Module #8: Health-Related Services (HRS)

8.1 Overview of the Health-Related Services (HRS) Table
8.2 Medical or Skilled Nursing Needs (PDF)
8.3 Definitions for Particular Health-Related Services (PDF)
8.4 Frequency of Help/Services Needed (PDF)
8.5 Expected to last, at this frequency, and child is not expected to become independent at this task for at least six months or more?
8.6 Unexpected Functional Eligibility Determination for Medically Involved Children

8.1 Overview of the Health-Related Services (HRS) Table

The HRS Table assigns "weights" to each check box in complex ways.

There are many ways to get a Level of Care (LOC); even though one task for a child is not on the table or the screener cannot check it, the child may get a LOC some other way.

The screen logic can "see" if a child is unable to report problems, and for some HRS tasks, will assign heavier "weights" for that child. For example, a tracheostomy in a baby requires much more oversight than a tracheostomy in a healthy teenager who can report problems and get help if needed.

Medications (except for intravenous ones) are absent from the HRS section. Of course giving and monitoring medications are very important, often life-saving, tasks for children. Because these tasks are almost universally done for all children, they are not helpful in distinguishing nursing-home eligible children from non-eligible ones. It is difficult to remove subjectivity between "important," "dangerous," "life-saving" medications from "routine" ones, and the line cannot be drawn between routes of administration.

Seizures are not included in the CLTS FS. Instead, the first row of the HRS Table, which looks for life-threatening emergencies, is intended to distinguish, as objectively as possible, the "medically fragile" and thus hospital or nursing home eligible from others.

Similar issues arose with other tasks that may or may not make a child eligible. For example, therapies, therapy follow-through exercises, and wound and special skin care. They usually do not in themselves make a child Hospital or Nursing Home eligible. At times they can be so extensive and time-consuming that they would make a child Hospital or Nursing Home eligible. For now, the CLTS FS uses number of times per day as the objective criteria.

In summary, the HRS Table information may be partially addressed in another portion of the screen such as ADLs/IADLs where a screener feels they cannot fully describe a child. That is because the goal is to seek accurate results with the briefest possible screen. Information that could not objectively determine LOC was left out. Remember that responses to all questions on the Functional Screen for a child will be assessed in total when calculating functional eligibility.

Two children could have the same skilled nursing needs, but one might get a Nursing Home LOC and one not. That is because one did not have the functional impairments that are needed to be considered Nursing Home eligible.

Also, two children could have the same skilled nursing needs, but only one is expected to have those needs long-term, for more than six more months. The child with similar needs that are not expected to persist would not be eligible for long-term support programs.

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8.2 Medical or Skilled Nursing Needs

Detailed instructions for 8.2 Medical or Skilled Nursing Needs. (PDF)

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8.3 Definitions for Particular Health-Related Services

Detailed instructions for 8.3 Definitions for Particular Health-Related Services. (PDF)

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8.4 Frequency of Help/Services Needed

Detailed instructions for Frequency of Help/Services Needed. (PDF)

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8.5 Expected to last, at this frequency, and child is not expected to become independent at this task for at least six months or more?

A child must need long-term support, not just short-term. Sometimes the duration of a child's health-related needs may be challenging for screeners to discover. Health care professionals routinely make predictions about health conditions and treatments and their expected duration. Hopefully they have explained this to the parents or it is documented somewhere.

Check "No" if:

Child is likely to be independent with the task within the next 6 months.
Child is going to need less assistance (changing to a different frequency of intervention) with that task.
Child is expected to have surgery soon and to fully recover within several weeks after that.
Child is in intensive care now but is expected to recover within a few weeks/months.
Child is in a total body cast but it is expected to be removed and activity resumed in about three months.
Child has a temporary ostomy that is expected to be repaired within three months.

Check "Yes" if:

The child currently has a tracheostomy, central line, TPN or is on a ventilator, which is expected to be removed in less than 6 months. The screener is to give the benefit of the doubt in case it takes longer than expected to wean the child from these life-sustaining treatments.
Child is waiting for an organ transplant.
Child is receiving PT, OT and ST through the school system and the IEP indicates the therapy will continue next year.

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8.6 Unexpected Functional Eligibility Determination for Medically Involved Children

If the screener completes a CLTS FS for a child in a fragile medical state and thought the child would meet the functional eligibility requirements for a particular program and they did not, contact State Clinical Staff to discuss the outcome of the screen. This is especially important if medical intervention is pending functional eligibility for a particular program (e.g. Katie Beckett Medicaid Program). An example of such a child may be a child with recurrent cancer, a pending transplant but no current functional impairments. If this child's functional eligibility results indicated that they are not eligible for the Katie Beckett Program, please contact State Clinical Staff to discuss the situation further.