Overview

Fields 26-40 summarize the person’s strengths and needs that set the foundation for service planning and eligibility determination. The assessment section helps with selecting:

The certified assessor bases their assessment responses on information they gathered about the person’s current needs. This information should not reflect any natural or other supports the person has.

The certified assessor is responsible to ensure the person makes informed choices.

Children

For children, use a score of 99 until the child reaches the age at which a person usually attains the skill and its lack creates a need for additional services or supervision. This is especially applicable to fields 30-34 and 36. Before assessing children, review Assessing for age-appropriate behavior (PDF).

MnCHOICES automatically takes these age thresholds into account.

Field 26: Medical

Enter the code that best describes the person’s general need for medical attention related to their medical status. “Medical need” is defined as services that require licensed medical personnel (e.g., physician, physician’s assistant, registered nurse, licensed practical nurse).

01 – No serious/specialized medical needs

The person visits a physician annually for a check-up and as needed for colds, flu and other common medical needs.

02 – Needs specialized or frequent medical attention (office visits only, not on-site attention)

Example: The person visits an allergist on a regular basis for control of allergies and asthma or requires blood work for psychotropic or seizure medication monitoring.

03 – Needs on-call medical attention

The person’s need for medical attention is unplanned and not through regularly scheduled appointments.

Example: The person requires trained personnel to be available in case of status seizure activity, asthma or diabetes.

04 – Needs on-site medical attention (less than 24-hours per day)

The person requires regular and planned medical attention from trained personnel.

Example: The person requires a registered nurse or licensed practical nurse to provide daily insulin injections, clean their GI tube or perform periodic catheterization.

05 – Needs on-site medical attention (24-hours per day)

Example: The person is ventilator-dependent, requires frequent, unscheduled intramuscular medication or is at risk of aspiration.

99 – Unknown – Must justify in notes area

You must justify this code in the notes section.

Example: There are conflicting opinions between medical experts about the person’s needs.

Overriding health care needs

The certified assessor must consult with a registered nurse when the person has an overriding health care condition. Codes 03, 04, 05 and 99 might indicate an overriding health care condition.

An overriding health care need refers to a condition that affects the service options available to the person because the condition requires both:

Field 27: Vision

Enter the code that best describes the person’s level of visual impairment. You should complete the assessment while the person is wearing corrective lenses, if applicable. If a person requires but refuses to wear lenses and interventions have proven unsuccessful, the assessment will reflect impaired vision. Document the specifics of the situation in the notes section.

01 – No impairment

The person does not wear glasses or contacts and has normal vision.

02 – Impairment corrected to normal with glasses or contacts

The person wears glasses or contacts and, with correction, has normal vision.

03 – Difficulty at level of print, graphics or small objects

Even with correction, the person has difficulty seeing newspaper print or small objects. Correction is not a viable option.

04 – Difficulty at level of obstacles in environment

Even with correction, the person has restricted areas of vision (e.g., tunnel vision) and has difficulty with tasks such as:

05 – No useful vision

Even with correction, the person does not have useful vision. Medical correction is not a viable option.

99 – Unknown (justify in notes)

You must justify this code in the notes section.

Examples:

Field 28: Hearing

Enter the code that best describes the person’s level of hearing impairment. You should complete the assessment while the person is wearing aids, if applicable. If person requires but refuses to wear aids and interventions have proven unsuccessful, the assessment will reflect impaired hearing. Document the specifics of the situation in the notes section.

01 – No impairment

The person’s hearing is normal without any correction.

02 – Loss present, no correction needed

The person’s impairment is slight.

Examples:

03 – Impairment – Correctable (with aid)

The person’s hearing impairment is mild.

Example: The person has situational difficulty hearing and understanding normal speech, but with hearing aid(s), they can hear and understand normal conversation in most situations.

04 – Impairment – Not correctable

The person’s impairment is moderate.

Example: The person has difficulty hearing and understanding normal speech in most situations. However, hearing aids are often helpful for the person to hear and be aware of their environment.

05 – Responds to alarm sounds or intense, low frequency noises

The person’s impairment is severe.

Example: The person consistently has difficulty hearing and understanding speech, even with hearing aids. They may hear environmental sounds such as fire alarms, smoke detectors, car horns, truck back-up alarms, railroad crossings and sirens. The person relies heavily on visual modes of communication to understand what is happening in the environment.

06 – No useful hearing/deaf

The person cannot hear and understand speech, even with hearing aids. They do not detect environmental sounds such as fire alarms, car horns, truck back-up alarms, railroad crossings and sirens. The person relies on visual modes of communication (e.g., American Sign Language and/or visual sirens) to understand what is happening in the environment.

99 – Unknown (justify in notes)

You must justify this code in the notes section.

Examples:

Field 29: Seizures

This field identifies if the person has a seizure disorder(s) and, if so, how well it is controlled. The person’s diagnosis must be documented by a physician.

01 – No history or evidence of seizures

The person does not have a history or evidence of seizures, or the person’s seizure history has been the result of a fever (febrile seizures).

02 – History of seizures, none recently

The person’s medical records refer to seizure activity, but there is no record of seizures within the past five years.

03 – Seizures – Controlled

The person has evidence of seizures within the past five years that both:

04 – Seizures – Partially controlled

The person has evidence of seizures within the past five years that both:

05 – Seizures – Uncontrolled

The person has seizures that indicate a greater possibility of injury to the person than partially controlled seizure activity. This could include frequent seizure activity or infrequent but very intense seizure activity. This level of seizure activity places the person at risk of injury or death and significantly affects the level of supervision required to ensure their health and safety needs are adequately met.

99 – Unknown (justify in notes)

You must justify this code in the notes section.

Example: The person is an infant with some seizure activity, but specialists are unable to determine the severity of the seizure disorder or the ability to control the disorder in the future.

Field 30: Mobility

Enter the code that best describes the person’s level of mobility. If the person’s mobility is limited by any medical condition, specify that condition in the notes section.

01 – No impairment

The person walks without difficulty.

02 – Walks short distances independently

The person walks with a rough gait, is at risk of falling down or has difficulty walking on uneven surfaces.

03 – Walks aided (with assistance)

The person may use a walker, crutches or need assistance from another person to ambulate.

04 – Propels own wheelchair – Bears weight for transfers

The person manually propels their own wheelchair, is mobile and can bear weight but is not ambulatory.

05 – Propels own wheelchair – total assistance with transfers

The person manually propels their own wheelchair but cannot bear weight for transfers. They are mobile but not ambulatory.

06 – Uses electric wheelchair

The person can independently operate their own electric wheelchair.

07 – Unable to propel wheelchair

The person can move their wheelchair slightly (e.g., to change their view), but they do not move the wheelchair from one room to another. Their wheelchair movements are for extremely short distances.

08 – Not mobile due to overriding medical conditions (specify in notes)

You must justify this code in the notes section.

Example: The person is confined to bed.

99 – Unknown (justify in notes)

You must justify this code in the notes section.

Examples:

Field 31: Fine motor skills

Enter the code that best describes the person’s level of fine motor skills that affects their independence in activities of daily living.

01 – No impairment

The person does not have impairment that affects their activities of daily living.

02 – Impairment present – Minimal effect on movement

Examples:

03 – Impairment – Requires occasional assistance

Example: The person has decreased grip strength, causing them to require assistance with handling some objects.

04 – Impairment – Requires frequent assistance/adaptations

Example: The person needs assistance or modifications to put buttons through buttonholes, tie shoelaces or use eating utensils.

05 – Impairment – Requires constant assistance/adaptations

Example: The person needs assistance in most activities of daily living because they cannot use items such as brushes, forks, spoons, buttons, zippers or pencils, either independently or with modifications.

06 – Overriding medical condition – Participation limited

You must justify this code in the notes section.

Example: The person had a stroke and cannot participate fully in routine activities.

99 – Unknown (justify in notes)

You must justify this code in the notes section.

Example: The person is a child who has not yet reached the developmental stage in which fine motor skills can be expected and/or assessed.

Field 32: Expressive communication

Enter the code that best describes the person’s typical mode of expression.

01 – Functional

The person makes their needs and wants known to others.

02 – Speech intelligible to familiar listeners

The person makes their needs and wants known to others, but only friends understand what they say.

03 – Speech difficult to understand

The person makes their needs and wants known to others, but even friends have difficulty understanding what they say.

04 – Speech unintelligible even to familiar listeners

The person attempts to vocalize their needs and wants through speech, but even those familiar with the person cannot understand what they are trying to say.

05 – Combines signs and/or gestures to communicate

The person makes their needs and wants known through signs and/or gestures commonly understood by others (e.g., American Sign Language).

06 – Uses single signs or gestures to express wants and needs

Examples:

07 – Uses augmentative communication aid

The person uses picture boards, electronic communication devices, etc.

08 – Does not have functional expressive communication

The person does not make their needs known through speech, sign, gesture or augmentative communication devices.

99 – Unknown (justify notes)

You must justify this code in the notes section.

Example: The person is a child who has not yet reached the developmental stage in which expressive communication skills can be expected and/or assessed.

Field 33: Receptive communication

Enter the code that best describes the person’s ability to understand communication from others.

01 – Comprehends conversational speech

The person understands verbal communication.

02 – Comprehends phrases with gestural cues/modeling prompts

The person understands verbal instructions, supplemented with gestures that imitate the request.

Example: The person understands instructions to sweep the floor by hearing verbal instructions and/or seeing gestures imitating the action of sweeping.

03 – Limited comprehension – One to two words

The person understands words and short phrases associated with routine events.

Example: The person understands phrases like “please wash your hands” or “it’s time to eat.”

04 – Comprehends signs/gestures/modeling prompts

The person understands standard signs for communication. They may use an interpreter effectively or respond appropriately to sign/gesture/modeling directions (e.g., American Sign Language).

05 – Does not comprehend verbal, visual or gestural communication

The person does not respond to messages given through speech, signs/gestures or pictures.

99 – Unknown (justify in notes)

You must justify this code in the notes section.

Example: You are unable to determine what communication the person understands.

Field 34: Self-preservation

Enter the code that best describes the person’s ability take necessary actions to ensure their own safety during both emergency and non-emergency situations. Evaluate this area by assessing what the person would do on their own if they were living independently in an unsupervised living arrangement.

01 – Is capable of self-preservation

The person appropriately recognizes signs/warnings of an emergency or dangerous situation and will go to a place of safety or seek help without prompting.

Examples: The person:

02 – Requires verbal/physical prompts for preservation

The person appropriately responds to emergencies or dangerous situations when given verbal/physical prompts from another person who provides general guidance or direct assistance.

Examples: The person:

03 – Is not capable of self-preservation

The person requires the presence of another person at all times to ensure their safety in the event of an emergency. The use of only verbal/physical prompts will not protect the person from dangerous situations.

Example: The person:

99 – Unknown

You must justify this code in the notes section.

Field 35: Vocational

Enter the code that describes the level of support a person needs to work.

01 – Independent – Requires typical training; May use adaptations

The person may need help locating and securing a job (e.g., completing applications, arranging an interview). They receive the same job training as any other new employee. They can and will call for assistance as needed, and they do not require a job coach for ongoing support. Casual and infrequent contact from a vendor or case manager is adequate to monitor the person’s work.

02 – Needs on-the-job training – Time-limited

The person requires assistance finding and/or being hired for a position. They may require extra help at the beginning of the job or learning significant new duties as the job changes. They may need occasional job coaching after a few days or weeks.

03 – Needs minimal support – With or without adaptations

The person probably will require assistance in all phases of job acquisition and training. They may require supervision from a job coach part of each day, but not necessarily every day, with the possibility of the need for consistent, active supervision into the future.

04 – Needs moderate support – With or without adaptations

The person requires support similar to code 03, except the support is more routine, frequent and for significant periods of time. The support is not physically and continually present, but there are provisions in place to have support available to the person on short notice. Changes in routine may require increased support.

05 – Needs intensive support – With or without adaptations

The person requires continual, on-site support, which might include hand-over-hand training. The job coach is within close proximity virtually all the time, including while on the job and during breaks, transport and other work-related activities.

09 – N/A (explain in notes)

Use this code if this field is not applicable. Justify this code in the notes section.

Example: The person does not work because they:

99 – Unknown

You must justify this code in the notes section.

Example: The person is a child 12 years old or younger and is not exploring vocational skills yet.

Field 36: Independent living skills

This field describes five skill areas assessed to determine the level of supervision or assistance the person needs:

Enter a code for each level. Do not code independent living skills based on situational limitations. Code what the person’s skill level would be if they were in a suitable environment to demonstrate those skills. For more information, refer to Definitions for Independent Living Skills (PDF)

01 – Independent

The person has sufficiently mastered the skills necessary for independence in this area. They do not need supervision or training.

02 – Minimal supervision (formal program not needed)

The person has mastered or partially mastered most of the skills needed for independent functioning in this area. They need some supervision, training and guidance (typically verbal prompting).

03 – Instruction required with expected outcome of increased independence

The person typically receives guidance through formalized instruction and training.

04 – Person participates with another’s assistance for all or portions of an activity

The person typically requires some level of assistance for all or portions of activities. They may need less assistance over time.

05 – Person unable to participate in activity

You must justify this code in the notes section.

99 – Unknown

You must justify this code in the notes section.

Field 37: Level of support and services

Enter the code that best describes the person’s need for level of support and services as determined through assessment and/or observational information that is appropriate for the person’s age.

Some of these codes refer to a 24-hour plan of care, which is support provided on a regular basis that can be formal or informal and either direct or indirect.

01 – Person accesses supports as needed

The person does not need supervision.

Example: The person calls a friend or appropriate service when they need help.

02 – Person requires some services, does not require 24-hour plan of care

The person does not require intermediate care facility for persons with developmental disabilities (ICF/DD) level of services.

Example: The person needs assistance with budgeting, money management, purchasing groceries or learning about community activities.

03 – Person needs 24-hour plan of care

The person needs a 24-hour plan of care that does not require 24-hour direct supervision.

Examples: The person:

04 – Person requires 24-hour plan of care with awake supervision

The person has overriding health care needs or behavior that is dangerous to themselves or others.

99 – Unknown

You must justify this code in the notes section.

Field 38: Challenging (excess) behavior scales

This field describes a group of data items for recording challenging behaviors the person displays. Use clinical information and other observational information available to determine the appropriate code level on the screening document. Challenging behaviors are divided into 10 areas:

Enter a code level for each of the 10 challenging behavior areas. Use the unknown (99) code level when the information is insufficient to make a valid assessment. You must justify this code in the notes section.

To determine code levels, refer to Challenging Behavior Screening Rating Scale (PDF) and Definitions of Challenging Behaviors Scales (PDF).

Field 39: Level of care

Enter the code that describes the person’s assessed level of care (LOC).

01 – Person meets ICF/DD LOC and may or may not be eligible for CFSS

The person is at risk for placement in an intermediate care facility for persons with developmental disabilities (ICF/DD) if alternative services are not available, suitable or desired.

For policy information, refer to CBSM – Level of care and Case Manager’s Guide to Determining ICF/DD Level of Care for ICF/DD and DD Waiver Services, DHS-4147A (PDF).

02 – Person meets NF LOC and may or may not be eligible for CFSS

The person meets nursing facility (NF) LOC, as determined by a MnCHOICES assessment, long-term care consultation (LTCC) assessment or preadmission screening. If the person meets both ICF/DD LOC and NF LOC, enter ICF/DD LOC into MMIS.

Example: The person has overriding health care needs and does not need habilitation (refer to CBSM – Habilitation).

03 – Person meets hospital or brain injury LOC or is eligible for CFSS

The person needs other services, such as public health nursing services, home care services or Brain Injury – Neurobehavioral (BI-NB)/Community Alternative Care (CAC) waivers.

04 – Person does not meet an institutional level of care and/or is not eligible for CFSS

The person can live in their own home with typical informal supports (e.g., friends and family).

99 – Unknown

You must justify this code in the notes section.

Note about semi-independent living services (SILS)

A person can access SILS with 02 (NF LOC), 03 (hospital or brain injury LOC or CFSS) or 04 (does not meet an institutional level of care and/or is not eligible for CFSS).

Field 40: Informed choice

Indicate if the person or their legal representative was informed of all program and service options:

If the action type (field 24) is 01–03, 11 or 12, field 40 must be Y.

If the person or their legal representative was not informed of choices and field 40 is N, the screening document will be rejected when submitted.

For more information, refer to: