Guidelines For Completing the OBRA 1 Form

(Prepared for screening entities outside the Division of Developmental Disabilities.)

  1. An authorized agent must complete an OBRA-1 form for all individuals age 18 years of age or older who are seeking admission to a nursing facility. In addition, OBRA-1 forms are to be completed for individuals seeking admission to Medicaid-funded programs for persons with developmental disabilities.
  2. Entities authorized to complete Level I Identification Screens are agents of the Department of Public Aid, Department on Aging, Department of Public Health, Department of Human Services (Division of Rehabilitation Services, Office of Mental Health, and Division of Developmental Disabilities), hospitals, or nursing facilities.
  3. For there to be a reasonable basis to suspect a developmental disability, the condition must have manifested itself prior to the age of 22. In other words, the condition must have been present during the developmental years. For example, an individual who experienced a traumatic brain injury as a child, resulting in a condition similar to mental retardation, would be considered a person with a developmental disability and would be assessed by a DD PAS agency. If that same person experienced the same injury at the age of 22, resulting in the same condition, the individual would not be considered a person with a developmental disability and would then be assessed by either DRS or DoA.
  4. Cerebral palsy and epilepsy are conditions that could indicate a developmental disability, since these conditions can result in impairments similar to mental retardation. In many cases, however, the intellectual functioning of individuals with cerebral palsy and epilepsy in no way resembles mental retardation. Since this can be a difficult determination for persons not trained in the field of developmental disabilities to make, all individuals with Cerebral Palsy and Epilepsy should be referred to a DDD PAS agency.
  5. MH PAS agencies conduct Level II assessments for individuals with a severe mental illness. Since it is difficult for persons not trained in the field of mental illness to determine the level of severity, all individuals for whom there is a reasonable basis to suspect any mental illness (regardless of the level of severity) should be referred to the MH PAS agency.
  6. In the event a DD PAS agency or MH PAS agency, while reviewing information collected during the initial screening (i.e., OBRA-1) process, determines an individual in fact does not have a developmental disability or mental illness, the agency will redirect the individual back to DRS or DoA. (Part V of the OBRA-1 documents this activity.) Such decisions do not necessarily indicate an error on the part of the DRS or DoA screener, as there may have been conditions present that indicate the need for determinations by a qualified mental retardation or mental health professional.
  7. In cases where there is a reasonable basis to suspect both a developmental disability and a mental illness, individuals should be referred to the DD PAS agency. Should the DD PAS agency determine the individual does not have a developmental disability, the individual will then be referred to the MH PAS agency. If it is determined the individual does have a developmental disability, the DD PAS agency will complete the pre-admission screening and assessment process.
  8. If an individual has Dementia (e.g., due to Alzheimer's, Parkinson's Disease, HIV disease, Huntington Disease, head trauma) with no known history of mental illness or developmental disability, the person should be referred to DoA or DRS for screening.