Draft - Pre-Admission Screening Manual Changes - Psychological Evaluation

Purpose

This Information Bulletin is directed to Pre-Admission Screening agencies to inform them of changes in required psychological assessments. These changes are intended to streamline the eligibility assessment process for individuals seeking new or different developmental disabilities Medicaid services.

Summary of Changes

200.50 B. Psychological Evaluation

When individuals with intellectual disability receive the initial screening for enrollment in services, and are suspected to be in the mild range, the psychological evaluation must be completed by a licensed psychologist, within five years prior to the date recorded on the DDPAS-2, Part II.

For individuals with intellectual disability documented to be in moderate, severe or profound range prior to age 18, a psychological assessment on record will be acceptable - i.e. it is not necessary to obtain a new assessment.

Psychological evaluations must include:

1. Assessment of adaptive functioning: Licensed psychologists have the latitude to determine which tool should be used. (Please note that the ICAP is not an adequate assessment of adaptive functioning.)

   Nationally standardized instruments for assessment of adaptive functioning are to be utilized by a licensed psychologist. Examples of such standardized instruments include but are but not limited to:

   1. American Association of Mental Retardation (AAMR) Adaptive Behavior Scales-2nd Ed.
   2. Vineland Adaptive Behavior Scale--II
   3. Adaptive Behavior Inventory (ABI) (English and Spanish) 
   4. Scales of Independent Behavior-R

   NOTE: questions regarding the acceptability of testing instruments shall be directed to the Department of Human Services Bureau of Clinical Services - (217) 782-9449.

2. Assessment of intellectual functioning:

   Nationally standardized instruments for assessment of intellectual functioning are to be utilized by a licensed psychologist. Examples of such standardized instruments include but are but not limited to:

   1. Stanford-Binet 5th Ed.
   2. Wechsler Adult Intelligence Scale-IV
   3. Wechsler Intelligence Scale for Children-IV

   NOTE: questions regarding the acceptability of testing instruments shall be directed to the Department of Human Services Bureau of Clinical Services - (217) 782-9449.

3. The psychological evaluation must provide a clear and concise summary of the information derived from a nationally accepted functional assessment instrument and nationally accepted standardized intellectual functioning instrument. Please note that the full assessments must be completed - abbreviated versions of instruments are not acceptable. This evaluation must, at a minimum, include the following elements:
   1. Cognitive/intellectual functioning that includes the scores from the standardized intellectual functioning instrument and an interpretation of these data.
   2. Developmental history that clearly addresses the age of onset of the developmental disability. (Refer to 500.20.G).
   3. Educational background
   4. Adaptive skill level
   5. Multi-axial diagnosis that includes a primary diagnosis
   6. Recommendations for future service delivery (e.g., school services, day program, vocational, employment, senior citizens services).
4. If substantial differences in test results (e.g., 10 - 15 points) are noted within the current battery of tests or between the current testing and that reported in years previous, the psychologist should attempt to identify and document the cause of the different test results and should refer the individual for additional assessments of various kinds, as appropriate. This may include confirmative retesting or assessments, such as:
   1. IQ
   2. Neurological Consultation
   3. Neuropsychological Assessment
   4. Medical Consultation
5. Any additional testing must be documented in the individual's record with the results coupled with a clear and concise clinical synthesis.
6. When a psychologist selects a different test other than the test administered previously, he/she should provide, in the analysis of findings, the rationale for selecting a different test.
7. Even though it is required that the psychological evaluation be current within five years, the clinical judgment and the service needs of the individual should dictate greater frequency and content of the psychological evaluation.

Effective Date