Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-011 - Arkansas Independent Assessment New 18 Manual

Current through Register Vol. 49, No. 6, June, 2024
SECTION II - ARKANSAS INDEPENDENT ASSESSMENT
			 (ARIA)
200.000 OVERVIEW
201.000 Arkansas Independent Assessment
			 (ARIA) System Overview
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. As such, it
				assesses an individual's capabilities and limitations in performing activities
				of daily living such as 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 administered by the Division of
				Developmental Services (DDS), the independent assessment does not determine
				whether an individual is Medicaid eligible as 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 is also 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 which is being phased in
				over time among different population groups. When implemented for a population,
				the ARIA system replaces and voids any previous IA systems.
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.
ARIA 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 interview conducted in person. 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 instrument 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 in order to ensure
				consistency and eliminate any 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 IA,
Click here to see an example results packet.
Individuals have the opportunity to 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 may also 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 (personal
				care, DD/ID, BH). DHS and the vendor provide internal quality review of the IA
				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 IA
				determines initial eligibility for services, then is used to inform the amount
				of services the beneficiary is to receive.
For clients who receive HCBS services, the IA results are used
				to develop the PCSP with the individual Medicaid beneficiary. 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 Medicaid home and
				community based services (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;
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 their 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.