20 CAR Part 607 — Arkansas Independent Assessment Provider Manual

Chapter XV

Subchapter B

20 CAR pt. 607 Arkansas Independent Assessment Provider Manual {#sec-20-car-pt.-607 omnilex-key=us-ar-regs-official--title-20-part-607--20 CAR pt. 607}

Arkansas Independent Assessment (ARIA) Section II Section II-1

SECTION II - ARKANSAS INDEPENDENT ASSESSMENT (ARIA) CONTENTS

200.000 OVERVIEW 201.000 Arkansas Independent Assessment (ARIA) System Overview 201.100 Developmental Screen Overview 202.000 Assessor Qualifications Overview 203.000 Appeals 204.000 Severability 210.000 BEHAVIORAL HEALTH SERVICES 210.100 Referral Process 210.200 Assessor Qualifications 210.300 Tiering 210.400 Possible Outcomes 220.000 DEVELOPMENTAL / INTELLECTUAL DISABILITIES SERVICES 220.100 Independent Assessment Referral Process 220.200 Assessor Qualifications 220.300 Tiering 220.310 Possible Outcomes 220.410 Battelle Developmental Inventory Screen 220.500 Complex Care 220.600 Referral Process 220.700 Assessor Qualifications 230.000 PERSONAL CARE SERVICES 230.100 Referral Process 230.200 Assessor Qualifications 230.300 Tiering 230.400 Possible Outcomes

200.000 OVERVIEW

201.000 Arkansas Independent Assessment (ARIA) System Overview 1-1 -24 The Arkansas Independent Assessment (ARIA) system is comprised of several parts that are administered through separate steps for each eligible Medicaid individual served through one of the state’s waiver programs or state plan Personal Care services. The purpose of the ARIA system is to perform a functional-needs assessment to assist in the development of an individual’s Person-Centered Service Plan (PCSP), Personal Care services plan and for certain populations to establish the per member per month payment to a managed care entity. As such, it assesses an individual’s capabilities and limitations in performing activities of daily living, including bathing, toileting, and dressing. It is not a medical diagnosis, although the medical history of an individual is an important component of the assessment as a functional deficiency may be caused by an underlying medical condition. In the case of an individual in need of behavioral health services, or waiver services, the independent assessment does not determine whether an individual is Medicaid eligible. That determination is made prior to and separately from the assessment of an individual. Federal statutes and regulations require states to use an independent assessment for determining eligibility for certain services offered though Home and Community-Based Services (HCBS) waivers. It also is important to Medicaid beneficiaries and their families that any type of assessment is based on tested and validated instruments that are objective and fair to everyone. In 2017, Arkansas selected the ARIA system. It has been phased in over time for different population groups. When implemented for a population, the ARIA system replaces and voids any previous IA systems.

Arkansas Independent Assessment (ARIA) Section II Section II-2

The ARIA system is administered by a vendor under contract with the Arkansas Department of Human Services (DHS). The basic foundation of the ARIA system is MnCHOICES, a comprehensive functional assessment tool originally developed by state and local officials in Minnesota for use in assessing the long-term services and supports (LTSS) needs of elderly individuals. Many individuals with developmental disabilities (DD)/intellectual disabilities (ID) and individuals with severe behavioral health needs also have LTSS needs. Therefore, the basic MnCHOICES tool has common elements across the different population groups. DHS and its vendor further customized MnCHOICES to reflect the Arkansas populations. The assessment is administered by professional assessors who have successfully completed the vendor’s training curriculum. The assessor training is an important component of ensuring the consistency and validity of the tool. The assessment tool is a series of more than 300 questions that might be asked during an in-person interview. The interview may include family members and friends as well as the Medicaid beneficiary. How a question is answered may trigger another question. Responses are weighted based on the service needs being assessed. The MnChoices assessment is computerized and uses computer program language based on logic (an algorithm) to generate a tier assignment for each individual. An algorithm is simply a sequence of instructions that will produce the exact same result to ensure consistency and eliminate interviewer bias. The results of the assessment are provided to the individual and program staff at DHS. The results packet includes the individual’s tier result, scores, and answers to all questions asked during the assessment. Click here to see an example results packet. Individuals can review those results and may contact the appropriate division for more information on their individual results, including any explanations for how their scores were determined. Depending upon which program the individual participates in, the results also may be given to service providers. The results will assign an individual into a tier which subsequently is used to develop the individual’s PCSP. The tiers and tiering logic are defined by DHS and are specific to the population served. DHS and the vendor provide internal quality review of the assessment results as part of the overall process. The tier definitions for each population group/waiver group are available in the respective section of this Manual. In the case of an individual whose services are delivered through the Provider-led Arkansas Shared Savings Entity (PASSE); the tier is used in the determination of the actuarially sound global payment made to the PASSE. Beginning January 1, 2019, each PASSE is responsible for its network of providers and payments to providers are based on the negotiated payment arrangements. For beneficiaries receiving state plan personal care, the assessment results determine initial eligibility for services, then are used to inform the amount of services the beneficiary is to receive. For beneficiaries who receive HCBS services, the assessment results are used to develop the PCSP with the individual Medicaid beneficiary and establishes the per member per month payment to a managed care entity. The Medicaid beneficiary (or a parent or guardian on the individual’s behalf) will sign the PCSP. Depending upon which program the individual participates in, department staff or a provider is responsible for ensuring the PCSP is implemented. The DHS ARIA vendor does not participate in the development of the PCSP, nor in the provision of services under the approved plan. There are four key features of every HCBS waiver: A. It is an alternative to care in an institutional setting (hospital, nursing home, intermediate care facility for individuals with developmental disabilities), therefore the individual must require a level of services and supports that would otherwise require that the individual be admitted to an institutional setting; B. The state must assure that the individual’s health and safety can be met in a non- institutional setting;

Arkansas Independent Assessment (ARIA) Section II Section II-3

C. The cost of services and supports is cost effective in comparison to the cost of care in an institutional setting; and, D. The PCSP should reflect the preferences of the individual and must be signed by the individual or the individual’s designee. The PCSP, as agreed to by the Medicaid beneficiary, therefore represents the final decision for setting the amount, duration, and scope of HCBSs for that individual. 201.100 Developmental Screen Overview 1-1 -24 Additionally, the vendor will perform developmental screens for children seeking admission into an Early Intervention Day Treatment (EIDT) program, the successor program to Developmental Day Treatment Clinic Services (DDTCS) and Child Health Management Services (CHMS) described in Act 1017 of 2013. Ark. Code Ann. § 20-48-1102. The developmental screen is the Battelle Developmental Inventory screening tool, which is a norm-referenced tool commonly used in the field to screen children for possible developmental delays. The state has established a broad baseline and will use this tool to screen children to determine if further evaluation for services is warranted. The screening results can also be used by the EIDT provider to further determine what evaluations for services a child should receive. The developmental disabilities screening process will sunset April 1, 2024. 202.000 Assessor Qualifications Overview 1-1 -24 All assessors who perform assessments on behalf of the vendor must meet the following qualifications: A. At least one-year experience working directly with the population with whom they will administer the assessment B. The ability to request and verify information from individuals being assessed C. Culturally sensitive to individuals assessed D. The necessary knowledge, skills and abilities to successfully perform and manage assessments including organization, time management, ability to address difficult questions and problematic individuals, effective communication, and knowledge of adult learning strategies E. Linguistically competent in the language of the individual being assessed or in American Sign Language or with the assistance of non-verbal forms of communication, including assistive technology and other auxiliary aids, as appropriate to the individual assessed or use the services of a telephonic interpreter service or other equivalent means to conduct assessments F. Ability to verify the information received from the individual and the individual’s family members, caregivers, and/or guardians by cross-referencing all available information The assessor SHALL NOT be related by blood or marriage to the individual being assessed or to any paid caregiver of the individual, financially responsible for the individual, empowered to make financial or health-related decision on behalf of the individual, or benefit financially from the provision of assessed needs. 203.000 Appeals 1-1 -24 Appeal requests for the ARIA system must adhere to the policy set forth in the Medicaid Provider Manual Section 160.000 Administrative Reconsideration and Appeals which can be accessed at

Arkansas Independent Assessment (ARIA) Section II Section II-4

https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful- information-for-providers/manuals/ 204.000 Severability 1-1 -24 Each section of this manual is severable from all others. If any section of this manual is held to be invalid, illegal, or unenforceable, such determination shall not affect the validity of other sections in this manual and all such other sections shall remain in full force and effect. In such an event, all other sections shall be construed and enforced as if this section has not been included therein.

210.000 BEHAVIORAL HEALTH SERVICES

210.100 Referral Process

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Independent assessment referrals are initiated by Behavioral Health (BH) service providers

identifying a beneficiary who may require services in addition to behavioral health counseling

services and medication management. Requests for functional assessment shall be transmitted

to DHS or its designee. Supporting documentation related to treatment services necessary to

address functional deficits may be provided.

DHS or its designee will review the request and make a determination to either:

1. Finalize a referral and send it to the vendor for a BH independent assessment
2. Provide notification to the requesting BH service provider that more information is needed
3. Provide notification to the requesting entity

Reassessments will occur annually unless a change in circumstances requires a new

assessment. A reassessment will be completed by staff employed by the independent

assessment contractor utilizing the current approved assessment instrument (ARIA), which was

approved prior to April 1, 2021, to assess functional need. An interview will be conducted in

person for initial assessments, with the option of using telemedicine to complete Behavioral

Health reassessments. The telemedicine tool must meet the 1915(i) requirement for the use of

telemedicine under 42 CFR 441.720 (a)(1)(i)(A) through (C).

210.200 Assessor Qualifications

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In addition to the qualifications listed in Section 202.000, BH assessors must have a four (4) year

bachelor’s degree or be a Registered Nurse with at least one year of mental health experience.

210.300 Tiering

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A. Tier Definitions:

1. Tier 1 means the score reflected that the individual can continue Counseling and Medication Management services but is not eligible for the additional array of services available in Tier 2 or Tier 3
2. Tier 2 means the score reflected difficulties with certain behaviors allowing eligibility for a full array of non-residential services to help the beneficiary function in home and community settings and move towards recovery.
3. Tier 3 means the score reflected difficulties with certain behaviors allowing eligibility for a full array of services including 24 hours a day/7 days a week residential services, to help the beneficiary move towards reintegrating back into the community. B. Tier Logic

Arkansas Independent Assessment (ARIA) Section II Section II-5

1. Beneficiaries aged 18 and over

Tier 1 – Counseling and Medication Management Services

Tier 2 – Counseling, Medication Management, and Support Services Tier 3 – Counseling, Medication Management, Support, and Residential Services Criteria that will Trigger Tiers Behavior

Does not meet criteria of Tier 2 or Tier 3

Mental Health Diagnosis Score of 4 AND Intervention Score of 1 or 2 in any ONE of the following Psychosocial Subdomains: Injurious to Self Aggressive Toward Others, Physical Aggressive Toward Others, Verbal/Gestural Socially Unacceptable Behavior Property Destruction Wandering/Elopement PICA Mental Health Diagnosis Score of 4 AND Intervention Score of 3 or 4 in any ONE of the following Psychosocial Subdomains: Injurious to Self Aggressive Toward Others, Physical Aggressive Toward Others, Verbal/Gestural Socially Unacceptable Behavior Property Destruction Wandering/Elopement PICA OR

Mental Health Diagnosis Score of 4 AND Intervention Score of 3 or 4 AND Frequency Score of 4 or 5 in any ONE of the following Psychosocial Subdomains: Difficulties Regulating Emotions Susceptibility to Victimization Withdrawal Agitation Impulsivity Intrusiveness

OR

Mental Health Diagnosis Score of 4 AND Intervention Score of 1, 2, 3 or

Arkansas Independent Assessment (ARIA) Section II Section II-6

4 AND Frequency Score of 1, 2, 3, 4 or 5 in the following Psychosocial Subdomain: Psychotic Behaviors OR

Mental Health Diagnosis Score of 4 AND Intervention Score of 4 AND Frequency Score of 4 or 5 in the following Psychosocial Subdomain: Manic Behaviors

OR

Mental Health Diagnosis Score of 4 AND PHQ-9 Score of 3 or 4 (Moderately Severe or Severe Depression) OR Geriatric Depression Score of 3 (>=10)

OR

Mental Health Diagnosis Score of 4 AND Substance Abuse or Alcohol Use Score of 3

When you see “AND”, this means you must have a score in this area AND a score in another area. When you see “OR”, this means you must have a score in this area OR a score in another area.

Arkansas Independent Assessment (ARIA) Section II Section II-7

2. Beneficiaries Under Age 18

Tier 1 – Counseling and Medication Management Services

Tier 2 – Counseling, Medication Management, and Support Services Tier 3 – Counseling, Medication Management, Support, and Residential Services Criteria that will Trigger Tiers Behavior

Does not meet criteria of Tier 2 or Tier 3

Mental Health Diagnosis Score

= 2 AND Injurious to Self: Intervention Score of 1, 2 or 3 AND Frequency Score of 1, 2, 3, 4 or 5 Mental Health Diagnosis Score >=2 AND Injurious to Self: Intervention Score of 4 AND Frequency Score of 1, 2, 3, 4 or 5 OR Mental Health Diagnosis Score =2 AND Aggressive Toward Others, Physical: Intervention Score of 1, 2 or 3 AND Frequency Score of 1, 2, 3, 4 or 5 Mental Health Diagnosis Score >=2 AND Aggressive Toward Others, Physical: Intervention Score of 4 AND Frequency Score of 2, 3, 4 or 5 OR Mental Health Diagnosis Score =2 AND Intervention Score of 3 or 4 AND Frequency Score of 2, 3, 4, or 5 in any ONE of the following Psychosocial Subdomains: Aggressive Toward Others, Verbal/Gestural Wandering/Elopement Mental Health Diagnosis Score >=2 AND Psychotic Behaviors: Intervention Score of 3 or 4 AND Frequency Score of 3, 4 or 5 OR Mental Health Diagnosis Score =2 AND

Arkansas Independent Assessment (ARIA) Section II Section II-8

Intervention Score of 2, 3 or 4 AND Frequency Score of 2, 3, 4, or 5 in any ONE of the following Psychosocial Subdomains: Socially Unacceptable Behavior Property Destruction OR

Mental Health Diagnosis Score

=2 AND Intervention Score of 3 or 4 AND Frequency Score of 3, 4, or 5 in any ONE of the following Psychosocial Subdomains: Agitation Anxiety Difficulties Regulating Emotions Impulsivity Injury to Others, Unintentional Manic Behaviors Susceptibility to Victimization Withdrawal

OR

Mental Health Diagnosis Score

=2 AND PICA: Intervention Score of 4

OR Mental Health Diagnosis Score

=2 AND Intrusiveness: Intervention Score of 3 or 4 AND Frequency Score of 4 or 5

Arkansas Independent Assessment (ARIA) Section II Section II-9

OR

Mental Health Diagnosis Score

= 2 AND Psychotic Behaviors: Intervention Score of 1 or 2 AND Frequency Score of 1 or 2

OR Mental Health Diagnosis Score

=2 AND Psychosocial Subdomain Score >=5 and <=7 AND Pediatric Symptom Checklist Score >15

210.400 Possible Outcomes 1-1 -24 A. For a beneficiary receiving a Tier 1 determination:

1. Eligible for Counseling and Medication Management services and may continue Tier 1 services with a certified behavioral health service provider.
2. Not eligible for Tier 2 or Tier 3 services.
3. Not eligible for auto-assignment to a Provider-led Arkansas Shared Savings Entity (PASSE) or to continue participation with a PASSE. B. For a beneficiary receiving a Tier 2 determination:
4. Eligible for services contained in Tier 1 and Tier 2.
5. Not eligible for Tier 3 services.
6. Eligible for auto-assignment to a PASSE or to continue participation with a PASSE. a. On January 1, 2019, the PASSE began receiving a PMPM that corresponds to the determined rate for the assigned tier. b. The PASSE is responsible for providing care coordination and assisting the beneficiary in accessing all needed services and, after January 1, 2019, for providing those services. C. For a beneficiary receiving a Tier 3 determination:
7. Eligible for services contained in Tier 1, Tier 2 and Tier 3.
8. Eligible for auto-assignment to a PASSE or to continue participation with a PASSE. a. On January 1, 2019, the PASSE began receiving a PMPM that corresponds to the determined rate for the assigned tier. b. The PASSE is responsible for providing care coordination and assisting the beneficiary in accessing all needed services and, after January 1, 2019, for ensuring those services are provided.

Arkansas Independent Assessment (ARIA) Section II Section II-10

220.000 DEVELOPMENTAL / INTELLECTUAL DISABILITIES SERVICES

220.100 Independent Assessment Referral Process 1-1 -24 A. Independent assessment referrals are initiated by the DHS Division of Developmental Disabilities (DDS) when a beneficiary has been determined, at one time, to meet the institutional level of care. DDS will send the referral for a Developmental Disabilities (DD) assessment to the current ARIA vendor. DDS will make referrals for the following populations:

1. Beneficiaries receiving services under the Community and Employment Supports (CES) 1915(c) Home and Community-Based Services Waiver.
2. Beneficiaries on the CES Waiver waitlist.
3. Beneficiaries applying for or currently living in a private Intermediate Care Facility (ICF) for individuals with intellectual or developmental disabilities.
4. Beneficiaries who are applying for placement at a state-run Human Development Center (HDC). To continue to receive services within these populations, all individuals referred must undergo an independent assessment annually. A reassessment will be completed by staff employed by the independent assessment contractor utilizing the current approved assessment instrument (ARIA), which was approved prior to April 1, 2021, to assess functional need. An interview will be conducted in person for initial assessments, with the option of using telemedicine to complete reassessments for members with intellectual or developmental disabilities. The telemedicine tool must meet the 1915(i) requirement for the use of telemedicine under 42 CFR 441.720 (a)(1)(i)(A) through (C). B. All populations, except for those served at an HDC, will be reassessed every three (3) years.
5. An individual can be reassessed at any time if there is a change of circumstances that requires a new assessment.
6. Individuals in an HDC only will be assessed or reassessed if they are seeking transition into the community. 220.200 Assessor Qualifications 1-1 -24 In addition to the qualifications listed in Section 202.000, DD assessors must have at least two- years’ experience with the ID/DD population and meet the qualifications of a Qualified Developmental Disability Professional (QDDP). 220.300 Tiering 1-1 -24 A. Tier Definitions:
7. Tier 2 means that the beneficiary scored high enough in certain areas to be eligible for paid services and supports.
8. Tier 3 means that the beneficiary scored high enough in certain areas to be eligible for the most intensive level of services, including 24 hours a day/7 days a week paid supports and services. B. Tiering Logic:
9. DDS tier logic is organized by categories of need, as follows:

Arkansas Independent Assessment (ARIA) Section II Section II-11

1. Safety: Your ability to remain safe and out of harm’s way
2. Behavior: Behaviors that could place you or others in harm’s way
3. Self-Care: Your ability to take care of yourself, such as bathing yourself, getting

dressed, preparing your meals, shopping, or going to the bathroom

Tier 2: Institutional Level of Care Tier 3: Institutional Level of Care and may need 24 hours a day/7 days a week paid supports and services to maintain current placement Safety Level High A. Self-Preservation Score > = 4 AND B. Caregiving Capacity/Risk Score > = 6 AND C. Caregiving/Natural Supports Score > = 6 AND D. Mental Status Evaluation Score (in the home) = 3 or 4 AND E. Mental Status Evaluation Score (in the community) = 2 A. Self-Preservation Score > = 16 AND B. Caregiving Capacity/Risk Score = 11 AND C. Caregiving/Natural Supports Score of = 7 AND D. Mental Status Evaluation Score (in the home) Score = 5 AND E. Mental Status Evaluation Score (in the community) Score = 3 Safety Level Medium A. Self-Preservation Score > = 4 AND B. Caregiving Capacity/Risk Score > = 6 AND C. Caregiving/Natural Supports Score > = 6 AND D. Mental Status Evaluation Score (in the home) = 2 AND E. Mental Status Evaluation Score (in the community) = 2

Safety Level Low A. Self-Preservation Score > = 4 AND B. Caregiving Capacity/Risk Score > = 6 AND C. Caregiving/Natural Supports Score > = 6 AND D. Mental Status Evaluation Score (in the home) = 1

Arkansas Independent Assessment (ARIA) Section II Section II-12

AND E. Mental Status Evaluation Score (in the community) Score = 1 Behavior Level High A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of > = 5

• < = 7 in at least ONE of the following Subdomains: Aggressive Toward Others, Physical; Injurious to Self; Manic Behaviors; PICA; Property Destruction; Psychotic Behaviors; Susceptibility to Victimization; Wandering/Elopement; AND C. Caregiving Capacity/Risk Score of > = 6 AND D. Caregiving/Natural Supports Score of > = 5] OR A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of > = 5
• < = 7 in at least THREE of the following Subdomains: Aggressive Toward Others, Verbal/Gestural; Agitation; Anxiety Difficulties Regulating Emotions; Impulsivity; Injury to Others (Unintentional); Intrusiveness; Legal Involvement; Socially Unacceptable Behavior; Withdrawal C. AND at least one of the following scores: Behavior Level High A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of > = 8
• < = 9 in at least TWO of the following Subdomains: Aggressive Toward Others, Physical; Injurious to Self; Manic Behaviors; PICA; Property Destruction; Psychotic Behaviors; Susceptibility to Victimization; Wandering/Elopement OR A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of > = 8
• < = 9 in at least THREE of the following Subdomains: Aggressive Toward Others Verbal/Gestural; Agitation; Anxiety; Difficulties Regulating Emotions; Impulsivity; Injury to Others (Unintentional); Intrusiveness; Legal Involvement; Socially Unacceptable Behavior; Verbal/Gestural; Withdrawal

Arkansas Independent Assessment (ARIA) Section II Section II-13

Caregiving Capacity/Risk Score of > = 9 Caregiving/Natural Supports Score of > = 5 Behavior Level Low A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of > = 3

• < = 4 in at least ONE of the following Subdomains: Aggressive Toward Others, Physical; Injurious to Self; Manic Behaviors PICA; Property Destruction; Psychotic Behaviors; Susceptibility to Victimization; Wandering/Elopement C. AND at least one of the following scores: Caregiving Capacity/Risk Score of < = 8 Caregiving/Natural Supports Score of < = 3 OR A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of >=5- <=7 in at least one of the following Subdomains: Aggressive Toward Others, Verbal/Gestural; Agitation; Anxiety Difficulties Regulating Emotions; Impulsivity; Injury to Others (Unintentional); Intrusiveness; Legal Involvement; Socially Unacceptable Behavior; Withdrawal C. AND at least one of the following scores: Caregiving Capacity/Risk Score of < = 8 Behavior Level Low A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of > = 8
• < = 9 in at least ONE of the following Subdomains: Aggressive Toward Others, Physical; Injurious to Self; Manic Behaviors; PICA; Property Destruction; Psychotic Behaviors; Susceptibility to Victimization; Wandering/Elopement] OR A. Neurodevelopmental Score of 2 AND B. Psychosocial Subdomain Score of > = 8
• < = 9 in at least TWO of the following Subdomains: Aggressive Toward Others, Verbal/Gestural; Agitation; Anxiety; Difficulties Regulating Emotions; Impulsivity; Injury to Others (Unintentional); Intrusiveness; Legal Involvement; Socially Unacceptable Behavior; Withdrawal

Arkansas Independent Assessment (ARIA) Section II Section II-14

Caregiving/Natural Supports Score of < = 3 Self-Care Level High A. Neurodevelopmental Score of 2 AND B. Scores within stated range in at least THREE of any of the following:

1. ADL’s: Score of at least 4 in Eating Score of at least 5 in Bathing Score of at least 4 in Dressing Score of at least 3 in Toileting Score of at least 4 in Mobility Score of at least 4 in Transfers
2. Functional Communication: Score of 2 or 3 in Functional Communication
3. IADLs: Score of 3 in any of the following IADLs (Meal Preparation, Housekeeping, Finances, Shopping)
4. Safety: Self-Preservation Score of >=4 AND a score in at least one of the following areas: Caregiving Capacity/Risk Score of > = 9 Caregiving/Natural Supports Score of > = 4 Treatment/Monitoring Score of at least 2 Self-Care Level High A. Neurodevelopmental Score of 2 AND B. Treatments/Monitoring Score of at least 2 C. AND at least one of the following scores: Caregiving Capacity/Risk Score > = 10 Caregiving/Natural Supports Score of = 7 Self-Care Level Medium A. Neurodevelopmental Score of 2 AND B. Scores within stated range in at least THREE of any of the following:
5. ADLs: Score of 1-11 in Eating Score of 1-11 in Bathing Score of 1-10 in Dressing

Arkansas Independent Assessment (ARIA) Section II Section II-15

Score of 1-11 in Toileting Score of 1-10 in Mobility Score of 1-10 in Transfers 2. Functional Communication: Score of 1 in Functional Communication 3. IADLs Score of 3 in any of the following IADLs: (Meal Preparation, Housekeeping, Finances, Shopping) 4. Safety: Self-Preservation Score of > = 2 AND a score in at least one of the following areas: Caregiving Capacity/Risk Score of > = 9 Caregiving/Natural Supports Score of > = 4 Self-Care Level Low A. Neurodevelopmental Score of 2 AND B. Scores within stated range in at least THREE of any of the following combinations: Score of 1-11 in Eating Score of 1-11 in Bathing Score of 1-10 in Dressing Score of 1-11 in Toileting Score of 1-10 in Mobility Score of 1-10 in Transfers] OR Neurodevelopmental Score of 2 AND Score of >=1 in any of the following: IADLs (Meal Preparation, Housekeeping, Finances, Shopping) Self-Care Level Low A. Neurodevelopmental Score of 2 AND B. Scores within stated range in at least THREE of any of the following combinations: Score of at least 4 in Eating Score of at least 5 in Bathing Score of at least 4 in Dressing Score of at least 3 in Toileting Score of at least 4 in Mobility Score of at least 4 in Transfers C. AND at least one of the following scores: Caregiving Capacity/Risk Score of >= 10 Caregiving/Natural Supports Score of 7

When you see “AND”, this means you must have a score in this area AND a score in another area. When you see “OR”, this means you must have a score in this area OR a score in another area.

Arkansas Independent Assessment (ARIA) Section II Section II-16

220.310 Possible Outcomes 1-1 -24 A. For beneficiaries on the CES Waiver, Waiver waitlist, or in an ICF: Both Tier 2 and Tier 3 determinations will result in the beneficiary being eligible for auto- assignment to a PASSE or to continue participation with a PASSE.

1. On January 1, 2019, the PASSE began receiving a PMPM that corresponds to the determined rate for the assigned tier.
2. The PASSE is responsible for providing care coordination and assisting the beneficiary in accessing all eligible services and, after January 1, 2019, for ensuring those services are delivered. B. For beneficiaries seeking admission to an HDC:
3. Tier 2 Determination: a. Not eligible for admission into an HDC, will be conditionally admitted to begin transitioning to community settings. b. Eligible for auto-assignment to a PASSE or to continue participation with a PASSE. i. After January 1, 2019, the PASSE began receiving a PMPM that corresponds to the determined rate for the assigned tier. ii. The PASSE is responsible for providing care coordination and assisting the beneficiary in accessing all eligible services and, after January 1, 2019, for ensuring those services are provided.
4. Tier 3 Determination: a. Eligible for HDC admission, if deemed appropriate and an appropriate bed is available. b. Not eligible for auto-assignment to a PASSE or to continue participation with a PASSE, if the client chooses admission to the HDC. C. If the beneficiary does not receive a tier on the assessment, the vendor will refer him or her back to DDS for re-evaluation of institutional level of care. 220.410 Battelle Developmental Inventory Screen 1-1 -24 A. The screening tool that will be used by the vendor is the most recent edition of the Battelle Developmental Inventory (BDI) Screening Tool. The BDI screens children in the following five domains: adaptive, personal/social, communication, motor, and cognitive. B. Definitions used for the screening process:
5. Cut Score - The lowest score a beneficiary could have for that age range and standard deviation to pass a particular domain.
6. Pass - The child’s raw score is higher than the cut score, and the child is not referred for further evaluation
7. Refer – The child’s raw score is lower than the cut score, and the child is referred for further evaluation of service need
8. Age Equivalent Score - The age at which the raw score for a subdomain is typical
9. Raw Score – Is the score the child received on that domain. It is compared to the cut score to determine if the child receives a pass or refer.

Arkansas Independent Assessment (ARIA) Section II Section II-17

6. Standard Deviation - A measurement used to quantify the amount of variation; the standard deviation will be applied to the child’s raw score so that their score can be compared to the score of a child with typical development. C. The standard deviation of -1.5 will be applied to all raw scores. Any score that is more than 1.5 standard deviations below that of a child with typical development will be referred for further evaluation for EIDT services. D. Assessors who administer the Battelle Developmental Inventory screen must meet the qualifications of a DD assessor, listed in Section 220.200 and undergo training specific to administering the tool. 220.500 Complex Care 1-1 -24

220.600 Referral Process

1-1 -24

Once a member is attributed to a PASSE, DHS may initiate a referral for a member to get a

complex care assessment that will determine whether the member is eligible for Complex Care

services. A PASSE member may be consider for the Complex Care if the member has been

assessed or re-assessed as Tier 2 or 3 and if:

1. A member has an intellectual/developmental disability AND a behavioral health need OR
2. A member requires a higher level of care coordination and services due to court

involvement OR

C. A member’s behavioral health needs are complex.

To continue to receive Complex Care services, members must receive a complex care

assessment annually and be assessed as needing Complex Care services. A reassessment will

be completed by appropriate DHS-approved staff using the appropriate Complex Care

assessment tool. If a member does not meet the need for Complex Care services, the member

will be placed back in Tier 3. An in-person interview will be conducted for initial assessments,

with the option of using telemedicine to complete reassessments for members who meet the

criteria for Complex Care. The telemedicine tool must meet the 1915(i) requirement for the use

of telemedicine under 42 CFR 441.720 (a)(1)(i)(A) through (C).

220.700 Assessor Qualifications

1-1 -24

In addition to the qualifications listed in Section 202.000, Complex Care assessors must have a

four (4) year bachelor’s degree or be a Registered Nurse with at least one year of mental health

experience.

230.000 PERSONAL CARE SERVICES

230.100 Referral Process

1-1 -24

Independent assessment referrals are initiated by Personal Care (PC) service providers

identifying a beneficiary who may require PC services. After January 1, 2019, individuals who

are enrolled in a PASSE do not require a personal care assessment to continue services.

Requests for functional assessment shall be transmitted to DHS or its designee, and will require

supporting documentation. Supporting documentation that must be provided include:

1. A provider completed form that has been provided by DHS; and
2. A referral form if it is an initial referral.

Arkansas Independent Assessment (ARIA) Section II Section II-18

DHS or its designee will review the request and make a determination to:

1. Finalize a referral and send it to the vendor for a PC independent assessment, or
2. Provide notification to the requesting entity that more information is needed, and that the

PC provider may resubmit the request with the additional information, or

C. Provide notification to the requesting entity that the request is denied, for example, if a

functional assessment has been performed within the previous ten (10) months and there

is no change of circumstances to justify reassessment.

Reassessments must be conducted in person or by telemedicine and occur annually but may

occur more frequently if a change of circumstances necessitates such.

230.200 Assessor Qualifications

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In addition to the qualifications listed in Section 202.000, PC assessors must be a Registered

Nurse licensed in the State of Arkansas.

230.300 Tiering

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A. Tier Definitions:

1. Tier 0 means you did not score high enough in any of the activities of daily living (ADLs) such as eating, bathing, or toileting to meet the state’s eligibility criteria for personal care services. A Tier 0 means that you did not need any “hands on assistance” in being able to bathe yourself, feed yourself and dress yourself as examples.
2. Tier 1 means you scored high enough in at least one of the ADLs such as eating, bathing, toileting, to be eligible for the state’s Personal Care services. A Tier 1 means that you need “hands on assistance” to be able to bathe yourself, dress yourself, or feed yourself, as examples. B. Tiering Logic

Tier 0 Tier 1 Functional Status (ADLs)

Score < 3 in all of the following ADLs: Eating, Bathing, Dressing, Personal Hygiene/Grooming, Mobility, Transferring, Toilet Use/Continence Support, Positioning Score of > = 3 in at least ONE of the following ADLs: Eating, Bathing, Dressing, Personal Hygiene/Grooming, Mobility, Transferring, Toilet Use/Continence Support, Positioning

230.400 Possible Outcomes 1-1 -24 Upon successful completion of an assessment, the tier determination will determine eligibility of service levels. Possible outcomes include: A. Tier 0 Determination

1. Not currently eligible for Personal Care services.
2. May be reassessed when a change in circumstances necessitates a re-assessment. B. Tier 1 Determination
3. Currently eligible for up to 256 units (64 hours) per month of Personal Care services.

Arkansas Independent Assessment (ARIA) Section II Section II-19

2. The PC assessment is submitted to DHS or its designee who reviews it, along with any information submitted by the provider to authorize the set amount of service time per month. The PC assessment is not used to assign clients to a PASSE.