DDES Memo Series 2006-18
To: Listserv
For: Area Administrators/Assistant Area Administrators
Bureau Directors
Community Integration Specialists
County Departments of Community Programs Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Development Disabilities and Long-Term Support Coordinators
Program Office Directors
Tribal Chairpersons/Human Services Facilitators
ICFs-MR Directors
From: Sinikka Santala, Administrator
Division of Disability and Elder Services
Subject: ICF/MR
Restructuring Initiative – Long Term Care Functional Screen
Document Summary
This memo requires counties to administer (or delegate administration
of) a Long-Term Care (LTC) Functional Screens for each ICF/MR resident for
whom the county is responsible. All screens are to be completed by June
30, 2007 in accord with Department requirements for screener
certification and quality assurance.
Although Wisconsin's ICF/MR Restructuring Initiative was implemented
over a year ago, with many people with developmental disabilities being
successfully relocated from ICFs and Nursing Homes, approximately 900
people (and 570 at State Developmental Disability Centers) still remain in
these institutional settings. Whether these relocations are a result of
closing or downsizing of an ICF/MR, or because a court has ruled at the
person's WATTS review that the community is the "most integrated
setting," each person must now have eligibility determinations
completed and reviewed/updated annually. It is critical that Wisconsin
utilize the same standard for determining Levels of Care (LOC) for all
individuals with developmental disabilities. Counties have done a good job
in completing LTC functional screens on the individuals who have moved or
are in transition planning.
This memo requires uniform implementation of the LTC functional Screen
for the development, review and implementation of service plans arising
from the ICF/MR relocation initiative. As part of the annual required
Watts review process, and/or to learn more about the individuals remaining
in these facilities, most counties have already been completing functional
screens for some of the individuals for whom they are responsible.
In an effort to ensure statewide consistency for all people with
developmental disabilities, counties are requested to complete a LTC
Functional Screen on all individuals with developmental disabilities who
still reside in ICF/MRs and Nursing Homes by July 2007.
As of July 2006, the Bureau of Quality Assurance (BQA) discontinued
their responsibility for completing level of care determinations for
people with developmental disabilities. BQA will, however, continue to
update levels of care until a screen has been completed on every
individual.
For adults receiving long-term care in State Developmental Disability
Centers, initial functional screens will be completed by Center staff.
However, counties will retain responsibility for completing initial
screens for all children residing at State Developmental Disability
Centers using the Children's LTC Functional Screen. All subsequent
functional screens (updates) will become the responsibility of each
applicable county. A county may delegate the completion of the initial
functional screen to any facility, if the facility has sufficient
state-certified screeners to complete the objective within the existing
timeframes and is willing to assume this responsibility.
To support county efforts to complete functional screen in a timely
fashion, DDES is offering stipends of $100 for all initial LTC Functional
Screens completed by county staff by December 31, 2006. For initial
screens completed after January 1, 2007, a $50 stipend per individual will
be offered. No reimbursement will occur after June 30, 2007, at which time
it is expected that every person with a developmental disability will have
received a LTC Functional Screen. This additional funding option only
applies to individuals who have been identified as part of the ICF/MR
Restructuring Initiative (i.e. residents of a facility, receiving services
prior to December 31, 2004; not those on wait lists). Due to the funding
source, this stipend is only payable to responsible counties completing
the screen, not to facilities.
The Department is also anticipating that by 2007, individualized
"Needs Reports" generated from LTC Functional Screen contents
will be available for use by counties at Watt's Reviews. These Needs
Reports will provide guardians' and judges a summary of the individual's
needs and some context of where and how others with similar needs are
supported in their communities. The automated Needs Reports will save
counties significant staff time (by replacing narratives) and improve the
quality of Watts Reviews (by providing detailed individual information and
statewide context of support options to foster more informed decisions
about "most integrated environments"). The automated Needs
Reports will help counties meet the requirements of Wisconsin Act 33 more
effectively and efficiently, by using it as the starting point for the
"Community Plan" that counties are required to complete for all
residents of ICF/MRs.
Developmental Disabilities LOC Discrepancies and Functional Screen
Reviews
The Department has no intention of altering facility residents' LOCs by
this change from BQA to the LTC Functional Screen for determinations of
LOCs. The Functional Screen LOC determination logic was developed with BQA
and experts in Developmental Disabilities Services. Numerous individual
and aggregate analyses have proven that the LTC FS yields accurate LOC
results if the screen is completed accurately. In most cases, when a LOC
seems too low, it is because the screener missed some key information -
often involving preventative interventions, e.g. door alarms and
supervision to prevent elopement. Among 2006 DD facility relocations, a
significant number LTC FS levels of care results were lower than previous
BQA levels of care.
This is of concern and is being addressed. In particular, counties
completing Functional Screens for residents of ICF/MRs or State Centers
must follow the following 4 steps:
- County screeners must communicate with DD facility staff, who are
the most familiar with each resident, regarding the previous BQA LOC
and the new LTC FS LOC results. If a change occurs, the screener must
consult with facility staff, and if a consensus cannot be reached,
proceed to step 4. If a facility screener produces a different LOC
result, proceed to step 4.
- Whenever the LTC FS level of care is lower than the last BQA level
of care, or whenever anyone questions a LOC result, the screener
(and/or Screen Lead) will review the screen results to determine the
possible cause of the change. Aspects that will be considered include:
whether the earlier BQA LOC was based on clinical information that is
no longer true; whether all LTC FS items have been completed and are
accurate; and/or whether all LTC FS instructions have been followed,
particularly regarding preventative interventions.
- The screener should review the LTC FS with facility staff most
familiar with the resident.
In most cases, particular needs can be clarified and the LTC FS edited
to yield a more accurate LOC. If either party still thinks the LTC FS
LOC is not correct, proceed to Step 4.
- Contact Rebecca Boyea of the Developmental Disabilities Services
Section, who will review the case with the screener and facility
staff. (Becky formerly worked at Northern Wisconsin Center and is now
a Community Integration Specialist and LTC FS lead for DDSS). These
screen reviews will resolve individual cases and will provide
invaluable feedback for the Department to improve LTC FS items and
instructions. Becky can be reached at (715)-289-3082 or boyeara@dhfs.state.wi.us
.
This Functional Screen review process is in addition to the existing
appeals processes, which remain the same. (FS reviews can be requested
with or without appeals, and will always be done as part of the appeal
process.)
Counties are expected to implement this FS review process so that DD
facilities are not financially hindered by lower LOCs resulting from
inaccurate LTC FS.
Resources: Screener certification requirements, process, screens, and
instructions can be found at
http://www.dhfs.state.wi.us/LTCare/FunctionalScreen/
REGIONAL OFFICE CONTACT: Community Integration Specialists
Developmental Disabilities Services Section
Bureau of Long Term Support
CENTRAL OFFICE CONTACT: Mike Linak, Chief
Developmental Disabilities Services Section
Bureau of Long Term Support
Division
of Disability and Elder Services
MEMO WEB SITE: http://dhfs.wisconsin.gov/dsl_info
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