Arizona Long Term Care Services Preadmission Screening for the Developmentally Disabled Applicant
Arizona Long Term Care System (ALTCS) is the state of Arizona’s Medicaid program. ALTCS provides long-term care services to Arizona residents who are aged, blind, disabled or have a developmental disability. There are two primary components of eligibility: financial and medical.
Medical eligibility for ALTCS is determined through a Preadmission Screening (PAS). In general, the PAS is an evaluation conducted by a registered nurse or social worker from ALTCS, otherwise known as PAS assessors.
The PAS assessor’s job is to determine whether the applicant’s current functional abilities and medical stability (resulting from their developmental disability) meet the need for services at the Intermediate Care Facility (ICF) level of care. This determination will be based off of a points system, and an applicant with developmental disabilities will be medically eligible so long as he/she scores at least 40 points.
The Scoring Process
There are three PAS categories for an applicant who is developmentally disabled:
- Intake Information Category – This involves gathering of the applicant’s basic demographic background, and is not calculated in the total PAS score.
- Functional Assessment Category – This category is measured by three age groups:
- Ages six months through five years: The PAS assessor will score according to developmental milestones, such as walking and talking, dependent on the specific age of the applicant.
- Ages six through 11 years: The PAS assessor will score according to the applicant’s need for assistance with independent living skills, communication and behaviors. Independent living skills include rolling and sitting, crawling and standing, ambulation, climbing stairs or ramps, wheelchair mobility, dressing, personal hygiene, bathing or showering, toileting, level of bladder control, and orientation.
- Ages 12 and older: The PAS assessor will score according to the applicant’s need for assistance with independent living skills (including hand use, ambulation, wheelchair mobility, transfer, eating or drinking, dressing, personal hygiene, bathing or showering, food preparation, community mobility and toileting), communication and cognitive abilities, and behaviors.
- Medical Assessment Category – The PAS assessor will score this section based on the applicant’s medical condition(s), specific services and treatments needed/received and the frequency of those services, current medications, medical stability, sensory functioning, physical measurements, current placement, ventilator dependency, and eligibility for Division of Developmental Disabilities (DDD).
It is not uncommon that applicants with developmental disabilities are eligible to receive services from the Arizona Department of Economic Security (DES)/DDD, but are not at the ICF level of care. In this circumstance, the applicant would be ineligible to receive ALTCS benefits.
Requesting a Screening
Typically, a PAS is automatically requested as part of the ALTCS application. However, if there is a question whether an applicant will medically qualify prior to application, a private PAS can be requested. A private PAS can be requested by calling ALTCS at 602-417-6600, by faxing a written request to 602-253-6038, or by visiting your local ALTCS office to request the PAS assessor of the day.
In preparation for the PAS, we recommend that you obtain a list of the applicant’s current doctors and their contact information, a list of current prescriptions and dosage, the last six months of medical records, and all care reports and staff notes reflecting level of assistance and all tasks (if applicable). We also believe that it is very important to have a family member and/or current caregiver attend the PAS so that all information is properly conveyed to the PAS assessor.
For more information regarding the ALTCS application process, you can visit https://www.azahcccs.gov/Members/GetCovered/Categories/DD-ALTCS.html.
Information for this article was provided by Emily R. Taylor of Emily R. Taylor, Attorney PLLC.
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