Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-009 - Manual Update ARCHOICES 1-18

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
ARCholces In Homecare Home and
			 Community-Based 2176 Waiver
212.100 An Overview of Resource Utilization
			 Groups (RUGs)
Thie ARCholces Waiver provides beneficiaries with a monthly
				allocation of attendant care hours to be used at the beneficiary's discretion
				throughout the month. The number of attendant care hours approved for each
				beneficiary is based on the results of that beneficiary's most recent
				assessment using the ArPath Assessment Tool.
The ArPath Assessment Tool uses a software program that
				includes an algorithm to evaluate certain responses within an extensive
				questionnaire to determine whether the beneficiary meets the functional
				eligibility criteria to participate In the waiver program. The ArPath
				Assessment Tool then uses another algorithm to evaluate other responses to
				determine which Resource Utilization Group (RUG) reflects the beneficiary's
				functional abilities. A RUG Is a tier group consisting of individuals with
				similar functional abilities.
In 2013, attendant care services were detennined based on an
				RN's discretionary interpretation of a beneficiary's responses to the ArPath
				Assessment Tool's questionnaire. Between 2013 and January 1,2016, when the
				ARCholces program was implemented, DAAS recorded beneficiary RUG placement and
				the number of paid attendant care hours utilized by beneficiaries each month in
				order to detemiine the type and amount of resources that beneficiaries with
				similar functional abilities were used in a given month.
While the reality of living with a disease or condition can
				vary greatly even among individuals with the same diagnosis, a RUG placement
				allows DAABHS to better predict the type and extent of care that an individual
				needs. The purpose of transitioning to a RUG-based care allocation system is to
				provide more predictable and objective outcomes that better reflect the reality
				of a beneficiary's needs by organizing the allocation around functional
				ability.
As of January 1, 2016, the allocation of attendant care hours
				became based on which RUG the beneficiary is placed in by the ArPath Assessment
				Tool. The specific number of attendant care hours assigned to a particular RUG
				was determined by considering an average of the number of hours used by
				beneficiaries placed in that RUG prior to the implementation of the ARCholces
				program. The following chart shows the number of hours assigned to each
				RUG.
RUG
Category
RUG
Monthly
Hours
Special Rehab
RBO
157
RA2
97
RA1
55
Extensive Care
SE3
352
SE2
201
SE1
153
Special Care
SSB
161
SSA
112
Clinically Complex
ceo
143
CBO
94
CA2
69
CA1
36
Impaired Cognition
ISO
116
IA2
81
IA1
38
Behavioral Problems
BBO
118
BA2
62
BA1
30
Reduced Physical Function
PDO
137
PCO
99
PBO
81
PA2
53
PA1
28
RUG Requirements
The ArPath Assessment Tool evaluates the assessment responses
				using an algorithm, which is basically a "rule book" for the software. This
				particular rulebook is divided into chapters, known as screeners, and each
				screener is responsible for evaluating a small portion of the assessment
				responses in order to produce a numerical score. Below is a list of the
				screeners and the possible scores:
Screener
Possible Scores
Activities of Daily Living (ADL)
4-18
instrumental Activities of Daily Living (lADL)
0-3
Rehab
0-1
Behavior Problems
0-1
Extensive Care
0-1
Special Care
0-1
Clinically Complex
0-1
Cognitive Impairment
0-1
Cumulative
0-5
Each RUG requires a different combination of screener scores in
				order for a beneficiary to be placed in that RUG. The ArPath Assessment Tool
				utilizes the criteria for each RUG in the exact order that they are listed in
				the above chart and it places the beneficiary in the first RUG on the list
				whose criteria are satisfied by the assessment responses.
The following is a description of the screener scores required
				for each Special Rehab RUG.
A. RBO
			 requires a Rehab screener score of 1 and an ADL score of at least 11.
B. RA2 requires a Rehab screener score of 1,
			 an lADL score of at least 2, and an ADL score of no more than 10.
C. RA1 requires a Rehab screener score of 1,
			 an lADL score of 1 or 0, and an ADL score of no more than 10.
The following is a description of the screener scores required
				for each Extensive Care RUG.
A. SE3 requires a Cumulative screener score
			 of at least 4, an Extensive Care screener score of 1, and an ADL score of at
			 least 7.
B. SE2 requires a
			 Cumulative screener score of either 2 or 3, an Extensive Care screener score of
			 1, and an ADL score of at least 7.
C. SE1 requires a Cumulative screener score
			 of no more than 1, an Extensive Care screener score of 1, and an ADL score of
			 at least 7.
The following is a description of the screener scores required
				for each Special Care RUG.
A. SSB requires an ADL score of at least 14
			 and a score of 1 for either the Extensive Care screener or the Special Care
			 screener.
B. SSA has two possible
			 combinations:
1. An Extensive Care screener
			 score of 1 with and ADL score of no more than 6, or
2. An ADL score within the range of 7-13 and
			 a score of 1 for either the Extensive Care screener or the Special Care
			 screener.
The following Is a description of the screener scores required
				for each Clinically Complex RUG.
A. ceo requires an ADL score of at least 11
			 and a score of 1 for either the Clinically Complex screener or the Special Care
			 screener.
B. CBO requires an ADL
			 score within the range of 6-10 and a score of 1 for either the Clinically
			 Complex screener or the Special Care screener.
C. CA2 requires and ADL score no higher than
			 5, an lADL score of at least 1, and a score of 1 for either the Clinically
			 Complex screener or the Special Care screener.
D. CA1 requires and ADL score no higher than
			 5, an lADL score of 0, and a score of 1 for either the Clinically Complex
			 screener or the Special Care screener.
The following is a description of the screener scores required
				for each Impaired Cognition RUG.
A. IBO requires a Cognitive Impairment
			 screener score of 1 and an ADL score within the range of 6-10.
B. 1A2 requires a Cognitive Impairment
			 screener score of 1, an lADL score of at least 1, and an ADL score of no more
			 than 5.
C. IA1 requires a Cognitive
			 Impairment screener score of 1, an lADL score of 0, and an ADL score of no more
			 than 5.
The following Is a description of the screener scores required
				for each Behavioral Problems RUG.
A. BBO requires a Behavior Problems screener
			 score of 1 and an ADL score within the range of 6-10.
B. BA2 requires a Behavior Problems screener
			 score of 1, an lADL score of at least 1, and an ADL score of no more than
			 5.
C. BA1 requires a Behavior
			 Problems screener score of 1, an lADL score of 0, and an ADL score of no more
			 than 5.
The following is a description of the screener scores required
				for each Reduced Physical Function RUG.
A. PDO requires a Rehab screener score of 0
			 and an ADL score of at least 11.
B.
			 PCO requires a Rehab screener score of 0 and an ADL score of 9 or 10.
C. PBO requires a Rehab screener score of 0
			 and an ADL score of 6, 7, or 8.
D.
			 PA2 requires a Rehab screener score of 0, an lADL score of at least 1, and an
			 ADL score of no more than 5.
E. PA1
			 requires a Rehab screener score of 0, an lADL score of 0, and an ADL score of
			 no more than 5.
Screener Requirements
Activities of Daily Living f
				ADL)
A beneficiary's ADL score ranges from 4 to 18. It is based on
				the collective score among responses to the 5 items in the assessment that are
				listed below. Only 4 of the 5 responses will add to the overall ADL score
				because the response to Mode of nutritional intake may override the response to
				Eating.
A. Bed
			 mobility
B. Transfer
			 toilet
C. Toilet use
D. Eating
E. Mode of nutritional intake
Bed mobility, Transfer toilet, and Toilet use are all scored in
				the following way:
A.
			 Independent gets 1 point,
B.
			 Independent, set up help only gets 1 point,
C. Supervision gets 1 point,
D. Limited assistance gets 3
			 points,
E. Extensive assistance
			 gets 4 points,
F. Maximal
			 assistance gets 5 points,
G. Total
			 dependence gets 5 points, and H. Activity did not occur gets 5 points Eating is
			 scored in the following way:
A.
			 Independent gets 1 point,
B.
			 Independent, set up help only gets 1 point,
C. Supervision gets 1 point,
D. Limited assistance gets 2
			 points,
E. Extensive assistance
			 gets 3 points,
F. Maximal
			 assistance gets 3 points,
G. Total
			 dependence gets 3 points, and
H.
			 Activity did not occur gets 3 points.
However, 3 points will be added to the ADL score, and the
				Eating score will be ovenidden if the response to Mode of nutritional intake is
				any of the following:
A.
			 Combined oral and parenteral or tube feeding,
B. Nasogastric tube feeding only,
C. Abdominal feeding tube, or
D. Parenteral feeding tube only
E. Instnjmental Activities of Daily Living
			 (lADL) A beneficiary's lADL score ranges from 0 to 3. It is based on the
			 collective score among the responses to the following items in the assessment:
A. Meal
			 preparation-perfomiance.
B.
			 Managing medication-performance, or
C. Phone use-performance.
The responses to each item are scored in the following
				way.
A. Independent gets 0
			 points.
B. Independent, set up help
			 only gets 0 points.
C. Supervision
			 gets 0 points.
D. Limited
			 assistance gets 0 points.
E.
			 Extensive assistance gets 0 points.
F. Maximal assistance gets 1 point
G. Total dependence gets 1 point.
H. Activity did not occur gets 1 point.
Rehab
A beneficiary's Rehab screener score is 0 by default, but it
				equals 1 if during the week prior to the assessment the beneficiary spends a
				total of at least 120 minutes in any combination of the following types of
				therapy:
A. Speech-language
			 pathology,
B. Occupational therapy,
			 or
C. Physical therapy.
Behavior Problems
A beneficiary's Behavior Problems score is 0 by default, but it
				equals 1 if the beneficiary has exhibited any of the following at any time
				within 3 days of the assessment:
A. Wandering,
B. Verbal abuse,
C. Physical abuse,
D. Socially inappropriate or disruptive
			 behavior,
E. Resists
			 care,
F. Delusions, or
G. Hallucinations. Extensive Care
A beneficiary's Extensive Care screener score is 0 by default,
				but It equals 1 if the response to Mode of nutritional Intake Is either
				Abdominal feeding tube or Parenteral feeding tube only. It will also equal 1 if
				the assessment records that any of the following treatments have been utilized
				within 3 days of the assessment:
A. IV medication,
B. Suctioning,
C. Tracheostomy care, or
D. Ventilator or respirator.
Special Care
A beneficiary's Special Care screener score Is 0 by default,
				but It equals 1 if the assessment records that Radiation therapy has been
				utilized within 3 days of the assessment or any of the following combinations
				of responses are logged In the assessment:
A. A turnlng/reposltioning program has been
			 utilized within 3 days of the assessment and the response to Most severe
			 pressure ulcer Is either:
1. Deep craters In
			 the skin or
2. Breaks in the skin
			 exposing muscle or bone;
B. Aphasia has been exhibited within 3 days
			 of the assessment and the Mode of nutritional intake Is either:
1. Nasogastric tube feeding or
2. Combined oral and parenteral or tube
			 feeding;
C. Wound care
			 has been perfonned within 3 days of the assessment and the response to either
			 of the following items is yes:
1. Major skin
			 problems or
2. Skin tears or
			 cuts;
D. Fever and
			 Vomiting are exhibited within 3 days of the assessment;
E. Fever Is exhibited within 3 days of the
			 assessment and the response to Weight loss of 5% Is yes;
F. Fever Is exhibited within 3 days of the
			 assessment and the response to Mode of nutritional Intake Is either:
1. Nasogastric tube feeding or
2. Combined oral and parenteral or tube
			 feeding;
G. Fever is
			 exhibited within 3 days of the assessment and the response to Pneumonia is any
			 of the following:
1. Primary diagnosis for
			 current stay;
2. Diagnosis present,
			 receiving active treatment; or
3.
			 Diagnosis present, monitored but no active treatment;
H. Fever is exhibited within 3 days of the
			 assessment and the response to Dehydration is yes; or
I. A beneficiary's ADL score is at least 10
			 and the response to either Multiple sclerosis or Quadriplegia is any of the
			 following:
1. Primary diagnosis for current
			 stay;
2. Diagnosis present,
			 receiving active treatment; or
3.
			 Diagnosis present, monitored but no active treatment.
Clinically Complex
A beneficiary's Clinically Complex screener score is 0 by
				default, but it equals 1 if any of the following Is recorded during the
				assessment:
A.
			 Mode of nutritional intake is either Nasogastric tube feeding or Combined oral
			 and parenteral or tube feeding;
B.
			 The response to Cognitive skills for daily decision making is No discemable
			 consciousness, coma and the response to any of the following is either Total
			 dependence or Activity did not occur:
1. Bed
			 mobility,
2. Transfer
			 toilet,
3. Toilet use, or
4. Eating;
C. Any form of Sepsis is recorded in the
			 Other Diseases section of the assessment;
D. The response to Dehydration is
			 yes;
E. The beneficiary's ADL score
			 is at least 10 and the response to Hemiplegia is any of the following:
1. Primary diagnosis for current
			 stay;
2. Diagnosis present,
			 receiving active treatment; or
3.
			 Diagnosis present, monitored but no active treatment;
F. Gl or GU bleeding has been exhibited in
			 the 3 days prior to the assessment;
G. The response to Pneumonia is any of the
			 following:
1. Primary diagnosis for current
			 stay;
2. Diagnosis present,
			 receiving active treatment; or
3.
			 Diagnosis present, monitored but no active treatment;
H. The response to End stage disease, 6 or
			 fewer months to live is yes;
I.
			 Chemotherapy was utilized within 3 days of the assessment;
J. Dialysis was utilized within 3 days of
			 tlie assessment;
K. A transfusion
			 occurred within 3 days of the assessment;
L. Oxygen therapy was utilized within 3 days
			 of the assessment; or
M. The
			 response to Foot problems is either Foot problems limit walking or Foot
			 problems prevent walking.
Impaired Cognition
A beneficiary's Impaired Cognition screener score is 0 by
				default, but it equals 1 if the score recorded on the Cognitive Performance
				Scale (CPS) is at least a 3.
Cumulative
A beneficiary's Cumulative screener score can range from 0 to
				5. It is based on the collective score after adding the scores from the Special
				Care, Clinically Complex, and Impaired Cognition screeners. An additional point
				may be added if either of the following occurs:
A. The response to Mode of nutritional intake
			 is Parenteral feeding only or
B. IV
			 medication is utilized within 3 days of the assessment.