Section 240.715   Determination of Need

 

a)         To be eligible to receive Community Care Program (CCP) services, an individual shall exhibit a need for long term care.  The Determination of Need, a standardized form, specifies the factors which together determine the individual's need for long term care.

 

b)         The need for long term care is based upon the determined need for a continuum of in-home and community-based services to prevent inappropriate or premature placement in an institutional long term care facility.

 

c)         The extent and degree of an applicant's/client's need for long term care shall be determined on the basis of impaired cognitive and functional status as well as the available physical/environmental supports provided to the applicant/client by family, friends or others in the community.

 

d)         The Determination of Need consists of two parts:

 

1)         The Mini-Mental State Examination (Folstein, Folstein and McHugh, 1975, no later editions or amendments included) measures cognitive functioning of the applicant/client.

 

A)        The applicant/client who receives a score equal to or more than 21 shall be considered to be cognitively intact and zero points shall be added to the Part A, Level of Impairment, score on the Determination of Need.

 

B)        The applicant/client who receives a score of 20 or less or who has been diagnosed by a physician or psychiatrist as having dementia, Alzheimer's disease, or organic brain syndrome shall be considered to be cognitively impaired and ten points shall be added to the Part A, Level of Impairment, score on the Determination of Need.

 

C)        Ten additional points shall be added to the Part A, Level of Impairment, score on the Determination of Need for the applicant/client who meets the following three criteria:

 

i)          Applicant/client has been adjudicated disabled or incompetent by a Probate Court judge or judge assigned to render a decision on such matters in a court of competent jurisdiction; and

 

ii)         a physician or psychiatrist licensed by the State of Illinois has certified that in his/her professional judgement the applicant/client suffers from Alzheimer's disease, organic brain syndrome, or dementia; and

 

iii)        a physician or psychiatrist licensed by the State of Illinois has certified that in his/her professional judgement the applicant/client requires 24-hour home and community-based services to remain in the home.

 

2)         The Determination of Need measures the applicant's/client's ability to perform the following activities of daily living (ADLs) and instrumental activities of daily living (IADLs):

 

A)        Activities of Daily Living

 

i)          Eating

 

ii)         Bathing

 

iii)        Grooming

 

iv)        Dressing

 

v)         Transferring

 

vi)        Incontinence

 

B)        Instrumental Activities of Daily Living

 

i)          Preparing meals

 

ii)         Being alone

 

iii)        Telephoning

 

iv)        Managing money

 

v)         Routine health

 

vi)        Special health

 

vii)       Outside home

 

viii)      Laundry

 

ix)        Housework

 

e)         The Determination of Need scale includes the six ADLs and nine IADLs identified. Each function is scored in two parts:  Part A – Level of Impairment, and Part B – Unmet Need for Care.

 

1)         Part A, Level of Impairment, of the Determination of Need measures the ability of the applicant/client to perform each ADL and IADL function.  A scoring range of zero through three indicates the degree of impairment of the applicant/client in the performance of ADLs and IADLs.

 

A)        A score of zero for any function indicates that the applicant/client performs or can perform all essential components of the activity, with or without an existing assistive device, such that:

 

i)          no significant impairment of function remains; or

 

ii)         activity is not required by the applicant/client (routine health and special health only); or

 

iii)        the applicant/client may benefit from but does not require supervision or physical assistance.

 

B)        A score of one for any function indicates that the applicant/client performs or can perform most essential components of the activity, with or without an existing assistive device, but some impairment of function remains such that the applicant/client requires some supervision or physical assistance to accomplish some or all components of the activity.  This includes the applicant/client who:

 

i)          experiences minor, intermittent fatigue in performing the activity; or

 

ii)         takes longer time to accomplish than an unimpaired person requires; or

 

iii)        must perform the activity more frequently than an unimpaired person.

 

C)        A score of two for any function indicates that the applicant/client cannot perform most of the essential components of the activity, even with an existing assistive device, and requires a great deal of assistance or supervision to accomplish the activity.  This includes the applicant/client who:

 

i)          experiences frequent fatigue in performing the activity; or

 

ii)         takes an excessive amount of time to perform the activity; or

 

iii)        must perform the activity much more frequently than an unimpaired person.

 

D)        A score of three for any function indicates that the applicant/client cannot perform the activity and requires someone to perform the task, although the applicant/client may be able to assist in small ways, or requires constant supervision.

 

2)         Part B, Unmet Need for Care, of the Determination of Need measures the need of the applicant/client for assistance/performance/supervision for each ADL and IADL function which is not being met by non-CCP resources in the community (e.g., family, friends, local services).

 

A)        A score of zero for any function indicates that there is no impairment, or that the applicant's/client's need for assistance is met to the extent that the applicant/client is at no risk to health or safety if additional assistance is not acquired, or that additional assistance will not benefit the applicant/client, or that the applicant's/client's needs are being met by non-CCP resources and, therefore, the applicant/client has no need for assistance.

 

B)        A score of one for any function indicates that the applicant's/client's need for assistance is met most of the time, but the applicant's/client's health and safety are at minimal risk if additional assistance is not acquired.

 

C)        A score of two for any function indicates that the applicant's/client's need for assistance is not met most of the time, and the applicant's/client's health and safety are at moderate risk if additional assistance is not acquired.

 

D)        A score of three for any function indicates that the applicant's/client's need for assistance is rarely, or never, met and the applicant's/client's health and safety are at severe risk, which would require acute medical intervention, if additional assistance is not acquired.

 

(Source:  Amended at 23 Ill. Reg. 5642, effective May 1, 1999)