according to subsection (C):
i. Activities of daily living,

ii. Continence,

iii. Sensory,

iv. Orientation, and

v. Behavior.

c. The sum of the weighted scores equals the functional score. The weighted score per item can range from 0 to 15. The maximum functional score attainable by an applicant or member is 166.

2. Medical score.
a. In the medical assessment matrix, all items in the following categories are scored according to:
i. Medical conditions as specified in subsection (C), and

ii. Medical or nursing services and treatments in subsection (C).

b. The Administration calculates the medical score based on the applicant's or member's:
i. Diagnosis of Alzheimer's, or dementia, or organic brain syndrome (OBS);

ii. Diagnosis of paralysis; and

iii. Current use of oxygen

c. The maximum medical score attainable by an applicant or member is 31.5.

3. Total score.
a. The sum of an applicant's or member's functional and medical scores equals the total score.

b. The total score is compared to the established threshold score as calculated under this Section. The threshold score is 60.

c. As defined in R9-28-303, an applicant or member is determined at immediate risk of institutionalization if the total score is equal to or greater than 60.

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

1. 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.

2. 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:
a. Does not have the scored medical condition,

b. Does not need the scored medical or nursing services, or

c. Does not receive the scored medical or nursing services.

FUNCTIONAL ASSESSMENT

# of Points Available Per Item (P)

Weight (W)

Range of Possible Weighted Score Per Item (P) x (W)

Activities of Daily Living Section

Mobility

0-3

5

0-15

Transfer

0-3

5

0-15

Bathing

0-3

5

0-15

Dressing

0-3

5

0-15

Grooming

0-3

5

0-15

Eating

0-3

5

0-15

Toileting

0-3

5

0-15

Continence Section

Bowel

0-3

1

0-3

Bladder

0-3

1

0-3

Sensory Section

Vision

0-3

2

0-6

Orientation Section

Place

0-4

.5

0-2

Time

0-4

.5

0-2

Emotional or Cognitive Behavior Section

Aggression-Frequency

0-3

1.5

0-4.5

Aggression-Intervention

0-3

1.5

0-4.5

Self-injurious-Frequency

0-3

1.5

0-4.5

Self-injurious-Intervention

0-3

1.5

0-4.5

Wandering-Frequency

0-3

1.5

0-4.5

Wandering-Intervention

0-3

1.5

0-4.5

Resistiveness-Frequency

0-3

1.5

0-4.5

Resistiveness-Intervention

0-3

1.5

0-4.5

Disruptive-Frequency

0-3

1.5

0-4.5

Disruptive-Intervention

0-3

1.5

0-4.5

MEDICAL ASSESSMENT

# of Points Available Per Item (P)

Weight (W)

Range of Possible Weighted Score Per Item (P) x (W)

Medical Conditions Section

Paralysis

0-1

6.5

0 or 6.5

Alzheimer's, or OBS, or Dementia

0-1

20

0 or 20

Services and Treatments Section

Oxygen

0-1

5

0 or 5

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