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 R9-28-305 - Preadmission Screening Criteria for an Applicant or Member who is Developmentally Disabled (DD)

Universal Citation: AZ Admin Code R 9-28-305

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

A. 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:

1. Twelve years of age and older,

2. Six through 11 years of age, and

3. Birth through 5 years of age.

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

1. 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.

2. Functional assessment category. The functional assessment category differs by age group as indicated in subsections (B)(2)(a) through (e):
a. 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:
i. 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;

ii. 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

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

b. 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:
i. 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;

ii. Communication, including expressive verbal communication and clarity of communication; and

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

c. For an applicant or member 6 months through 5 years of age, the assessor solicits the functional assessment category information on an applicant's or member's performance with respect to a series of developmental milestones that measure an applicant's or member's degree of functional growth.

d. 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.

3. Medical assessment category. The assessor solicits medical assessment category information on an applicant's or member's:
a. Medical condition;

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

c. Current medication;

d. Medical stability;

e. Sensory functioning;

f. Physical measurements; and

g. Current living arrangement, ventilator dependency and eligibility for DES Division of Developmental Disabilities program services.

C. 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 assessor's PAS instrument responses 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 category. Each response is assigned a number of points which is multiplied by a weighted numerical value, resulting in a weighted score for each response.

b. The following items are scored as indicated in subsection (D), under the Functional Assessment matrix:
i. 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 are also scored;

ii. 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 are scored;

iii. For an applicant or member 6 months of age through 5 years of age, items in the developmental milestones section are scored based on the age of the applicant.

c. The sum of the weighted scores equals the functional score. The range of weighted score per item and maximum functional score for each age group is presented below:

AGE GROUP

RANGE FOR WEIGHTED SCORE PER ITEM

MAXIMUM FUNCTIONAL SCORE ATTAINABLE

12+

0 - 11.2

124.1

6-11

0 - 24

112.5

0-5

0 - 5.0

106.02

d. No minimum functional score is required.

2. Medical score.
a. Subsections (C)(2)(a)(i) through (iii) are scored as indicated in subsection (D), under the Medical Assessment matrix:
i. The assessor shall score designated items in the medical conditions for an applicant or member 12 years of age and older and 6 years of age through 11 years of age.

ii. The assessor shall score designated items in the medical conditions and medical stability sections for an applicant or member 6 months of age through 5 years of age.

iii. The assessor shall complete only the medical assessment section of the PAS for an applicant or member less than 6 months of age. There is no weighted or calculated score assigned. The assessor shall refer the applicant or member for physician consultant review.

b. The Administration calculates the medical score from information obtained in the medical assessment category. Each response to a scored item is assigned a number of points. 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 OF POINTS PER ITEM

MAXIMUM MEDICAL SCORE ATTAINABLE

12+

0 - 20.6

21.4

6-11

0 - 2.5

5

0-5

0 - 10

60

c. No minimum medical score is required.

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 an established threshold score in R9-28-304. For an applicant or member who is DD, the threshold score is 40. Based upon the PAS instrument an applicant or member with a total score equal to or greater than 40 is at immediate risk of institutionalization.

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

1. Functional assessment points. An applicant or member age group 0 to 5: The value is received for each negative response. An applicant or member age groups 6 to 11 and 12+: the lowest value in the range of points available per item in the functional assessment category 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 a medical condition specified in the following matrices,

b. Does not need medical or nursing service as specified in the following matrices, or

c. Does not receive any medical or nursing service as specified in the following matrices.

AGE GROUP 12 AND OLDER FUNCTIONAL ASSESSMENT

# of 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 Abili

ties 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

# of Points Available Per Item (P)

Weight (W)

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

Medical Condition Section

Cerebral Palsy

0-1

0-.4

0-.4

Epilepsy

0-1

0-.4

0-.4

Moderate, Severe or Profound Mental Retardation

0-1

0-20.6

0-20.6

AGE GROUP 6-11 FUNCTIONAL ASSESSMENT

# of 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 6-11 Medical Assessment

# of Points Available Per Item (P)

Weight (W)

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

Medical Condition Section

Cerebral Palsy

0-1

0-2.5

0-2.5

Epilepsy

0-1

0-2.5

0-2.5

AGE GROUP 0 - 5 FUNCTIONAL ASSESSMENT

Weight

6 -9 Months

5.0

9-11 Months

4.1

12-17 Months

2.9

18-23 Months

2.125

24-29 Months

1.75

30-35 Months

1.55

36-47 Months

1.34

48-59 Months

1.14

60 Months+

1.03

AGE GROUP 0 - 5 MEDICAL ASSESSMENT

Weight

Cerebral Palsy

5.0

Epilepsy

5.0

Moderate, Severe, or Profound Mental Retardation (36 Months and older only)

15.0

Autism + M-CHAT (18 Months and older only) Fails at least six M-CHAT based questions

7.0

Autism + Behaviors (30-35 Months only) Exhibits at least 3 of 4 specific behaviors

5.0

Autism + Behaviors (36 Months and older only) Exhibits at least 6 of 8 specific behaviors

10.0

Drug Regulation + Administration (6 Months to 35 Months)

1.0

Drug Regulation + Administration (36 Months and older)

1.5

Non-Bowel/Bladder Ostomy Care (6 Months to 35 Months)

7.0

Non-Bowel/Bladder Ostomy Care (36 Months and older)

5.0

Tube Feeding (6 Months to 35 Months)

7.0

Tube Feeding (36 Months and older)

5.0

Physical Therapy or Occupational Therapy (6 Months to 35 Months)

1.0

Physical Therapy or Occupational Therapy (36 Months and older)

1.5

Acute Hospital Admission (One)

1.0

Acute Hospital Admissions (Two or more)

2.0

Direct Care Staff Trained (6 Months to 11 Months)

0.5

Direct Care Staff Trained (12 Months and older)

1.0

Special Diet

2.0

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