1003 Preadmission Screening Criteria for an Applicant or Member who is Elderly or Physically Disabled (EPD)

Revised 08/27/2024

Policy

The PAS instrument for an applicant or member who is EPD includes the following categories:

• Intake information category. The Assessor solicits intake information category information on an applicant’s or member’s demographic background. The components of the intake information category are not included in the calculated PAS score.

• Functional assessment category. The Assessor solicits functional assessment category information on an applicant’s or member’s:

  • Need for assistance with activities of daily living in the residential environment or other routine setting, including:

    • Bathing;

    • Dressing;

    • Grooming;

    • Eating;

    • Mobility; and

    • Transferring;

  • Communication and sensory skills, including hearing, expressive communication, and vision; and

  • Continence, including bowel and bladder functioning.

• Emotional and cognitive functioning category. The Assessor solicits emotional and cognitive functioning category information on an applicant’s or member’s:

  • Orientation to person, place, and time. In soliciting this information, the Assessor shall also take into account the caregiver’s judgment; and

  • Behavior, including:

    • Wandering;

    • Self-injurious behavior;

    • Aggression;

    • Resistiveness; or

    • Disruptive behavior.

• Medical assessment category. The Assessor solicits medical assessment category information on a customer’s:

  • Medical conditions that have an impact on the customer’s functional ability in relation to activities of daily living, continence, and vision;

  • Medical condition that requires medical or nursing service and treatment;

  • Medication, treatment, and allergies;

  • Specific services and treatments that the customer is currently receiving; and

  • Physical measurements, hospitalization history, and ventilator dependency.

 

The Assessor shall use the PAS instrument to assess a customer who is EPD as specified in this Section. A copy of the PAS instrument is available from the Administration. The Administration uses the Assessor’s PAS assessment to calculate three scores: a functional score, a medical score, and a total score.

• Functional score.

  • The Administration calculates the functional score from responses to scored items in the functional assessment and emotional and cognitive functioning categories. For each response to a scored item, a number of points is assigned, which is multiplied by a weighted numerical value. The result is a weighted score for each response.

  • The functional items in the following categories are scored according to the matrix shown below:

    • Activities of daily living;

    • Continence;

    • Sensory;

    • Orientation; and

    • Behavior.

  • The sum of the weighted scores equals the functional score. The weighted score per item can range from 0 to 15. The maximum functional score attainable by a customer is 166.

• Medical score.

  • In the medical assessment matrix, all items in the following categories are scored according to:

    • Medical conditions according to the matrix below, and

    • Medical or nursing services or treatments according to the matrix below.

  • The Administration calculates the medical score based on the customer's:

    • Diagnosis of Alzheimer’s, dementia, or organic brain syndrome (OBS);

    • Diagnosis of paralysis; and

    • Current use of oxygen.

  • The maximum medical score attainable by an applicant or member is 31.5.

• Total score.

  • The sum of a customer’s functional and medical score equals the total score.

  • The total score is compared to the established threshold score as calculated under this Section. For a customer who is EPD, the threshold score is 60.

  • A customer is determined at immediate risk of institutionalization if the total score is equal to or greater than 60.

 

The following matrices represent the number of points available and the respective weight for each scored item.

• Functional assessment points. The lowest value in the range of points available per item in the functional assessment category, zero, indicates minimal to no impairment. Conversely, the highest value indicates severe impairment.

• Medical assessment points. The lowest value in the range of points available per item in the medical assessment category, zero, indicates that the customer:

  • Does not have the scored medical condition;

  • Does not need the scored medical or nursing services; or

  • Does not receive the scored medical or nursing services.

Functional Assessment Category/Item	Points Available per Item (P)	Weight (W)	Range of Possible Weighted Score per Item (P) x (W)
ACTIVITIES OF DAILY LIVING SECTION
Mobility	0 – 3	5	0 – 15
Transfer	0 – 3	5	0 – 15
Bathing	0 – 3	5	0 – 15
Dressing	0 – 3	5	0 – 15
Grooming	0 – 3	5	0 – 15
Eating	0 – 3	5	0 – 15
Toileting	0 – 3	5	0 – 15
CONTINENCE SECTION
Bowel	0 – 3	1	0 – 3
Bladder	0 – 3	1	0 – 3
SENSORY SECTION
Vision	0 – 3	2	0 – 6
ORIENTATION SECTION
Place	0 – 4	0.5	0 – 2
Time	0 – 4	0.5	0 – 2
EMOTIONAL OR COGNITIVE BEHAVIOR SECTION
Aggression – Frequency	0 – 3	1.5	0 – 4.5
Aggression – Intervention	0 – 3	1.5	0 – 4.5
Self-Injurious – Frequency	0 – 3	1.5	0 – 4.5
Self-Injurious – Intervention	0 – 3	1.5	0 – 4.5
Wandering – Frequency	0 – 3	1.5	0 – 4.5
Wandering – Intervention	0 – 3	1.5	0 – 4.5
Resistiveness – Frequency	0 – 3	1.5	0 – 4.5
Resistiveness – Intervention	0 – 3	1.5	0 – 4.5
Disruptive – Frequency	0 – 3	1.5	0 – 4.5
Disruptive – Intervention	0 – 3	1.5	0 – 4.5

 

Medical Assessment Category/Item	Points Available per Item (P)	Weight (W)	Range of Possible Weighted Score per Item (P) x (W)
MEDICAL CONDITIONS SECTION
Paralysis	0 – 1	6.5	0 – 6.5
Alzheimer’s, OBS, or Dementia	0 – 1	20	0 – 20
SERVICES AND TREATMENTS SECTION
Oxygen	0 – 1	5	0 – 5

 

Definitions

Term	Definition
Aggression	Physically attacking another, including: Throwing an object; Punching; Biting; Pushing; Pinching; Pulling hair; Scratching; or Physically threatening behavior.
Bathing	The process of washing, rinsing, and drying all parts of the body, including an applicant’s or member’s ability to transfer to a tub or shower and to obtain bath water and equipment.
Continence	The customer’s ability to control the discharge of body waste from bladder and bowel.
Current or currently	Belonging to the present time.
Dressing	The physical process of choosing, putting on, securing fasteners, and removing clothing and footwear. Dressing includes choosing a weather-appropriate article of clothing but excludes aesthetic concerns. Dressing includes the customer’s ability to put on artificial limbs, braces, and other appliances that are needed daily.
Eating	The process of putting food and fluids by any means into the digestive system.
Emotional and cognitive functioning	An customer’s orientation and mental state, as evidenced in aggressive, self-injurious, wandering, disruptive, and resistive behaviors.
Functional assessment	An evaluation of information about a customer’s ability to perform activities related to: Developmental milestones; Activities of daily living; Communication; and Behavior.
Grooming	A customer’s process of tending to appearance. Grooming includes: Combing or brushing hair; Shaving; and Oral hygiene (including denture care). Grooming does not include aesthetics such as styling, skin care, nail care, and applying cosmetics.
Intervention	Therapeutic treatment, including the use of medication, behavior modification, and physical restraints to control behavior. Intervention may be formal or informal and includes actions taken by friends or family to control the behavior.
Medical assessment	An evaluation of a customer's medical condition and the customer’s need for medical services.
Medical or nursing services and treatments, or services and treatments	Specific, ongoing medical, psychiatric, or nursing intervention used actively to resolve or prevent deterioration of a medical condition. Durable medical equipment and activities of daily living assistive devices are not treatment unless the equipment or device is used specifically and actively to resolve the existing medical condition.
Mobility	The extent of a customer’s purposeful movement within a residential environment.
Orientation	A customer’s awareness of self in relation to person, place, and time.
Physically disabled	A customer who is determined physically impaired by the Administration through the PAS assessment as allowed under the Administration’s Section 1115 Waiver with CMS.
Resistiveness	Inappropriately obstinate and uncooperative behaviors, including: Passive or active obstinate behaviors; Refusing to participate in self-care; or Refusing to take necessary medications. Resistiveness does not include difficulties with auditory processing or reasonable expressions of self-advocacy.
Self-injurious behavior	Repeated self-induced, abusive behavior that is directed toward infliction of immediate physical harm to the body. Self-injurious behavior does not include suicide attempts, accidents or risky lifestyle choices.
Sensory	Of or relating to the senses.
Toileting	The process involved in a customer's managing the elimination of urine and feces in an appropriate place.
Transferring	A customer's ability to move horizontally or vertically between two surfaces within a residential environment, excluding transfer for toileting or bathing.
Vision	The ability to perceive objects with the eyes.
Wandering	A customer's moving about with no rational purpose and with a tendency to go beyond the physical parameter of the residential environment.

 

Proof

Proof of immediate risk of institutionalization shall be demonstrated through:

• Customer score equal to or higher than the applicable PAS threshold score; or

• Finding by a physician consultant reviewer that the customer has this status.

Legal Authority

Program	Legal Authorities
ALTCS	AAC R9-28-304