The Coordinated Assessment System (CAS) is a comprehensive assessment tool that OPWDD uses to identify a person's strengths, needs and interests to help with the person-centered planning for his/her care.
The CAS starts with a conversation to gather information. The CAS looks at all areas of the person's life such as living skills, health, behavior and supports to help develop a care plan that is unique to you. This approach also includes talks with others who know the person well, such as their circle of support, family members, friends and staff providing your supports.
The CAS is now being used for people who are 18 years of age or older, newly eligible or who are transitioning to adult services.
The CAS process
The CAS is a three-part process which includes:
- discussion/observation with the person
- discussion with others who know the person well (such as family members, residential support staff, Consumer Advisory Board (CAB) representatives), and
- a review of supporting documents, such as medical evaluations, etc.
The CAS assessor is trained to listen and consider all information shared to get an idea of the person's strengths, needs and abilities across multiple settings. The CAS assessor reviews the information gathered from all the talks and the provided documents before the CAS is completed.
- Please be advised that assessment meetings are occasionally selected for a routine OPWDD CANS/CAS Field Observation (CFO). OPWDD is committed to ensuring that assessors are conducting quality assessments, in order to best identify care planning needs, supports, and services. For this reason, it is necessary for us to routinely review an assessor’s work by observing their process. This means that an OPWDD Field Observer (FO) may sit in and observe the assessment meeting. The FO would not actively participate in the interview, but would be there to listen and observe the assessor’s process. As with any CAS assessment, the person’s private information will be protected as per OPWDD’s Privacy Practices.
An initial assessment is completed when the person is being assessed for the first time with the CAS.
A routine reassessment is a comprehensive reassessment at specified intervals, during the course of service (e.g., two years after the initial assessment).
A Significant Change in Condition (SCIC) reassessment is conducted when it has been determined that a significant improvement or decline in a person’s behavioral and/or medical condition or functioning has occurred since the last assessment and before the scheduled reassessment. SCIC reassessment qualifying events:
- Accidents or events resulting in serious personal injury - a qualifying event includes, but is not limited to, accidents or events resulting in serious personal injury (i.e., due to motor vehicle accidents, slips/trips/falls, burns, poisoning, choking, falling objects, physical assault, physical injury under negligent personal care and treatment or injury during use of equipment such as lifts, bathers, etc.)
- Major medical event - a qualifying event includes a major medical event or prolonged illness that results in significant changes in the person’s behavioral and/or medical functioning
- Major psychiatric event or decompensation resulting in extended inpatient psychiatric hospitalization - a qualifying event includes a major psychiatric event or decompensation that results in significant changes in the person’s behavioral and/or medical functioning
- Significant improvement in behavior or physical functioning - a significant improvement in behavior or physical functioning may be related to an improvement in acute medical condition, recovery from prolonged illness, or stabilization resulting from psychiatric and/or medical intervention
These qualifying events will not normally be resolved without intervention by staff (i.e., are not “self-remitting”); impact more than one area of the person’s medical/health and/or behavioral status; require professional review and/or revision of the person’s care plan, and result in the newly identified need for reduced or enhanced direct support and/or clinical hours to address the decrease/increase in oversight and/or supervision to maintain health and safety.
If a person has had a CAS assessment completed and is believed to have experienced a significant change in condition, in the form of an improvement or an increase in need, please contact OPWDD by sending a message via secure email to: [email protected] and including documentation that substantiates the change and information regarding the impact on the person's supports/needs.
Involvement of those responsible for maintaining the person’s care plan
Care Managers (CMs)/Qualified Disabilities Professionals (QIDPs)/those responsible for maintaining the care plan may be interviewed in the process by the CAS assessor. In some instances, especially if the person only receives minimal services, the CM/QIDP/those responsible for maintaining the care plan may be one of the only resources for information for the person. The person may also ask that the CM/QIDP/those responsible for maintaining the care plan or other staff be present during the discussion with the CAS assessor, but it is not required for the CM/QIDP/those responsible for maintaining the care plan to be present during the assessment/discussion/observation, unless the person chooses an in-person interview and lives alone in the community with no actively involved family member or paid supports available to be present in the home at the time of the assessment. When a person lives alone in the community and there is a need for an in-person interview, the CM/QIDP/those responsible for maintaining the care plan and CAS assessor should partner to identify a solution to complete the CAS assessment. This may mean identifying an “alternate” public setting (office space, library, etc.), identifying another support who could be present, or presence in the home from CM/QIDP/those responsible for maintaining the care plan.
Once the CAS is completed
After the CAS has been completed by the CAS assessor, it is electronically transferred within 48 hours to the person's record in the OPWDD computer system, CHOICES. The CM/QIDP/those responsible for maintaining the care plan will review the CAS summaries with the person, his/her actively involved family member and/or legal guardian and his/her supports (i.e., residential provider, Consumer Advocacy Board (CAB), as appropriate and within 30 days. At this time, the person, his/her family and/or guardian may provide any other information they would like included in the person-centered planning process and in creating the Life Plan.
The CAS summaries will be used to create the Life Plan. They provide the CM/QIDP/those responsible for maintaining the care plan with information about the person's needs, strengths and interests. Details provided in the CAS summaries will help the CM/QIDP/those responsible for maintaining the care plan confirm information already known about the person, or will identify areas that require further exploration or assessment.
State laws and regulations require that an assessment chosen by OPWDD must be used to review and record a person’s strengths and needs, as a condition of receiving OPWDD services. OPWDD uses the CAS to conduct these required assessments for individuals 18 years and older. The CAS is a tool that is very effective at helping OPWDD to learn more about the strengths and needs of people with intellectual and/or developmental disabilities. Participation from the person and/or people who are close to the person is necessary. Completion of the CAS assessment is one of the requirements for receiving OPWDD services and is needed prior to the authorization of those services.
CAS Summary Disagreement
Review of the CAS summaries is an opportunity for the person to talk about any questions or concerns about the information in the assessment. It is necessary to document and capture details of the review, beliefs, opinions, and the perspectives of others to provide context for understanding his/her unique interests, skills, abilities and needs. The CM/QIDP/those responsible for maintaining the care plan may need to talk with those who know the person well, those who were interviewed by the assessor, and review the documents used by the assessor to develop a full understanding of the person's strengths and support needs. A list of persons interviewed and documents reviewed can be found in the OPWDD CAS Assessment Administration summary, located in the person’s supporting documents section of CHOICES.
Questions About CAS
Once this review has been completed, if there are questions and concerns that have not been resolved, the CM/QIDP/those responsible for maintaining the care plan must submit the following via secure email server to [email protected]:
- CAS/CANS Request for Review Form
- The note/documentation of the CAS summary discussion and review with at least the person and primary supports (actively involved family/Legal Guardian and residential supports, as applicable) written by the CM/QIDP/those responsible for maintaining the care plan.
- Note/documentation MUST be attached to the email and capture details of the review, including newly learned information, need for any follow-up, and how this information is addressed in the Life Plan.
- Include specific item(s) that have been identified as questions and/or concerns.
- Document the context and details around why the team feels the items are of concern.
- Add any additional information that may be an important consideration in the review of the person's CAS
- The documentation reviewed by the assessor, as listed on the CAS Administration Report.
OPWDD will follow up with the CM/QIDP/those responsible for maintaining the care plan and/or person/primary supports, as appropriate, to provide a response to the questions/concerns, which may include additional guidance and/or action.
If the person or family has any additional questions or concerns, they may call 1-518-473-7484 for further support.