Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXI - Home and Community-Based Services Waivers › Subpart 7 - Community Choices Waiver › Chapter 81 - General Provisions › Section XXI-8107 - Resource Assessment and Allocation Process

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each Community Choices Waiver
				  applicant/participant shall be assessed using the uniform international
				  resident assessment instrument (interRAI). This assessment provides researched
				  and validated measures of an individual's functional status. The assessment is
				  used to verify if an individual meets nursing facility level of care and
				  generates a resource utilization group (RUG) score. This score is used to
				  establish an individual's services and supports budget.
B. The RUG score assigns an individual to one
				  of 23 distinct groups in seven major groupings. Individuals are assigned to a
				  group based on a hierarchy and are assigned to the highest group for which they
				  qualify. The following seven major groupings will be utilized to determine the
				  waiver assistance needed to complete various activities of daily living (ADLs)
				  and instrumental activities of daily living (IADLs).
1. Special Rehabilitation. Individuals in
				  this group had at least 120 minutes of rehabilitation therapy (physical,
				  occupational and/or speech) within the seven days prior to the interRAI
				  assessment.
2. Extensive Services.
				  Individuals in this group received one or more of the following services and
				  have an ADL index of 7 or more:
a.
				  tracheostomy;
b. ventilator or
				  respirator;
c.
				  suctioning;
d. parenteral/IV
				  feeding only;
e. combined oral and
				  parenteral/tube feeding; or
f. IV
				  medications.
3. Special
				  Care. Individuals in this group must meet one of the following criteria:
a. have one of the following conditions or
				  treatments and have an ADL index of 7 or greater:
i. stage 3 or 4 pressure ulcers and
				  turning/positioning program;
ii.
				  combined oral and parenteral/tube feeding or nasogastric feeding only and
				  aphasia;
iii. fever with either
				  vomiting, weight loss, dehydration, nasogastric tube or parenteral feeding, or
				  pneumonia; or
iv. radiation
				  therapy; or
b. have one
				  of the following conditions and have an ADL index of 10 or greater:
i. cerebral palsy;
ii. multiple sclerosis;
iii. quadriplegia; or
c. are receiving one of the extensive care
				  services (as listed in B.2 above)and have an ADL index of 6 or less.
d. - h.iv. Repealed.
4. Clinically Complex. Individuals in this
				  group have one of the following conditions or treatments:
a. septicemia;
b. dehydration;
c. hemiplegia and an ADL index of 10 or
				  greater;
d. pneumonia;
e. end-stage disease;
f. comatose (confirmed by totally dependent
				  in the four ADLs used in the ADL index);
g. foot problems that limit/prevent
				  walking;
h. gastrointestinal (GI)
				  or genitourinary (GU) bleeding;
i.
				  diabetes;
j. combined oral and
				  parenteral/tube feeding or nasogastric tube feeding only;
k. chemotherapy;
l. dialysis;
m. transfusions;
n. oxygen therapy; or
o. one of the special care conditions or
				  treatments listed in 3.a above and an ADL index of 6 or less.
5. Impaired Cognition. Individuals
				  in this group have a cognitive performance scale of 3 or more and an ADL index
				  of 10 or less.
6. Behavior
				  Problems. Individuals in this group have one or more of the following behavior
				  problems and an ADL index of 10 or less:
a.
				  wandering;
b. verbally
				  abusive;
c. physically
				  abusive;
d. socially
				  inappropriate/disruptive;
e.
				  resists care;
f. sexually
				  inappropriate;
g. hallucinations;
				  or
h. delusions.
7. Physical Function. Individuals
				  who did not meet the criteria for any of the previous categories.