Guidance on the Health Risk Screening Tool

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.24.005

This Information Bulletin replaces DD.21.015.

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 IntellectAbility. The HRST assigns scores to 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 for health concerns.

All Community Integrated Living Arrangement (CILA) residential providers funded by the Division of Developmental Disabilities (DDD) to provide residential waiver funded services are required to use the HRST web-based application for their individuals receiving residential 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 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 Level;
  • QIDPs (or other equivalent staff such as RN Trainer, Licensed Practical Nurse, Residential Director, etc.) are authorized Raters for administering the HRST after completing Rater Training through IntellectAbility. The Rater completing the HRST 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
  • Updated HRST data will be downloaded to DDD from IntellectAbility bi-annually in January and July. These downloads include updated HRSTs.

Provider Guidelines:

  • Providers must submit the HRST with their rates packet for new individuals. Incomplete packets submitted will be rejected and returned so that all necessary documentation can be included.
  • Individuals with an HRST transferring from one provider to a new provider:
    • For individuals who are transferring from one CILA provider to another CILA provider, CILA providers will have the option of submitting the current CILA provider's HRST or the new CILA provider may complete a new HRST and submit it with the individual's CILA Funding Request Packet. The individual's basic information will be transmitted to IntellectAbility and the individual's HRST record will be electronically transferred to the new CILA provider. The new CILA provider can either review and utilize the existing HRST record or may complete a new screening for the individual. and the new CILA provider can complete a new electronic HRST.
  • Individuals who are new to DD Services or do not have an HRST:
    • For new admissions of individuals who are coming to DD services from the community or are transitioning from other DD funded services or in any instance the individual does not have an HRST the CILA provider must complete a new HRST and submit it with the individual's CILA Funding Request Packet. Individuals entering CILA in these circumstances receive a Pre-Award Letter (PAL). The DDD informs IntellectAbility of the PAL with the individual's information and proposed CILA provider. Upon notification from DDD, IntellectAbility will create the initial profile which allows the CILA provider to complete the HRST. Incomplete packets submitted will be rejected and returned so that all necessary documentation can be included.
  • Individuals transitioning from a State Operated Developmental Center (SODC):
    • For new admissions of individuals from an SODC the CILA providers may contact IntellectAbility and request the individual's SODC HRST be made available to the new CILA provider or the new CILA provider may complete a new HRST and submit it with the individual's CILA Funding Request. Incomplete packets submitted will be rejected and returned so that all necessary documentation can be included.
  • The DDD will transmit to IntellectAbility on a weekly basis individual information for every person who is issued a CILA Pre-Award Letter (PAL). IntellectAbility will then add this person to the CILA agency's HRST database. Once added to the CILA agency's HRST database, the CILA Agency can then review the current CILA provider's HRST or complete a new initial HRST. Either the current or new HRST must be included with the individual's CILA Funding Request Packet.
  • If the individual is not present in their HRST database this would mean the person has not been issued a PAL or enrolled for CILA residential billing by DHS. To rectify, you should do the following:
    • If this is the individual's initial HRST and a PAL has been issued, please check with the Region Representative who issued the PAL.
    • If the individual has been issued their CILA Award Letter and Rate Sheet, review the "NOTES" section at bottom of the person's CILA Rate Sheet. DHS puts a note on each person's rate sheet identifying any existing problems or issues which must be addressed before the person can be enrolled for billing purposes.
    • Follow up with your Independent Service Coordination (ISC) agency or Region Representative to see if any enrollment conflicts, such as a termination from the previous CILA residential provider or another DHS program are still outstanding.

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.
  • Gatekeeper Processes:
    • Those staff initially targeted to be Gatekeepers will need to inform IntellectAbility support via their support email: ilsupport@ReplacingRisk.com. IntellectAbility 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.

Raters:

  • The Gatekeeper is responsible for registering Raters in the IntellectAbility HRST electronic 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 but their input can be included when completing the HRST.
  • The system will not allow screening access without completing the self-guided, 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 electronic screening annually, and within 14 days when there is a change in health status.

Payment and Billing:

  • 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.
  • Providers are responsible for paying their HRST bills in a timely manner. Providers will receive a bill from IntellectAbility on a quarterly basis. If an IntellectAbility bill is over 90 days delinquent, IntellectAbility may turn off access to the HRST account and charge the provider a $250 reinstatement fee.
  • Providers who fall behind in payment to IntellectAbility may also be subject to sanctions by the DDD.
  • Data transmissions between the DDD and IntellectAbility happen weekly. These data transmissions inform IntellectAbility of individuals who have been issued a PAL, enrolled for CILA, terminated from CILA, and/or transferred from one CILA provider to another.
    • Updated HCL scores are used to recalculate the individual's CILA rate and the funding the CILA agency will receive.
    • Incomplete, out-of-date and missing HCL scores will potentially result in lower CILA rates and reimbursements.
    • Incomplete, out-of-date and missing HCL scores will need to be updated by the CILA provider electronically with IntellectAbility and will be updated at the next download. HCL scores submitted by paper will not be accepted or processed except for an individual's initial CILA Funding Request.
    • It is each CILA agency's responsibility to keep ALL individual's HRST information up-to-date and accurate with IntellectAbility.
    • The DDD will only accept or process paper HRST information for an individual's initial CILA Funding Request. All HRST and HCL updates after processing the initial CILA Funding Request will be through the electronic download from IntellectAbility.

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

Effective Date:

Initial 08/25/2021

Revised 03/08/2024