Health Risk Screening Tool (replaces DD.24.005)

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.24.012

This Information Bulletin replaces DD.24.005

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 applying to and 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

NOTE: At the time of this IB update, IntellectAbility is working on developing a process for ISC agencies to electronically access the individuals in their geographic coverage area.

  • The HRST should be updated within 14 calendar 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: Lowest 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 mid December and mid June for implementation in CILA Rate calculations in January and July. Raters are strongly encouraged to not have incomplete HRSTs in process when the downloads occur. These downloads include updated HRSTs.

Provider Guidelines:

  • All individuals applying for CILA residential supports will be issued a Pre-Award Letter (PAL), except State Operated Developmental Center (SODC) transfers. The PAL does not require the provider to complete a nursing packet. The completed nursing packet is submitted after the provider has access to the individual's HRST.
  • The individual applying for CILA supports will be issued a PAL assigning that individual to the new provider. Once the PAL is issued, the DDD's records will reflect that the individual is now associated with the new provider.
  • The individual's basic information will be transmitted to IntellectAbility. Upon notification from DDD, IntellectAbility will allow access to the individual's historic HRST profile if one exists. If an historic profile does not exist, a new profile will be populated automatically. This allows the CILA provider to complete the HRST before submitting the CILA Funding Request Packet.
  • Individuals transitioning from a State Operated Developmental Center (SODC):
  • The Bureau of Transition Services will submit the SODC HRST on paper copy with the funding packet to rates.
  • The DDD will transmit to IntellectAbility, on a weekly basis, individual information for every person who is issued a CILA PAL. An HRST from the web-based platform must be included with the individual's CILA Funding Request Packet.
  • Providers must submit the HRST with their CILA Funding Request Packet for all new individuals. Incomplete packets submitted will be rejected and returned so all necessary documentation can be included.
  • If the individual is not present in the CILA provider's HRST database, this would mean the person has not been issued a PAL or enrolled for CILA residential billing by DHS. To correct the issue, the CILA provider 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 the 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 organization. The Gatekeeper would:
  • Ensure user accounts are made inactive when needed;
  • Request additional user accounts for other staff members in their organization.
  • Gatekeeper Processes:
  • The CILA provider's 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 organization from within the HRST application.
  • Gatekeepers will be trained via an online tutorial on how to:
  • Create other Gatekeeper user accounts.
  • 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 should 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:

  • The HRST also provides Service and Training considerations within the online platform that are tailored to the individual's health care needs. 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 provider'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 calendar 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 Intermittent Community Integrated Living Arrangement (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 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.
  • HCL scores are updated electronically with the DDD twice a year (in December and June) and with the submission of the nursing packet for a new placement. If it is discovered in January or July that the HCL is not reflected correctly, please reach out to DHS.DDDComments@illinois.gov. These are the only months the HCL is updated.
  • Updated HCL scores are used to recalculate the individual's CILA rate and the funding the CILA provider 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.
  • It is each CILA provider's responsibility to keep ALL individual's HRST information up-to-date and accurate with 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 09/01/2024