Guidance on the Health Risk Screening Tool

Purpose:

The Health Risk Screening Tool (HRST) is used to detect health risks and destabilization early. The HRST is a reliable, normed and objective tool developed by Intellect Ability. The HRST assigns scores of 22 health and behaviorally related rating items. The total points result in a Health Care Level that indicates an associated degree of health risk. The Health Care Level (HCL) can range from 1 - 6; level 1 being the lowest risk for health concerns and level 6 being the highest risk of health concerns.

All Community Integrated Living Arrangement (CILA) providers funded by the Division of Developmental Disabilities (DDD) to provide waiver funded services are required to use the HRST web-based application for their individuals receiving CILA supports.

General Overview:

• The HRST should be completed at-a-minimum of once every 365 days. Independent Service Coordination (ISC) agencies should be using the HRST in developing the individual's Personal Plan. The ISC should request a current copy of the HRST from the provider agency.
• The HRST should be updated within 14 days of a health status change. A health status change is typically an event or episode that is likely to affect any rating item. A change in health status is defined by the following examples, but may not be limited to:
  • Hospitalizations
  • Emergency room/critical care visits
  • Behavioral changes or unusual changes in routine that vary from baseline or familiar presentations
  • Communication by the person of changes in wellness that could impact any of the 22 rating items (the intent is not to document changes in mood, but to document significant behavioral changes that could potentially manifest into an increase in health risk)
  • Any event thought to signal a health event
  • Injuries that would increase an individual's health care risk level
• QIDPs (or other equivalent staff such as RN Trainer, Licensed Practical Nurse, Residential Director, etc.) are authorized Raters for administering the HRST. The Rater should know the individual well, have access to the individual's medical charts and be able to ask for feedback from people who know the individual best. Note: DSPs are not allowed to complete the HRST but can be granted View Only status.
• The HRST detects health risk and destabilization in 22 rating items.
• The screen will result in a Health Care Level (HCL). They are defined as follows:
  • Level 1: Low Risk
  • Level 2: Low Risk
  • Level 3: Moderate Risk
  • Level 4: High-Moderate Risk
  • Level 5: High Risk
  • Level 6: Highest Risk

Provider Guidelines:

• Providers should submit the HRST with their rates packet for new individuals.
• For new individuals, if the web-based application is unable to be completed, the provider can choose not to submit the HRST at that time.
  • This will result in the nursing portion of the rates packet to be rejected, however, the remainder of the rates packet can be processed which will include the base rate for nursing, but without the additional nursing funding that is based on the client's nursing packet. When the agency determines they can serve the individual, the agency can re-submit the completed nursing rate packet with a turn-around form to the Division allowing the additional nursing funding to be added in the rate.
• When submitting an HRST to the DDD for a rate determination, providers must submit an updated copy of the HRST from the HRST web-based application.
• When an individual leaves their current residential provider for a new residential provider, the previous provider is responsible for providing the new provider a copy of the most recent HRST. At this time, the HRST information is not able to be transmitted electronically between provider agencies.

Gatekeeper: 

• Each CILA Provider will need to designate a staff member(s) to serve as an "HRST Gatekeeper(s)". This Gatekeeper is responsible for overseeing the HRST within their agency. The Gatekeeper would:
  • Ensure user accounts are made inactive when needed
  • Request additional user accounts for other staff members in their organization
  • Deactivate and manage individuals served records for their agency
• Gatekeeper Processes:
  • Those staff initially targeted to be Gatekeepers will need to inform Intellect Ability support via their support email: ilsupport@ReplacingRisk.com. Intellect Ability support staff will manually create the provider's initial Gatekeeper user profile.
  • This Gatekeeper will then have the ability to request other approved Gatekeepers and standard user accounts for their agency from within the HRST application.
  • Gatekeepers will be trained via an online tutorial on how to:
    • Create other Gatekeeper users
    • Change the status of an existing Gatekeeper account
    • Request user accounts
    • Change the status of an existing user account
    • Add, deactivate and manage individuals served records for their agency

Raters:

• The Gatekeeper is responsible for registering Raters in the system so they are able to participate in training to become a Rater.
• The Rater (QIDPs or other equivalent staff such as RN Trainer, Licensed Practical Nurse, Residential Director, etc.) must complete the online, self-guided training prior to rating any individuals served.
• DSPs cannot be Raters.
• The system will not allow screening access without completing the self-guided, online Rater training. 

Clinical Review:

A Clinical Review occurs when an individual receives a HRST HCL of 3 or higher. Within 14 calendar days an RN/Clinical Reviewer must complete a formal Clinical Review.

• The Gatekeeper is responsible for registering Clinical Reviewers in the system.
• Only Registered Nurses (RN) are able to function as a Clinical Reviewer.
• To become a Clinical Reviewer, the RN must complete the online, self-guided HRST Rater training and complete the Clinical Reviewer live webinar.
• Clinical Reviewers are required to complete any Clinical Reviews.
• If the HRST screening was completed by an RN initially, the RN can utilize the Quick Clinical Review feature found on the HRST Scoring Summary. They will see the Quick Clinical Review button at the bottom of the Scoring Summary page.

Achieving Auditing Compliance:

• HRST Service and Training Considerations are to be reviewed by the team to help address risks that have been identified.. It is up to the agency's discretion if a service or training consideration should be acted upon. If it is determined that any given Service and Training Consideration does not apply, providers should document it as such using the dropdown found next to each Service and Training Consideration statement. Providers can also use this dropdown feature to assign a priority to the given Consideration, if they so choose.
• Individuals with HCLs of 3 and higher are required to have a Clinical Review completed within 14 calendar days by an RN.
• The Raters are required to be QIDPs (or other equivalent staff such as RN Trainer, Licensed Practical Nurse, Residential Director, etc.).An individual should receive the HRST within 45 days of admittance, annually, and within 14 days when there is a change in health status. 

Payment:

• The DDD funds the cost of the HRST web-based application for each individual in CILA and ICILA. The DDD funding for HRST has been incorporated since 2019 into each person's CILA funding under "Miscellaneous Consultants" on the CILA Rate Sheet. You may reference Information Bulletin DD.19.009 on HRST which details HRST funding and can be found at: https://www.dhs.state.il.us/page.aspx?item=121143.
• Providers are responsible for paying their HRST bills in a timely manner. Providers will receive a bill from HRST on a quarterly basis. If an HRST bill is over 90 days delinquent, HRST may turn off access to the HRST account and charge the provider a $250 reinstatement fee.
• Providers who fall behind in payment to HRST may also be subject to sanctions by the DDD.

If providers have questions about their HRST account, they should reach out directly to Intellect Ability: ilsupport@replacingrisk.com

Effective Date: 

08/25/2021