Team 2: Intake and DD Eligibility Meeting Minutes (5-19-14)

Members Present

Meeting Notes

Discussions were held about the following topics:

1. Expenditures for Psychological assessments in FY '13: Everyone was asked to bring data from their organization regarding the amount of Funds spent on Psychological Evaluations in the past year.  Reports spread across five different PAS agencies - $141,000 for 476 individual assessments (average $296.00 per assessment varying in rate by region). These evaluations result in very few persons deemed ineligible; about 5 to 10 per PAS agency.
   1. PAS expressed concern over getting Psychological evaluations updated before PUNS registration; the demand would be more than many PAS agency's contracted Psychologists could keep up with and the agencies budgets would not support the expense. There are far more people who are screened than there are who receive a full evaluation. The cost would be prohibitive. 
2. DHS-DDD standard is currently for the assessment to be completed by a Licensed Clinical Psychologist; evaluations from a School Psychologist are secondary sources that are taken into account. No single instrument, document or contribution is the sole determiner of eligibility/presence of a developmental disability.
3. Need for a Psychological evaluation done by a Clinical Psychologist for every person who applies to DDD.
   1. Team says no as long as there is consistent, comprehensive supporting documentation.
   2. Yes for those coming with autism as a related condition.
   3. Primary source completed by a Licensed Professional specializing in the area of interest (Clinical Psychologist, Neurologist)
   4. Secondary source would be School Psychologist, records from Primary Care doctor, Department of Rehabilitation services, or recent Social Security evaluation.
   5. It was noted that Social Security completes full Psychological evaluations on people to verify disability. However these records are generally not available. Can someone discover why SS won't release these records?
   6. Work team was asked for a group to discuss and make recommendations on a list of acceptable documentation, similar to how an I-9 employment verification is completed - you MUST have one from column A and two or more from column B. Column A would be diagnostic. 
4. Team expressed concern for persons/families being determined ineligible after being on the PUNS list for a period of time is very difficult for families to accept. Data (How many)? We do not know the exact number of times this occurs.
5. It was noted that waiving the five year requirement for severe and profound ID will cut down on theabove figures quite a bit.
6. Federal rule (Administration on Developmental Disability) for age of onset is 22. 18 y/o is consistent with DSM IV criterion and CMS is OK with that being age of onset for DHS-DDD. 
7. Recommendations from last meeting endorsed by the Team
   1. Recommendations from Psychologist regarding placement is not binding. Educate them on the array of services available and language reflecting each level of support.
   2. Medical history required within the last 90 days but history and physical within 1 year; bring them in line with each other. Maybe these should be required only for persons needing skilled nursing or to help establish validity of related conditions. Is it actually necessary information to determine eligibility in ALL situations? Recommend it be needed within a period of time after services begin - or when pulled from PUNS?
   3. DD PAS 4 not needed to determine initial eligibility.
   4. Quarterly meetings between DHS and PAS agencies to discuss issues, new information and training. 
8. Active Treatment (as a requirement) vs. deficits in three or more areas of functioning. CMS does not require proof of the need for Active Treatment within Home and Community Based Services (waiver). It is not a federal requirement to document that the person MUST benefit from Active treatment. You must demonstrate that the person has deficit in three or more functional areas, but that is all. What are the minimum supports needed to address identified deficits?
9. Requirement to verify the need for active treatment?

   Team says no, not at intake/eligibility determination.

10. Standardized Intake Process:
    1. Right now, each agency develops their own intake screening forms. Intake usually occurs over the phone with some walk-ins.
    2. Universal assessment tool is in the works. DDD staff will see what they can find before next meeting.
    3. Pros: consistent message to individuals and families; data could show how much additional work PAS does; centralized data system; standardized form(s) would increase portability in the event that a person moves from one agency to another; will help in training new staff.
    4. Cons: standardization could render the process impersonal; fails to take into account geographical nuances.
    5. How much information is the right amount at intake?
11. Recommendations for Intake:
    1. No acronyms, especially on the initial call.
    2. Explain each step in detail.
    3. Be careful using language such as money/funds vs. services. Suggest not talking about funds/money at all.
    4. Identify and talk about natural supports (especially if the person is going to wait on PUNS). 
    5. DDD - develop a brief "fact" sheet.
    6. Information discussed needs to be consistent across agencies.

Next Meeting

 June 19 in Lincoln, IL from 10am to 2pm

PAS workers to get data for initial PUNS registrations. PAS agencies will bring their intake forms. DDD staff will bring information on the Universal Assessment Tool being discussed.