Waiver of Responsibility for Property and Injuries

							Waiver Children’s Program Training
     Decision Guide for CLS

             September 2009

  Audrey Craft-Mental Health Services to
           Children & Families
            Price Pullins-Chief
         Psychologist/Consultant
  Office of Medical & Psychiatric Services
   What We Will Do Today

• Introductions
• Review Category of Care Decision
  Guide for CLS
• Review narrative format for
  documenting Category of Care
• Questions
• Provide Training Certificates
           Introduction

The decision guide is a tool to:
• Assist the child’s team in determining
  the amount of publicly supported CLS
  hourly care.
• Ensure consistency across the State of
  Michigan.
• Review the care needs of the child and
  the resources available to the family.
 Determining Category of
          Care
•There are four Category of Care
 definitions for children with
 challenging behaviors
•There are two Categories of Care
 definitions for children with
 medical and physical needs that
 do not meet criteria for PDN.
Determining Category of Care
for Children with Challenging
          Behaviors

 To determine the amount of CLS
 services in the home, an assessment of
 the child’s needs, the family’s
 circumstances, and natural supports are
 required. This assessment should be a
 part of the annual planning process.
     Assessment of Need

• Type of behaviors identified
• Frequency, intensity and duration
  of the identified behaviors
• How recently serious behaviors
  occurred
• Specific effects of the behavior on
  persons in the family and property
       Assessment of Need

• Level of family intervention required to
  prevent behavioral episodes
• Extent that family must alter normal
  routine to address the behavioral needs
  of the child
• Prognosis for change in the child’s
  behavior
• Does the child function better in one
  setting then he does in another setting
• Age, size and mobility of child
        Category of Care IV
Demonstrates mild level behaviors that may
interfere with the daily routine of the family.
Mild Behavior:      Infrequent or intermittent
behaviors including pinching, hitting, slapping,
kicking, head banging, and/or elopement
without careful supervision when there is
evidence of lack of judgment regarding danger,
or an extremely high activity level requiring
extensive supervision and redirection.
          Category of Care III
Demonstrates a daily pattern of medium level
behaviors     including      self-injurious,   physically
aggressive or assaultive behaviors that have not
resulted in hospitalization or emergency room
treatment for injuries in the past year, or has
engaged     in    occasional,      significant  property
destruction that is not life-threatening.
Pattern of Behavior: In addition to a single serious
episode in the last year, significant daily behaviors
are documented.
Medium Behavior: Includes behaviors defined in the
Category II definition of “moderate behavior" when
emergency room treatment or hospitalization have
not been required for treatment of injuries resulting
from the behavior.
         Category of Care II
Demonstrates a daily pattern of moderate self-
injurious, physically aggressive or assaultive
behavior when medical intervention, or hospital
emergency room treatment has been required for
treatment of injuries in the past year without
resulting hospitalization, or if the child has
engaged in frequent,significant property
destruction that is not life-threatening.
Moderate Behavior: Includes behaviors that pose
a significant risk of injury to self or others in the
immediate environment.
         Category of Care I

Demonstrates a pattern of severe self-injurious,
physically aggressive or assaultive behavior, or
life threatening property destruction that has
occurred one or more times in the past year.
Documented evidence of additional behavioral
problems on a frequent basis each day supports
a need for one-to-one intensive behavioral
treatment.
Severe Behavior: Poses a very significant risk of
serious injury or death to self, a family member,
or others in the immediate environment.
  Determining Category of
   Care for Children with
 Medical and Physical Needs
When determining which category is most
appropriate to the child’s medical and physical
care needs, the following definitions should be
used to decide whether the needs support the
necessity for CLS hourly care. The categories do
not, in and of themselves, establish eligibility for
publicly funded hourly care.
         Category of Care IV


A medical condition that:
• Requires significant levels of daily assistance or
  guidance with ADLs.
• Is stable and observations and interventions are
  required infrequently.
• Requires minimal intervention and training.
• Is associated with minimal or no risk to health
  status.
       Category of Care III

A medical condition that:
• Routinely requires daily hourly care or support
  in order to maintain and/or improve health
  status.
• Clinical observations and interventions may be
  intermittent.
• Medical interventions are typically associated
  with minimal risk to health status and delayed
  interventions are not associated with imminent
  risk to health status.
       Decision Guide Table
         (Manual Appendix 10-a)

• The determination of the amount of publicly
  supported hourly care should result from the
  PCP and FCP process and be reassessed at
  least annually.

• Children and families may qualify for services
  in more than one resource section.
                               DOCUMENTED CATEGORY OF NEED FOR HOURLY
                                        CARE AUTHORIZATION*


ADDITIONAL FAMILY              CATEGORY   CATEGORY   CATEGORY   CATEGORY
   RESOURCES                      IV         III         II         I

Section I – Number of
Caregivers

   1. Two or more                 4-8       6-10       8-12       12-16
      caregivers live in
      home; both work F/T
   2. Two adult
      caregivers; one             2-8        2-8       4-10       10-16
      works F/T
   3. Two adult                   2-4        2-6        4-8       8-12
      caregivers; neither is
      employed
   4. One adult caregiver
      lives in home and           4-8       4-10       8-12       12-16
      works F/T
   5. One adult caregiver;        2-6        2-8       8-10       10-14
      does not work F/T
                             DOCUMENTED CATEGORY OF NEED FOR HOURLY
                                      CARE AUTHORIZATION*


ADDITIONAL FAMILY            CATEGORY   CATEGORY   CATEGORY   CATEGORY
   RESOURCES                    IV         III         II         I


Section II – Health Status
of Caregivers
                                6-8       6-10       10-14      12-16
   1. Significant health
      issues                    4-6        4-8       8-12       10-12
   2. Some health issues


Section III – Additional
dependent children
                                2-4        2-6        4-8       8-12
   1. Applicant has one or
      more sibs, age five
      or older                  4-6        4-8        6-8       8-12
   2. Applicant has one or
      more sibs under
      age five.
                                DOCUMENTED CATEGORY OF NEED FOR HOURLY
                                         CARE AUTHORIZATION*


ADDITIONAL FAMILY               CATEGORY   CATEGORY   CATEGORY   CATEGORY
   RESOURCES                       IV         III         II         I


Section IV – Additional
Children with Special Needs
   1. Applicant has one or         4-8        6-8        4-8       8-12
       more siblings with
       nursing needs
   2. Applicant has one or         2-4        2-6       N/A        N/A
       more siblings with
       non-nursing special
       needs

Section V – Night
Interventions
    1. Requires 2 or fewer         2-4        2-6        4-8       8-12
       interventions at night
       or total time less
       than one hour
    2. Requires 3 or more          4-8        6-8       6-10       8-12
       interventions
       requiring one hour or
       more to complete

Section VI – School
Child attends school an           6 max      6 max      8 max     12 max
average of 25 hours per
week
       Category of Care Decision
            Responsibility

The MDCH CWP Clinical Review Team will
prior authorize waiver services for those
children who:
    • Meet the criteria for Category of Care I
    • Have been approved for CLS exception hours

The responsible CMHSP will prior authorize waiver
services for those children who meet the criteria for
Categories of Care II, III, or IV
         Documentation

Documentation must support the Category of Care
determination and must be maintained in the child’s
record.

If care needs meet criteria for Category of Care I, all
supporting documentation must be sent to MDCH CWP

Category of Care assessment and determination of
hourly care documented annually or if the child’s
condition has changed
Questions?