010.00 Authority and Responsibility
This manual provides the policies and procedures to be followed by developmental disabilities Individual Service Coordination (ISC) agencies to conduct Pre-Admission Screening (PAS) as set forth in the following documents:
- Omnibus Reconciliation Act of 1987.
- Illinois Nursing Home Care Act (210 ILCS 45/2-201.5).
- Illinois Department of Healthcare and Family Services Rule 89, Illinois Administrative Code 140.642 (Screening Assessment for Nursing Facility and Alternative Residential Settings and Services).
- Department of Human Services Community Services Agreement.
- 89 Illinois Administrative Code, Part 144 (Developmental Disabilities Services).
020.00 Role of ISC Agencies
The role of the ISC agency is to ensure compliance with applicable federal and state laws, arrange for and conduct assessments, make necessary determinations regarding eligibility for services, educate individuals and families, and make referrals and provide linkage to appropriate and needed services. The PAS process will prevent inappropriate admissions to long-term care facilities (nursing facilities and Intermediate Care Facilities serving persons with Developmental Disabilities [ICFs/DD] ) and inappropriate enrollments in waiver programs.
The Department of Human Services (DHS) has the responsibility to oversee the accuracy, quality, and appropriateness of services provided by its contracted entities, including those provided by its ISC agencies. As part of this process, the Department reserves the right to review and approve or reject any PAS assessments and determinations made by its contracted entities. (See Section 070.00)
030.00 Persons Served by ISC Agencies
Persons who are eligible to receive PAS services are the following:
- Persons to be screened using the OBRA-1 Initial Screen (See Chapter 100)
- All persons requesting admission to a nursing facility, regardless of funding source, will be screened using the OBRA-1 Initial Screen.
- All persons requesting developmental disabilities services that will be funded through Medicaid will be screened, first, using the OBRA-1 Initial Screen.
- Persons to be Screened through the Level II PAS Screening
- Individuals for whom there is a reasonable basis to believe there is the presence of a developmental disability as determined by the OBRA-1 Initial Screen process who are seeking admission to nursing facility services (i.e., Intermediate Care Facility or Skilled Nursing Facility), regardless of the individual's funding source. (For individuals for whom payment will be provided by private funds, the PAS agency will use the number 999999999 for the Medicaid Recipient I.D. number on all DDPAS forms.)
- Individuals for whom there is a reasonable basis to believe there is a presence of a developmental disability as determined by the OBRA 1 Initial Screen process who are Medicaid eligible or expected to become Medicaid eligible within 60 days, and who are seeking admission to an Intermediate Care Facility for individuals with a Developmental Disability (ICF/DD, ICF/DD-16), including those provided by a Specialized Living Center (SLC), Skilled Nursing Facility for Pediatric Residents (SNF/PED), or State-Operated Developmental Center (SODC); or any Medicaid waiver service funded under the Home and Community-Based Services Waiver program. (For individuals who are pending Medicaid eligibility within the next 60 days, the PAS agency will use the number 888888888 for the Medicaid I.D. number on all DDPAS forms.)
040.00 Overview of Responsibilities of ISC Agencies
The ISC agencies' responsibilities include the following activities:
- Provide PAS services to a designated geographic service area to ensure compliance with Federal and State Pre-Admission Screening laws and regulations.
- Assess individuals for whom there is a reasonable basis to believe there is the presence of a developmental disability who are seeking admission to nursing facilities, regardless of funding source.
- Assess individuals who are seeking Medicaid-funded services in a developmental disability setting and who are Medicaid eligible or are expected to become Medicaid eligible within 60 days.
- Conduct and arrange for assessments required to complete the PAS process for an individual.
- Determine the specific service needs for individuals based on an interpretation of these assessments and evaluations, including the presence of a developmental disability, the need for 24-hour nursing care, and the need for active treatment for the developmental disability.
- Screen for guardianship needs and, if necessary, refer the individual who may have guardianship needs to the local Office of State Guardian (OSG).
- Educate individuals and families, presenting all options and facilitating the service selection process.
- Link individuals to needed support services in accordance with the requirements of Federal and State criteria.
- Coordinate PAS activities with other screening entities within the state, including those representing the Division of Mental Health, the Division of Rehabilitation Services, the Department on Aging, and other entities designated as screeners according to rules and regulations of the Illinois Department of Healthcare and Family Services.
- Complete all documentation required to support the ISC agency's determinations.
- Supply necessary information to the existing or potential service provider.
- Adapt the screening and assessment processes, as necessary, to meet the cultural background, language, ethnic origin, and means of communication of all individuals presenting for services.
- Provide 24-hour accessibility for individuals, families, and providers.
- Develop and implement an internal quality enhancement protocol that will ensure and document the quality and appropriateness of the assessments and determinations made under the PAS process.
050.00 Geographic Responsibility for PAS Functions
Out of State
For individuals located in other states who are seeking services in Illinois facilities and whose current services are not funded through Illinois public funding resources (e.g., Illinois Medicaid, Illinois Department of Human Services, Illinois Department of Children and Family Services, etc.), PAS activity must be provided by a PAS entity in the state in which the individual is currently located.
For individuals located in other states whose current services are funded through Illinois public funding resources and for individuals now located in Illinois, the following guidelines are provided in order to enable ISC agencies to make consistent decisions regarding geographic responsibility, in order to provide more prompt and less costly response to individuals' service needs.
The ISC agency is responsible for screening and assessing individuals who are located in the geographic area assigned to the ISC agency by DHS. The screening entity completing the OBRA-1, if other than a ISC agency, will refer the individual to the ISC agency responsible for the geographic area in which the individual is currently located. The ISC agency that receives the OBRA-1 is responsible for providing PAS services or for referring the individual to the appropriate ISC agency, according to the following considerations:
- If an individual is not located in a hospital, institution or state-funded setting, developmental disability PAS services will be provided by the ISC agency serving the geographic area in which the individual is currently located.
- If an individual has been served in a hospital, institution, or state-funded setting for fewer than 180 calendar days, PAS services will be provided by the ISC agency serving the previous geographic area to which the individual has the greatest significant ties, according to one or more of the following factors:
- A previous location history of 180 or more days.
- Family members, friends, advocates, or community organizations who express an interest in providing future supports to the individual.
- The individual's or guardian's own expression of a preference for a geographic area, arising out of the individual's history.
- If an individual has stayed in a hospital, institution or state-funded setting for more than 180 calendar days and does not have significant ties to a previous geographic area, services will be provided by the ISC agency serving the geographic area that is the location of that hospital, institution, or state-funded setting.
- If an individual has stayed in a hospital, institution or state-funded setting for more than 180 calendar days and has significant ties to a previous geographic area, services will be provided by the ISC agency serving the geographic area in which those ties are located.
- It is possible that significant ties may not be discovered until the assessment process is under way or finished. The ISC agency where the individual is physically located has ultimate responsibility for completing the required assessments.
- In cases where a ISC agency is responsible for assessing an individual outside the ISC agency's own geographic area, the ISC agency serving the area where the individual is located must assist with scheduling and completion of assessments.
Transfer of Responsibilities - Individual Moving to Another Developmental Disability ISC Agency Service Area
If an individual or guardian chooses services outside a ISC agency's designated geographic area, ISC agencies are to use the following guidelines:
- Conduct the Pre-Admission Screening.
- Provide the individual or guardian with results of the Pre-Admission Screening, including the services for which the individual is eligible.
- Facilitate the decision process for the individual or guardian (by answering questions and providing information) so that the individual or guardian can make choices regarding appropriate services and geographic areas.
- When the individual or guardian determines which services and geographic area are desired, make referrals to providers within your area and contact the ISC agencies in other geographic areas in accordance with the wishes of the individual or guardian. If the individual wishes to explore service options outside the local ISC area, the ISC agency must proceed with the following steps:
- Provide the receiving ISC agency with all information and results pertaining to the PAS process, including copies of all Level II assessments, copies of all completed OBRA forms, information regarding assets and income, information regarding the services for which the individual is eligible, chooses, and currently receives.
- Assist the individual or guardian in establishing linkage with the receiving ISC agency by calling the agency and detailing the transfer in writing.
- Assist the receiving ISC agency, which is responsible for making and following referrals within its assigned geographic area.
- Serve as the contact for the individual until such time as a final provider selection has been made and an official transfer can be accomplished.
- The ISC agency in whose area the individual or guardian ultimately chooses to receive services shall work with the prospective provider of services to develop service and rates packages as necessary and conduct the required four weekly visits following service implementation.
060.00 Time Frames
Level II assessments must be completed within 90 days of the initial request or referral. Shorter time frames are necessary in cases of hospital discharge, crisis situations, etc.
070.00 Oversight by the Department of Human Services (DHS), Division of Developmental Disabilities (DDD)
The DHS has the responsibility to oversee the accuracy and quality of services provided by its contracted entities, including those provided by its ISC agencies. As part of this process, the DHS reserves the right to review and approve or reject PAS assessments and determinations that it finds to be inadequate or incorrect, according to provisions set forth in this manual.
Reviews of PAS assessments and determinations will typically occur according to the following general process, although unusual circumstances may call for occasional deviation from the process described below.
- PAS assessments and determinations will be reviewed as part of the normal activities of the DHS, including but not limited to, the following specific activities:
- Reviews of funding packets submitted to the DDD on behalf of individuals who are requesting services such as Community-Integrated Living Arrangement (CILA), Home-Based Support Services, etc. PAS assessments and determinations usually are required precursors to submission of these packets.
- Responses to referrals of concern from other governmental monitoring or screening entities, such as the Division of Mental Health or the Division of Rehabilitation Services, etc., who conduct pre-admission screenings of their own and with whom it is necessary to coordinate services.
- Routine monitoring of waiver and ICF/DD services (including PAS assessments and determinations).
- Preparations for hearings of appeals filed by individuals who are utilizing their rights under the Waiver to appeal determinations by ISC agencies that an individual does not meet programmatic eligibility criteria.
- For activities associated with A.1 through A.4, above, reviews of PAS assessments and determinations for which there are identified issues will be conducted by a Division of Developmental Disability, Qualified Intellectual Disability Professional (QIDP) or otherwise clinically qualified employee or consultant.
- If the results of the DHS review indicate that the information or findings in the PAS screening are inadequate, incomplete, or inaccurate, the ISC agency will be directed to correct the information and to complete a new PAS screening, based on the new or revised information.
- The results of the new PAS screening will be shared with the appropriate DHS staff members for oversight and review.
- When the new PAS screening has been approved by DHS staff, the ISC agency will inform the individual or guardian regarding the determinations arising from the new PAS screening and will follow the general procedures of this PAS Manual. If the person is found eligible, the ISC agency will explain options and assist with referral, linkage, funding arrangements, reporting, and follow-up, as documented on the DDPAS-10. If the person is found not eligible for services, the ISC agency will explain the reasons, propose other options if applicable, and inform the individual or guardian of the right to appeal, as described further in 1000.80 of this Manual and as documented on the DDPAS-10.
- All agency personnel who perform Level I and Level II PAS assessments and sign the forms documenting these activities must be Qualified Intellectual Disabilities Professionals (QIDPs) who have completed an initial DHS-approved 40-hour minimum training program, who obtain 12 hours of approved and documented continuing education credits each state fiscal year after the state fiscal year training is completed, and who are listed on the DHS/DDD's QIDP database. Credentialing for agency QIDPs is maintained through DDD.
- Questions regarding the oversight of PAS determinations described in Section 070.00 may be directed to the DDD Region Staff serving the geographic area in which the ISC agency is located.