Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.18-009 - Manual Update ARCHOICES 1-18
Current through Register Vol. 49, No. 9, September, 2024
Section II ARCholces In Homecare Home and Community-Based 2176 Waiver
Thie ARCholces Waiver provides beneficiaries with a monthly allocation of attendant care hours to be used at the beneficiary's discretion throughout the month. The number of attendant care hours approved for each beneficiary is based on the results of that beneficiary's most recent assessment using the ArPath Assessment Tool.
The ArPath Assessment Tool uses a software program that includes an algorithm to evaluate certain responses within an extensive questionnaire to determine whether the beneficiary meets the functional eligibility criteria to participate In the waiver program. The ArPath Assessment Tool then uses another algorithm to evaluate other responses to determine which Resource Utilization Group (RUG) reflects the beneficiary's functional abilities. A RUG Is a tier group consisting of individuals with similar functional abilities.
In 2013, attendant care services were detennined based on an RN's discretionary interpretation of a beneficiary's responses to the ArPath Assessment Tool's questionnaire. Between 2013 and January 1,2016, when the ARCholces program was implemented, DAAS recorded beneficiary RUG placement and the number of paid attendant care hours utilized by beneficiaries each month in order to detemiine the type and amount of resources that beneficiaries with similar functional abilities were used in a given month.
While the reality of living with a disease or condition can vary greatly even among individuals with the same diagnosis, a RUG placement allows DAABHS to better predict the type and extent of care that an individual needs. The purpose of transitioning to a RUG-based care allocation system is to provide more predictable and objective outcomes that better reflect the reality of a beneficiary's needs by organizing the allocation around functional ability.
As of January 1, 2016, the allocation of attendant care hours became based on which RUG the beneficiary is placed in by the ArPath Assessment Tool. The specific number of attendant care hours assigned to a particular RUG was determined by considering an average of the number of hours used by beneficiaries placed in that RUG prior to the implementation of the ARCholces program. The following chart shows the number of hours assigned to each RUG.
|
RUGCategory |
RUG |
Monthly Hours |
|
Special Rehab |
RBO |
157 |
|
RA2 |
97 |
|
|
RA1 |
55 |
|
|
Extensive Care |
SE3 |
352 |
|
SE2 |
201 |
|
|
SE1 |
153 |
|
|
Special Care |
SSB |
161 |
|
SSA |
112 |
|
|
Clinically Complex |
ceo |
143 |
|
CBO |
94 |
|
|
CA2 |
69 |
|
|
CA1 |
36 |
|
|
Impaired Cognition |
ISO |
116 |
|
IA2 |
81 |
|
|
IA1 |
38 |
|
|
Behavioral Problems |
BBO |
118 |
|
BA2 |
62 |
|
|
BA1 |
30 |
|
|
Reduced Physical Function |
PDO |
137 |
|
PCO |
99 |
|
|
PBO |
81 |
|
|
PA2 |
53 |
|
|
PA1 |
28 |
RUG Requirements
The ArPath Assessment Tool evaluates the assessment responses using an algorithm, which is basically a "rule book" for the software. This particular rulebook is divided into chapters, known as screeners, and each screener is responsible for evaluating a small portion of the assessment responses in order to produce a numerical score. Below is a list of the screeners and the possible scores:
|
Screener |
Possible Scores |
|
Activities of Daily Living (ADL) |
4-18 |
|
instrumental Activities of Daily Living (lADL) |
0-3 |
|
Rehab |
0-1 |
|
Behavior Problems |
0-1 |
|
Extensive Care |
0-1 |
|
Special Care |
0-1 |
|
Clinically Complex |
0-1 |
|
Cognitive Impairment |
0-1 |
|
Cumulative |
0-5 |
Each RUG requires a different combination of screener scores in order for a beneficiary to be placed in that RUG. The ArPath Assessment Tool utilizes the criteria for each RUG in the exact order that they are listed in the above chart and it places the beneficiary in the first RUG on the list whose criteria are satisfied by the assessment responses.
The following is a description of the screener scores required for each Special Rehab RUG.
The following is a description of the screener scores required for each Extensive Care RUG.
The following is a description of the screener scores required for each Special Care RUG.
The following Is a description of the screener scores required for each Clinically Complex RUG.
The following is a description of the screener scores required for each Impaired Cognition RUG.
The following Is a description of the screener scores required for each Behavioral Problems RUG.
The following is a description of the screener scores required for each Reduced Physical Function RUG.
Screener Requirements
Activities of Daily Living f ADL)
A beneficiary's ADL score ranges from 4 to 18. It is based on the collective score among responses to the 5 items in the assessment that are listed below. Only 4 of the 5 responses will add to the overall ADL score because the response to Mode of nutritional intake may override the response to Eating.
Bed mobility, Transfer toilet, and Toilet use are all scored in the following way:
However, 3 points will be added to the ADL score, and the Eating score will be ovenidden if the response to Mode of nutritional intake is any of the following:
The responses to each item are scored in the following way.
Rehab
A beneficiary's Rehab screener score is 0 by default, but it equals 1 if during the week prior to the assessment the beneficiary spends a total of at least 120 minutes in any combination of the following types of therapy:
Behavior Problems
A beneficiary's Behavior Problems score is 0 by default, but it equals 1 if the beneficiary has exhibited any of the following at any time within 3 days of the assessment:
A beneficiary's Extensive Care screener score is 0 by default, but It equals 1 if the response to Mode of nutritional Intake Is either Abdominal feeding tube or Parenteral feeding tube only. It will also equal 1 if the assessment records that any of the following treatments have been utilized within 3 days of the assessment:
Special Care
A beneficiary's Special Care screener score Is 0 by default, but It equals 1 if the assessment records that Radiation therapy has been utilized within 3 days of the assessment or any of the following combinations of responses are logged In the assessment:
Clinically Complex
A beneficiary's Clinically Complex screener score is 0 by default, but it equals 1 if any of the following Is recorded during the assessment:
Impaired Cognition
A beneficiary's Impaired Cognition screener score is 0 by default, but it equals 1 if the score recorded on the Cognitive Performance Scale (CPS) is at least a 3.
Cumulative
A beneficiary's Cumulative screener score can range from 0 to 5. It is based on the collective score after adding the scores from the Special Care, Clinically Complex, and Impaired Cognition screeners. An additional point may be added if either of the following occurs:
