1. Communication is Essential
Communication is essential. . . I don’t think anyone would argue with that statement so let’s talk about communication between In-home providers and the Division of Senior and Disability Services (DSDS)

2. OBJECTIVES:
Participants shall be able to identify elements of the process of communications between the Division of Senior and Disability Services and the Provider.
Participants shall be able to identify the process of service authorization.
Participants shall be able to identify specific requirements of service delivery.
These are the objectives we will be covering in this session.
You will be able to identify elements of the process of communications between the Division of Senior and Disability Services and the Provider.
You will be ale to identify the process of service authorization.
You will be able to identify specific requirements of service delivery.

3. Service Authorization Process
Service authorization process Or how does a new client sign up for services.

4. New Referrals Contact the Call Center 866 – 835 – 3505 Call Center
Determines the person is Medicaid active
Complete a prescreen
Referred to the appropriate Region to schedule a home visit and complete the assessment
Contact the call center at for all new referrals. The Call Center is where it all starts.
The Call center will determine if the person is Medicaid active. If the person is not Medicaid active, at the time of the call, the process will end. If the potential participant is Medicaid active, a prescreen is completed. The prescreen is a series of questions that will determine a preliminary level of care (LOC). The participant must have a level of care of 21 or greater to receive In-home services. If the prescreen criteria is met, the referral is sent to the appropriate region and a home visit is scheduled to complete the assessment. There are times when the LOC is met over the phone but based on the observations of the assessor and the answers to the questions the person does not meet LOC during the face to face assessment visit. It has happened. Be aware of the possibility.
As long as the participant has reached a level of care of 21 or greater, the assessor will work up a care plan and ask the participant to chose a provider.

5. What’s Next? The assessor will contact the provider.
The provider will accept or turn down the participant
The provider will access the care plan information in Web Tool
If the participant has met level of care, the assessor, with input from the participant, will develop a care plan.
The assessor will contact the provider the participant has chosen to determine their willingness to accept the participant. Should the provider accept the participant as part of their caseload, the provider will access the care plan information in Web Tool.

6. Service Delivery Requirements
Begin services within 7 calendar days of receipt of service authorization.
19 CSR (18)(K)
Services delivered by qualified staff.
Have the capability to deliver services outside regular business hours, on weekends and holidays.
19 CSR (18)(K)
Services must be initiated within 7 calendar days of receipt of service authorization. If services are not initiated within time the period - written justification must be maintained in the participant file and forwarded to the Rev team.
Services must be delivered by qualified staff. There are extensive rules with regard to training staff that must be followed. These rules are discussed in other power point presentations. I strongly urge you to provide the required training.
The provider must be able to provide services outside of regular business hour, for example on weekend and holidays.

7. Priority/Risk Indicators
Help providers prioritize delivery during temporary staffing shortages.
Assessors evaluate factors such as fragile, unreliable or insufficient support systems to determine priority.
Any changes regarding priority status during authorization period should be communicated to the REV team.
Priority/risk indicators are found in Web Tool. The indicator is located on the far right of the yellow bar of the participant case summary screen. They are listed as 1 high, 2 medium or 3 low. The priority risk rating is helpful to the provider. Should the provider be short staffed, they would provide services to the priority 1 participant first, the priority 2 participant second and the priority 3 participant 3 last.
The assessors will evaluate the support system of the participant to determine their priority/risk indicator.
When a provider notes changes that would change the priority status they should contact the Regional Evaluation Team (REV team).
For example: a participant now has a caregiver where before they did not, or a situation where the caregiver is no longer involved and the participant’s support system has become very fragile.

8. Providers Must: Maintain a business telephone answered 24/7.
Maintain a principal place of business.
Keep all participants, DSDS and MMAC informed of the business telephone number, street address and posted business hours.
These are contractual requirements and assume the contract has the same information in it. If changes have been made, you can make the changes or delete the slide.
Providers must maintain a business telephone identifying the agency name. Telephone services intended to block incoming calls is not appropriate.
The place of business should be open during posted business hours and have staff on site. All participants or participant’s representative are to be informed in writing of the business telephone, address and business hours.
Inform all participant and DSDS of any changes in the business telephone, street address and posted business hours.

9. Providers Communicate with . . .
Participants
Division of Senior and Disability Services
Physician
Other Caregivers/Family
Communication is essential. Certain communications, both verbal and written, are set out in the CSR regarding the client, DSDS, the physician, and caregivers involved with client care.
We are going to cover each separately.

10. The Participant . . . Distribute Provider's Code of Ethics
19 CSR (18) (J)
Distribute Client's Rights
19 CSR (18) (P)
Changes in the schedule, i.e., service delivery time, aide unable to make agreed service time.
Confidential participant records
19 CSR (24) (A)
The provider must have and enforce a written code of ethics which is distributed to all employees and clients. There are specific minimum prohibitions which shall be included in the code of ethics. The specific prohibitions are listed in the Code of State Regulation.
The participant will receive a copy of the Client's Rights statement and the provider must have a policy to ensure the client’s receipt. Documentation in the client file with client signature that all information was provided to the client shall verify compliance.
The participant is to inform the provider of changes in their schedule and the provider is to inform the participant of schedule changes.
Individual participant case or clinical records including records of service provision are confidential and shall be protected from damage, theft, and unauthorized inspection.

11. Providers are to communicate with DSDS
Provider’s supervisor, manager or nurse to make recommendations:
service plan changes
termination of services
19 CSR (18) (L) and (20) (D)
13 CSR (3) (H) 5
Contact the REV team
Providers are to communicate with the Division of Senior and Disability Services.
These recommendations should be in writing to the REV team, with verification in the client file to show compliance.
It will assist the REV team to have information as to the reasons why these recommendations are being made. Be as thorough as possible. However, if the Worker needs additional information they will contact you.

12. Provider's Responsibility to the Physician:
Obtaining physician’s approval of Advanced Personal Care (APC) plan CSR (5) (F) 2. A
Provider nurse to obtain physician orders for nursing tasks and APC tasks (9) RSMo
The provider’s nurse is responsible for obtaining physician's approval of the Advanced Personal Care plan. The provider nurse is responsible for obtaining physicians order for all nursing tasks and Advanced Personal Care tasks.
The provider should contact the participant's physician anytime the client's condition indicates a need for physician involvement.

13. Provider's Responsibility to the Participant’s Support System
Prevents duplication of services; i.e., Home Health.
Importance of involving and coordinating care plan with other caregivers.
It is very important to involve and coordinate the care plan with other caregivers. For example, if home health is providing services the in-home provider cannot duplicate the services home health is providing.
It is also important for the participant to have a back-up plan if services cannot be provided or in case of a natural or manmade disaster.

14. Communicating with the Regional Managers
Contribution report for SSBG/GR CSR (18) (T)
Changes in location, telephone number, administrative or corporate status, inform HCS Regional Manager and DSDS
19 CSR (18) (I)
The provider is responsible for reports Social Services Block Grant/General Revenue contributions by county shall be made to the Regional Manager that includes the balance on hand, contributions received and contributions used for authorized services and month ending balances. The provider shall submit to the regional manager a contributor report at the end of the month in which contributions are received and/or expended.
Providers are to notify the Regional Manager and the Missouri Medicaid Audit and Compliance Unit of changes in location, telephone #, administrative or corporate status.

15. Undelivered/Missed Units in Service Delivery
Units can be made up during the same month ONLY if service delivery will meet the needs of the participant.
Units can not be carried over to the next month. Units can only be made up during the same month as authorized and delivered ONLY if the missed services meet the needs of the client. Proper documentation justifying the need for making up services should be in the participant file.
Advanced Personal Care units are task specific and cannot be made up.

16. When to Discontinue Service
Any time closing notification is received from DSDS
Provider learns the participant has: + Died Entered a nursing facility + No longer needs services
Threatening or abusive behavior that places staff in jeopardy (notification verbally and in writing)
19 CSR (16) & 13 CSR (1) (C)
Discontinuation of service for any participant needing services shall occur only after appropriate conferences with the Division of Senior and Disability Services.
If the provider learns that the participant has died, entered a nursing facility, or no longer needs services, they should notify the appropriate Regional Evaluation Team in writing and request discontinuation of services.
Notify the appropriate Regional Evaluation Team verbally and in writing of threatening or abusive acts. Be as specific as possible when reporting the situation.

17. Providers are required to notify DSDS and participant in writing to request discontinuation of services:
Provider unable to meet the maintenance needs of a participant.
Noncompliance with previously agreed care plan.
Noncompliance requires persistent actions by participant and/or family. Other alternatives must be explored and exhausted prior to discontinuing services. Documentation should include all contacts with the participant, family, and DSDS.
Unable to meet needs: notify DSDS in writing IMMEDIATELY. A provider may be held responsible for neglecting a participant's needs without timely notice to DSDS.
The provider agency is to provide written notice of discharge to the client or client's family and the appropriate Regional Evaluation Team. Provider must continue to provide care in accordance with the plan of care for 21 days or until alternate arrangements have been made.
Requires 21 day notice
19 CSR (16)(D)

18. Department of Health and Senior Services employees are prohibited from accepting personal gifts.
1 CSR (7) (P) Employees of the division, evaluators, and any other persons involved in procurement decisions shall not accept for personal benefit gifts, meals, trips or any other thing of significant value or of monetary advantage, directly or indirectly, from a vendor.
Employees of the division shall not accept gifts, meals, things of significant value or of monetary advantage from a provider.
Regardless of how small it may seem, staff can not accept it. Holiday gifts of candy, baskets of fruit, offers of taking staff to or providing a meal are all unacceptable.

19. continued: 1 CSR 40-1.060 (7) (G & H)
The following shall be sufficient cause for suspension or debarment. Contacting proposal/bid evaluators or person having influence over the award for the purpose of influencing award of a contract; or giving gifts, meals, trips or any other thing of value or a monetary advantage for personal benefit to an employee of the division.
A license or contract may be suspended for giving gifts, meals, trips or things of value or monetary advantage for personal benefit to an employee of the division.

20. THE END
THANK YOU